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What is a fracture?

A fracture, in surgery, the breaking of any part of the bony structure of the body. The general cause of fracture is a stress too great to permit the integrity of the bone to be maintained. The stress may result from direct violence, when the bone is directly acted upon by some external force; in this case the interposed soft tissues are usually crushed and lacerated. It may also result from indirect violence, when the shock is distributed through various parts of the skeleton, the weaker bone or part of a bone being broken; for instance, a fall on the outstretched hands is likely to cause fracture of the collar-bone, although that is remote from the site of impact. A fracture may be simple, when the broken bone is contained within its surrounding soft tissues, or compound, when the broken end ruptures the skin. It may be comminuted, when the bone is broken in more than two pieces; or impacted when one broken end is driven into the other.

Greenstick fracture occurs in children, whose bones are not fully ossified and contain a large proportion of cartilage, and consists of a bent and splintered bone: this is an incomplete fracture, as are also depressed and fissured fractures. Multiple fracture is when more than one fracture is present. Fracture is rendered more likely by any morbid condition which weakens the bone, and by old age, when bone becomes more brittle.

Fracture may be recognized by the helpless condition of the limb, the extreme pain on movement of the affected part, and, frequently, a visible deformity. When the signs are present further investigation must be carried out with the minimum of movement. An unmistakable symptom is crepitus, by which is meant the grating sensation of the broken pieces passing over each other; this symptom should never be looked for except by a doctor.

The treatment of fracture aims at aligning the broken ends accurately together to restore the normal anatomy of the bone, and the part is secured by splints or other apparatus to secure immobility. Sometimes fixation of the broken fragments is secured by surgical operation and plating, pinning or screwing them together. When the bone has joined, gradually increasing movement is advocated in order to accustom the muscles and tendons to the resumption of their functions.

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