Bone Fractures and Interventions

For my STEAM project, I wanted to show the different kinds of bone breaks you can get, the positions the bone fragment can end up in, and the interventions that may be used. The piece drawn out covers classifying fractures and goes beyond describing how fractures are healed by outside intervention. There are many different types of fractures that are identified based on how they are broken. Treatment of these breaks is dependent on the type of break and the position of the bone after the fracture. There are so many options for interventions to use to immobilize the bone to allow it to heal properly. When a patient has a bone fracture there are some considerations on interventions to allow the bone to heal properly and allow the patient to be as independently functional as possible.

            There are different types of bone fractures based on how they are broken as shown in the diagram shown. There are two overarching categories for bone fractures which are open and closed fractures which are not shown. Closed fractures are fractures that do not puncture the skin whereas open fractures are when the fracture punctures the skin. There are quite a few types of fractures which include greenstick, spiral, oblique, transverse, comminuted, avulsion, and segmented all independently drawn out in a diagram. Greenstick fractures are incomplete fractures where part of the bone is fractured causing the other side to bend towards the break. As show there is a portion broken off although the bending is not shown to better illustrate a partial break. Spiral bone fractures are typically where the break wraps around the bone and result from a twisting force. The appearance will present similar to oblique breaks although it is more angulated as seen in the illustration. As you can see oblique breaks tend to appear diagonally across the bone like spiral breaks. Transverse bone breaks typically are breaks in a straight line across the bone although a distraction is drawn in the break the bone fragments will typically be touching or displaced. Comminuted bone breaks tend to have more than 2 bone fragments classified with 2 separate fractures in the same bone. Avulsion fractures typically happen with a break happening near a ligament or tendon where the connective tissue pulls a bone fragment from the bone. A segmented bone fracture tends to occur where there are 2 breaks in the same bone resulting in a floating segment of bone in between the fractures although the fragment may not be as cleanly segmented as illustrated in the diagram. There are many different types of bone fractures that may need different types of interventions depending on the location of the bone and position of the bone after fracture.

            A bone that is fractured can be repositioned due to the type of fracture and bone location on the body. When bones fracture the muscles around it will tense up to protect the injured bone which can pull the bones towards each other or even misalign them. There are 3 categories of misalignment that have been drawn to better visualize what they look like. Displacement of a bone is classified when the bone fragments misalign and are pulled past each other where they can be up against each other as illustrated. Angulation is the angle of the distal fragment to the proximal fragment where they no longer are aligned at a 180-degree angle rather they can end up at nearly a 90-degree angle. Distraction of the bone is the displacement at the longitudinal axis where the bone fragments can be pulled away from each other as seen in the first diagram. Reduction is where rotation or traction is applied to align the bones in place. Continuous traction may be required until immobilization is in place allowing the bones to remain aligned. These three different states of misalignment of the fractured bone can determine the treatment because of the number of fragments, amount of immobilization required, and type of misalignment.

            There are various types of interventions that may be required to immobilize and keep the bone fragments in alignment to allow them to properly heal. If the proper intervention is not chosen the bone may heal and the patient may not be able to regain full function of the area. As illustrated, there are many types of inventions that range from noninvasive to invasive. There is  cast immobilization where a plaster or fiberglass cast is applied to the affect area above and below the fracture to keep the bone fragments in alignment to allow for proper healing. The disadvantage is the cast cannot be removed until bone is healed. This intervention is the most commonly one used on bone fractures. The functional cast/brace is used to limit or control movement of nearby joints. This type of intervention is desirable for some but not most fractures due to the ability for the patient to remove it as shown is strapped by Velcro to immobilize the affect area. Traction is typically used to stretch and pull the muscles, tendons, and ligaments to get the bone fragments in alignment. This treatment is not typically definitive as it allows for the affected bone to have the proper intervention put into place while traction is being properly performed. External fixation is also used where the doctor places metal pins/screws into the bone above and below the fracture. As seen in the illustration the screws/pins are typically attached to a metal bar outside the body and are driven into the bone above/below the fracture along with any fragment. This device tends to stabilize the bone fragments allowing them to heal properly. This device is used when the patient has major tissue damage in the area and cannot handle immediate surgery. When surgical intervention is required/tolerable open reduction and internal fixation is used. This is when the doctor reduces the bone fragment into place where a metal plate is inserted on both sides of the fracture and over the fragment held in place by screws into the bone. As shown in the second illustration, bones like the femur require a metal rod to be inserted through the center of the bone secured by screws/pins. Each intervention is assessed based on the type of fracture, any misalignment, and patient comfort. There are many types of interventions used for different reasons on different types of bone fractures, but the main goal is to allow for proper healing and return to normal function after the intervention is removed.

Sources:

Campagne, D. MD (2022, November 14). Overview of fractures. Merck Manuals Professional Edition. Retrieved November 19, 2022, from https://www.merckmanuals.com/professional/injuries-poisoning/fractures/overview-of-fractures

Joseph, T. N. (2022). Fractures. Cedars. Retrieved November 17, 2022, from https://www.cedars-sinai.org/health-library/diseases-and-conditions/f/fractures.html

Throckmorton, T. MD (2021, August). Fractures (broken bones) – orthoinfo – aaos. OrthoInfo. Retrieved November 17, 2022, from https://orthoinfo.aaos.org/en/diseases–conditions/fractures-broken-bones/