What is a fracture?

A fracture is a break in the continuity of a bone caused by the application of a force greater than the bone tissue's resistance capacity.

Fractures can range from small cracks to complex injuries with multiple fragments and soft tissue involvement.

The most common causes include:

• Falls

• Traffic accidents

• Sports injuries

• Direct blows

• Bone diseases

The most common symptoms are:

• Intense pain

• Swelling

• Deformity

• Functional impairment

• Abnormal mobility

Treatment depends on the type of fracture, stability, location, and the patient's general condition.

Types of fractures

Fractures can be classified according to:

• The fracture pattern

• The mechanism of injury

• Bone exposure

• Stability

• Soft tissue involvement

Among the most common types are:

• Open fracture

• Closed fracture

• Transverse fracture

• Oblique fracture

• Spiral fracture

• Comminuted fracture

• Pathological fracture

• Stress fracture

Each one presents specific biomechanical characteristics and treatments.

Open fracture

An open fracture, also known as a compound fracture, occurs when there is a break in the skin between the fractured bone and the outside.

This type of fracture is a medical emergency due to the high risk of:

• Infection

• Bacterial contamination

• Vascular damage

• Soft tissue injury

Open fractures are usually caused by high-energy trauma such as traffic accidents or industrial injuries.

The treatment includes:

• Surgical debridement

• Antibiotics

• Bone stabilization

• Soft tissue management

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Closed fracture

A closed fracture is one in which the bone breaks without breaking the skin.

Although there is no external exposure, significant internal injuries to muscles, blood vessels, and soft tissues can occur.

Closed fractures are the most common and can range from simple to complex.

Treatment may include:

• Immobilization

• Orthopedic reduction

• Osteosynthesis

• Functional rehabilitation

  
  

Comminuted fracture

A comminuted fracture occurs when the bone breaks into multiple fragments.

It is generally caused by high-energy trauma and is often associated with:

• Increased instability

• Significant soft tissue injury

• Damaged healing

This type of fracture often requires surgical treatment through:

• Plates

• Screws

• Intramedullary nails

• External fixators

Recovery may be longer due to the biomechanical complexity of the injury.

Transverse fracture

A transverse fracture is characterized by a fracture line perpendicular to the longitudinal axis of the bone.

It usually occurs due to:

• Direct blows

• Bending forces

This pattern typically produces relatively stable fragments depending on the anatomical location.

Treatment can be conservative or surgical depending on:

• Displacement

• Stability

• Functional compromise

Spiral fracture

A spiral fracture presents a helical fracture line around the bone.

It is primarily caused by torsional or rotational forces.

It is common in:

• Sports injuries

• Accidents involving sudden turns

• Indirect trauma

This type of fracture can compromise bone stability and require surgical fixation to maintain proper alignment.

Oblique fracture

An oblique fracture is characterized by a diagonal line relative to the bone's axis.

It is usually caused by a combination of:

• Compression

• Flexion

• Torsion

Oblique fractures may tend to shift due to muscle forces acting on the fragments.

Treatment depends on the degree of stability and displacement.

Pathological fracture

A pathological fracture occurs when a bone breaks due to a pre-existing condition that weakens its structure.

It may be associated with:

• Osteoporosis

• Bone tumors

• Metastasis

• Infections

• Metabolic diseases

In these cases, the trauma may be minimal or even nonexistent.

Management requires treating both the fracture and the underlying condition.

Stress fracture

A stress fracture is an injury caused by repetitive microtrauma to the bone.

It is common in:

• Athletes

• Runners

• Military personnel

• People subjected to repetitive physical exertion

The most common locations include:

• Tibia

• Metatarsals

• Femur

• Calcaneus

Symptoms usually appear gradually, with pain related to physical activity.

Treatment generally includes:

• Rest

• Activity modification

• Rehabilitation

Bone consolidation

Bone healing is the biological process by which a fractured bone heals and regains its structural integrity.

This process occurs in different stages:

Inflammatory phase

It occurs immediately after the fracture and activates cellular repair mechanisms.

Repair phase

A bony callus forms, which gradually stabilizes the fracture.

Remodeling phase

The bone regains its structure and functional strength.

Bone consolidation can be influenced by:

• Age

• Nutrition

• Smoking

• Mechanical stability

• Systemic diseases

AO Classification

The AO classification is one of the most widely used international systems for classifying fractures.

It was developed to:

• Standardize diagnoses

• Facilitate medical communication

• Guide treatments

• Improve clinical trials

The classification considers:

• Anatomical location

• Complexity

• Fracture pattern

• Joint involvement

It is currently widely used in traumatology and orthopedic surgery worldwide.

Pseudoarthrosis

Pseudoarthrosis is a complication in which a fracture fails to heal properly after the expected healing time.

Instead of forming solid bone, a "false joint" develops between the fragments.

This may be due to:

• Mechanical instability

• Infection

• Poor vascularization

• Smoking

• Bone loss

Symptoms include:

• Persistent pain

• Abnormal mobility

• Lack of radiographic consolidation

Treatment usually requires reconstructive surgery and further bone stabilization.

Consolidation delay

Delayed union occurs when a fracture takes longer than expected to heal, but still retains the potential for healing.

It differs from nonunion because the biological process of healing remains active.

Associated factors include:

• Diabetes

• Poor nutrition

• Inadequate immobilization

• Infection

• Vascular deficit

• Fracture instability

Management may include:

• Biological optimization

• Strengthening of fixation

• Bone stimulation

• Controlled rehabilitation

Early detection is essential to prevent progression to pseudoarthrosis.

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