Fractures are the deterioration of the anatomical integrity of bones.
Open or closed according to their relations with the external environment; According to the condition of the fracture line, it is divided into 2 as complete and incomplete.
Child fractures differ physiologically and anatomically from adult fractures:
- Since the growth plates are in a cartilage structure in children, they do not show on the X-ray and it is necessary to take the X-ray from the healthy side and compare them in order to make a diagnosis.
- The periosteum is thick and the fracture heals quickly.
Torus and green tree fractures are common because the bones have high flexural properties.
Different deformities may develop in epiphyseal fractures.
Fracture Healing
Inflammatory Period:
Endostern, periosteum and surrounding soft tissues are fragmented in the fracture; blood, exudate and lymph accumulate (broken hematoma).
Repair Period
The hematoma becomes organized and there is fibroblast infiltration from the periphery (fibrous callus).
Within a week, bone begins to form (callus) with the release of collagen and Ca+2 by osteoblasts and chondroblasts.
If the bone ends are strongly joined by the internal fixator, it heals directly from the cortex to the cortex without the formation of callus.
Remodelling
While the bone is being made, it is also resorbed and thus new bone is formed.
Factors Affecting Fracture Healing
- Fracture healing; age (faster in young people), local factors, hormones, minerals and vitamins.
- Local factors are among the most important:
Blood supply to the soft tissue surrounding the fracture
Presence of infection (bad)
Immobilization
- Bone type (cancellous bone heals more easily) and degree of bone loss
Development of avascular necrosis
Presence of malignancy
Interposition (soft tissue penetration between bone ends)
Fracture Findings
Pain (due to rupture of the periosteum)
Loss of function
Deformity
Abnormal movement and crepitation
Neurovascular injuries
Radiological findings
Early Fracture Complications
Fat embolism
Development of infection (gas gangrene, osteomyelitis)
Tetanus
Hemorrhagic shock
compartment syndrome
Vascular-nerve injury
Posttraumatic reflex dystrophy
Late Fracture Complications
Nonunion-defective union (most common cause is insufficient reduction)
Avascular necrosis
Osteoarthrosis
Myositis ossificans
Late nerve palsies