A fracture is defined by the discontinuity or breakage of bones of the human body. We distinguish closed fractures (without wound and therefore no risk of infection) open fractures (with wound and risk of infection).
All the bones may be involved at all stages of life.
The causal mechanism of injury determines the type of fracture: compaction, avulsion if ligament injury, fracture of the femoral neck geared for example ...
What are the risks and health issues fractures?
All bones can be achieved but some fractures are most common in function of the age and location.
Compaction is characteristic of the vertebrae and occurs mainly in case of osteoporosis. Similarly, the femoral neck fracture occurs in a special way in the elderly.
Fracture risk factors are now identified: personal history of fracture fragility, age> 60 years, corticosteroids, history of fracture of the proximal femur in a first-degree relative, body mass index (BMI: weight / height squared) <19, early menopause (before age 40), smoking, alcohol abuse, decreased visual acuity, neuromuscular and orthopedic disorders.
What are the mechanisms of fractures?
A fracture occurs most often after trauma. Depending on the bone density (measured by BMD), a more or less violent trauma is necessary to break the bone.
For example: in a young patient, high energy is required to cause a fracture of the femur (accident of the public highway, high-rise fall ...) in an elderly patient, a simple fall from standing height enough.
In case of an open fracture, there is a communication between the outside and the fracture; the risk of infection is important because this communication represents an ideal gateway for infection.
How manifests a fracture?
Whatever the type of fracture, trauma is necessary for the cause. The main symptoms are a cracking, pain and swelling of the fractured region. Pain causes functional impairment, with inability example to set foot on the ground or to use the affected limb.
In an open fracture, skin lesions are visible with a break in the skin leaving collect a piece of bone. Nerves, muscles and vessels can also be affected.
In case of compaction, often vertebral pain is located in the back. No deformation is visible but palpation of the vertebra is painful. Signs of sciatica (leg pain) are also possible.
The bony avulsions follow a movement of a joint beyond the physiological possibilities; ligaments stretch and tear a piece of bone; exquisitely painful point is felt on palpation.
With what would it be confused fractures?
It should not be confused sprain or strain that affect joints and ligaments and fractures involving bones. A sprain can, however, be accompanied by avulsion fracture.
In the elderly, a broken hip meshed, that is to say, the femoral head and neck are nested, may go unnoticed because despite the pain, heel and leg can still move. Only radiography wide in these indications, will make the diagnosis.
Will it possible prevention of fracture?
The best prevention is still a good physical preparation, proper warm-up and a conservative sport.
Wearing appropriate clothing (knee, shin guards, helmet ...) avoids direct trauma.
The fight against risk factors is also recommended to prevent fractures. The diet should be balanced to avoid excess weight but also fight against deficiencies (lack of calcium and / or vitamin D). Tobacco and alcohol are two enemies of the bones and weaning is recommended.
If demineralization proven to bone densitometry (osteoporosis), hormone replacement therapy is offered in postmenopausal women (in the absence of cons-indication) and drugs fighting against bone destruction are available to all.
In case of suspected fracture, call for help, sit or lie the victim of severe pain to avoid discomfort and hold the two parts of the broken bone with a hand placed on each side to avoid they are mobile (intense pain factor). At best, place the fracture on a plane and straight support.
Tetanus immunization is checked for open fractures.
Fractures: when to consult?
Any persistent pain, swelling or deformity after trauma requires a medical consultation and possibly a radiograph.
Similarly, back pain, especially in patients with risk factors such as osteoporosis or treatment with corticosteroids should motivate a consultation not to neglect vertebral collapse.
What does the doctor faces a divide?
History of fracture risk factors (see above), mechanism of trauma and violence helps the practitioner to suspect a fracture. Palpation of bony prominences can highlight deformation or evocative painful point of a fracture or avulsion.
Elective pain on palpation of the spine fears vertebral collapse, but only the radiographic support or refute the diagnosis. Compaction can affect every facet of the vertebra or represent a compression fracture; MRI may specify any neurological compression.
In case of fracture of the femoral neck, several x-rays may be needed to clarify the type of fracture.
The common treatment of these fractures is the quiescence of the joint and the fight against pain.
Some are operable as femur fractures, open fractures or fractures settlement of unstable spine. For others, an asset or pulling suffice.
For open fractures, early antibiotic treatment prevents the risk of infection.
How to prepare for my next visit?
We must not neglect pain following injury and should be consulted.
In case of cast immobilization, any pain should be reported to the doctor to check the cast is not too tight and does not interfere with traffic.
If anticoagulant therapy is prescribed (spots) must be followed carefully to prevent phlebitis.
Wounds and sutures should be monitored; if they turn red, inflammatory with fever, a consultation is needed quickly.
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