Classification of fractures and principles of fracture management

Question 1

Describe the types of bony fractures that can occur

Answer 1

1. Single traumatic event
2. Stress fracture = repetitive stress in normal bone
3. Pathological fracture = normal stress in abnormal bone

Question 2

Describe cortical bone fracture types

Answer 2

• Spiral = torsion
• Butterfly = bending
• Short oblique = compression
• Transverse = tension

Question 3

Describe cancellous bone fracture types

Answer 3

• Comminuted fracture = fraction into 2+ fragments

- Greenstick fracture = bone incompletely divided, and periosteum remains intact

Question 4

Define the Le Fort facial features

Answer 4

• Le Fort 1 - Horizontal fracture of alveolar rim
• Le Fort 2 - Pyramid fracture; apex above nose bridge and extends inferolaterally through infraorbital rim
• Le Fort 3 - Involves zygomers and infraorbital rims, maxilla and paransal sinuses.

Question 5

Identify the common types of mandibular fracture

Answer 5

Common mandibular fracture:

• Condyle
• Body
• Angle
• Parasymphyseal area and symphysis

Question 6

Describe the essential features of the processes involved in healing of a bony fracture

Answer 6

1. Haematoma formation - solid swelling of clotted blood within tissue.
2. Inflammation/cellular proliferation
3. Callus formation:
   - only forms if fracture sites move -> stabilizes joint and bridges gap
   - Indirect healing = callus forms between fragments
   - Direct healing = fragments are immobile and no callus forms
4. consolidation
5. Remodelling

Question 7

Explain factors that can impede healing of fractures

Answer 7

Factors that can impede healing:

• Large gap between fragments
• Movement of fragments
• Low blood supply to fracture

Question 8

Describe complications with fractures:

Answer 8

• Neurovascular injury = damage to neurovascular vessels near fracture site: e.g. Axillary nerve near shoulder
• Compartment syndrome = tight casts causes pressure to build up due to swelling at fracture. Pressure can occlude capillaries, leading to ischaemia. Necrosis of muscle and nerves ensues.
• Non-union == failure for bones to unite. Hypertrophic non-union = periosteal of new bone is formed but needs better stability; biology needs to be improved.
• Mal-union = bones heals in unsatisfactory position.