Introduction

Introduction to Fractures

 Gregory R Waryasz MD Ashley Davidoff MD

The Common Vein 2011

Introduction

When a traumatic force overloads a bone, it will break like a “lifeless stick” within the briefest moment in time. The miracle of biology requires a little more time to heal the damage.  

This module explains the biology of bone that causes it both to break like a “lifeless stick” while enabling the dynamic process of healing.  Modern medicine cannot do much about the accidental forces imposed on bone, nor in general affect the nature of bone, but it assumes the responsibility of making an accurate diagnosis and administering appropriate treatment for optimal healing.

Fractures of the Body

The artistic rendering of fractures of the skeletal system starts with the top row of images representing the skull and c-spine fractures, followed by thoracic and lumbar spine in the next row, and progressively moving down through the upper limbs, pelvis and lower limbs with the last row representing fractures of the feet

Courtesy Ashley Davidoff MD copyright 2011 all rights reserved 88361c.8s

When forces to the body are excessive, they can overcome the remarkable strength of the bones and a fracture results.  When the bone fractures it loses its ability to function.  A fracture of the hip for example will result in both an inability of the hip to support the body as well as an inability to particpate in walking.  The patient thus becomes immobile.

The structure and function of the skeletal system is complex. The unique structure of each bone, complex attachments of bones to each other by tendons and ligaments and the attachment of the muscles to the bones requires understanding in order to comprehend the biology of fractures.  

The character of bone is similar to that of glass rather than rubber.  Although it is very strong it breaks with very small deformations.

The mechanism of injury, the resulting injury, and the manner in which they are treated, requires knowledge of the mechanical forces that are exerted during the injury.  Since the bones are tightly bound to other structures, the transmission to and consequences of those forces on other bones and soft tissues have significant implications in diagnosis and treatment. The forces that are necessary to enable optimal repair and healing also require understanding since if alignment is not correct then healing may be inadequate and non union or malunion may result.

Thus fractures are about abnormal forces on the bones and the ripple down effects on the structures related and connected to the bones.  The plain film, with its exquisite ability to reflect the structure of bone has a unique and important function in the diagnosis and treatment of fractures.  However it is extremely limited in visualizing soft tissue injury.  CT scanning adds the ability to solve subtle and complex issues of bone injury while MRI enables the visualization and evaluation of the soft tissue changes.