Traumatic fractures

Overview of traumatic fractures

Musculoskeletal injuries are common in professional athletes and common people. The World Health Organisation (WHO) reveals that nearly 50% of the current global population suffers from musculoskeletal injuries of some form or the other. While some may resolve in a very short time, others may take a long time to heal. The most common type of musculoskeletal injury observed on a regular basis is traumatic fractures. The NCBI statistics show that an estimated 1.5 million people all over the world suffer from traumatic fractures.

What are traumatic fractures?

Traumatic fractures are the categories of serious fractures that result from mechanical trauma. They mainly occur due to sudden mechanical blow or traumatic injuries to certain crucial parts of the body. They may range from accidental collisions, stabbing, or gunshot wounds. Unattended traumatic fractures of serious nature may lead to severe blood loss, coma and even death.

Types of traumatic fractures

Skull injuries

A skull fracture is defined as a break or discontinuity in any of the eight cranial bones. It mainly occurs due to sustained injury or blunt force trauma. The bones in the vicinity of the site of impact may also suffer a fracture if the intensity of the trauma is excessive. This may cause the underlying structures such as the blood vessels, the membrane and most important, the brain to get injured badly. The common causes of skull fracture are as follows-

• Accidental injuries (car or bike accidents)
• Mechanical trauma
• Blow to the skull or blunt force trauma
• Sports injuries
• Incorrect sports techniques, especially the ones that may affect the head

The different types of traumatic fractures of the skull are as follows-

• Linear skull fracture: Linear skull fractures are the breaks or discontinuities in the bone that extend from the outer to the inner table of the skull, and cover almost the entire thickness of the skull.
• Depressed skull fracture: This type of fracture also results from blunt force trauma, such as getting struck in the head by an object. These are basically comminuted fractures wherein the broken bone fragments are moved inwards.
• Diastatic skull fractures: In these cases, widening of the sutures of the skull occurs after one or more sutures of the skull get impacted by the progressing fracture line.
• Basilar skull fracture: These are found on the floor of the cranial vault, that is, the skull base. This is caused by a greater force than the remaining parts of the neurocranium.
• Cranial burst skull fracture: It is a closed diastatic skull fracture normally observed in children less than a year old. It is characterized by a diastatic skull fracture with cerebral extrusion beyond the external table of the skull under the scalp.

Arm Fractures 

Arm fracture is defined as the discontinuity in the bones of an arm or a portion of the arm due to overuse injury, mechanical trauma or certain chronic diseases. It mainly arises from a high-force impact or stress. Single or multiple bones of the fore, middle or upper arm may be affected due to these types of fractures. An arm fracture usually presents as-

• Swelling and pain the affected portion
• Breaks in the periosteum and endosteum
• Bluish or purplish discoloration of the affected regions
• Swelling and edema of the soft tissues
• Intense pressure pain
• Bleeding of the periosteal blood vessels
• Muscle pain, spasms, and cramps
• Damage to the structures close to the affected bones such as blood vessels and nerves
• Inability or pain in moving the affected regions
• Extremely slow regeneration of the affected bones, tissues and blood vessels

Arm fractures are mainly of the following two types-

• Humerus fracture: Humerus fracture is defined as the fracture of the bone of the upper arm known as the humerus. Humerus fractures are caused by vehicular accidents, gunshots, electric shocks, and seizures. These may occur in the proximal, middle or distal location.
• Forearm fracture: Forearm fracture refers to the fracture caused in the portion of the upper limb, between the wrist and the elbow. It is of two types- ulnar fracture and radial fracture.

Chest Injuries

Traumatic fractures of the chest affect the ribs, heart and the lungs. Chest injuries account for around 25% of the traumatic fracture deaths. These are of the following types –

Chest wall injuries:

• Chest wall contusions
• Rib fractures
• Sternal fractures
• Shoulder girdle fractures

Pulmonary injuries: 

• Pulmonary Contusion
• Pneumothorax injuries
• Haemothorax injuries

Airway injuries: Tracheobronchial tear.

Cardiac injuries: 

• Pericardial tamponade
• Myocardial contusion
• Traumatic arrest

Blood vessel injuries:

• Traumatic aortic rupture
• Thoracic aortic injuries
• Aortic dissection

Injuries of the torso: 

• Oesophageal injury
• Diaphragm injury

Diagnosis of traumatic fractures

The following laboratory tests are effective in detecting the occurrence and degree of traumatic fracture-

• Radiographic imaging (X-Ray)
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)

Treatment & prevention

Traumatic fractures do not heal by medications or minor treatments. Surgical interventions are always necessary. The fluid accumulated in the peritoneum, or the pericardium (cardiac membrane) can be channelled out through a tube or catheter in some cases. In some other cases, invasive surgical procedures are necessary.

Safety measures (protective devices) are always necessary whether one is driving on the road or is engaged in some sports activities. Laws and regulatory rules pertaining to these activities should be made very strict in different countries. This may gradually help reduce the incidences of accidents and traumatic fractures.

References