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Complications are likely to result in cases of excess blood loss or punctures to certain organs, possibly leading to shock. Swelling and bruising may result, more so in high-impact injuries. Pain in the affected areas may differ where severity of impact increases its likelihood and may radiate if symptoms are aggravated when one moves around.
Several precautions may decrease the risk of getting a pelvic fracture. One study that examined the effectiveness of vitamin D supplementation found that oral vitamin D supplements reduced the risk of hip and nonvertebral fractures in older people. Certain types of equipment may help prevent pelvic fractures for the groups which are most at risk.
Children in general are at greater risk because of their high activity levels. Children that have risk-prone behaviors are at even greater risk.
Over 2.5 million child abuse and neglect cases are reported every year, and thirty-five out of every hundred cases are physical abuse cases. Bone fractures are sometimes part of the physical abuse of children; knowing the symptoms of bone fractures in physical abuse and recognizing the actual risks in physical abuse will help forward the prevention of future abuse and injuries. Astoundingly, these abuse fractures, if not dealt with correctly, have a potential to lead to the death of the child.
Fracture patterns in abuse fractures that are very common with abuse are fractures in the growing part of a long bone (between the shaft and the separated part of the bone), fractures of the humeral shaft (long bone between the shoulder and elbow), ribs, scapula, outer end of the clavicle, and vertebra. Multiple fractures of varying age, bilateral fractures, and complex skull fractures are also linked to abuse. Fractures of varying ages occur in about thirteen percent of all cases.
Supracondylar humerus fractures account for 55%-75% of all elbow fractures. They most commonly occur in children between ages 5–8, because remodeling of bone in this age group causes a decreased supracondylar anteroposterior diameter.
Bone mineral density decreases with increasing age. Osteoporotic bone loss can be prevented through an adequate intake of vitamin C and vitamin D, coupled with exercise and by being a non-smoker. A study by Cheng et al. in 1997, showed that greater bone density indicated less risk for fractures in the calcaneus.
Colles fractures occur in all age groups, although certain patterns follow an age distribution.
- In the elderly, because of the weaker cortex, the fracture is more often extra-articular.
- Younger individuals tend to require a higher energy force to cause the fracture and tend to have more complex intra-articular fractures. In children with open epiphyses, an equivalent fracture is the "epiphyseal slip", as can be seen in other joints, such as a slipped capital femoral epiphysis in the hip. This is a Salter I or II fracture with the deforming forces directed through the weaker epiphyseal plate.
- More common in women because of post-menopausal osteoporosis.
Removable splints result in better outcomes than casting in children with torus fractures of the distal radius.
Distal radius fractures are the most common fractures seen in adults, with incidence in females outnumbering incidence in males by a factor of 2-3. Men who sustain distal radius fractures are usually younger, generally in their fifth decade (vs. seventh decade in females). The elderly are more susceptible because of the osteopenia and osteoporosis commonly seen in this age group. The majority of these fractures are extra-articular (i.e. not involving the joint).
This is also a common injury in children which may involve the growth plate (Salter-Harris fracture).
In young adults, the injury is often severe as a greater force is necessary to produce the injury.
Hand and wrist injuries are reported to account for fifteen to twenty percent of emergency room injuries, and metacarpal fractures represent a significant number of those injuries. Hand injuries of this sort are most prevalent among fifteen- to thirty-five-year-old males, and the fifth metacarpal is the one most commonly affected.
Males are nearly fifty percent more likely to sustain fracture from a punch mechanism than females. Male intentional punch injuries are correlated predominantly with social deprivation, while female punch intentional injuries show more correlation with psychiatric disorders.
Approximately 3.7 male hand injuries, per 1000, per year, and 1.3 female hand injuries, per 1000, per year, have been reported. Common mechanisms of injury are gender specific. Although the fiscal cost is not available, it can be asserted that the cost is reasonably significant per individual, depending on the cost of emergency care, immobilization, surgery, follow up doctors’ visits, etc. in addition to the fiscal impact from loss of and/or limited work abilities.
Olecranon fractures are rare in children, constituting only 5 to 7% of all elbow fractures. This is because in early life, olecranon is thick, short and much stronger than the lower extremity of the humerus.
However, olecranon fractures are a common injury in adults. This is partly due to its exposed position on the point of the elbow.
Hip fractures are seen globally and are a serious concern at the individual and population level. By 2050 it is estimated that there will be 6 million cases of hip fractures worldwide. One study published in 2001 found that in the US alone, 310,000 individuals were hospitalized due to hip fractures, which can account for 30% of Americans who were hospitalized that year. Another study found that in 2011, femur neck fractures were among the most expensive conditions seen in US hospitals, with an aggregated cost of nearly $4.9 billion for 316,000 inpatient hospitalizations. Rates of hip fractures is declining in the United States, possibly due to increased use of bisphosphonates and risk management. Falling, poor vision, weight and height are all seen as risk factors. Falling is one of the most common risk factors for hip fractures. Approximately 90% of hip fractures are attributed to falls from standing height.
Given the high morbidity and mortality associated with hip fractures and the cost to the health system, in England and Wales, the National Hip Fracture Database is a mandatory nationwide audit of care and treatment of all hip fractures.
Bone stability after a fracture occurs between 3 and 4 weeks. Some experts suggest not wearing glasses or blowing the nose during this time as it can affect the bone alignment. Full bone fusion occurs between 4 and 8 weeks. General activity is fine after 1–2 weeks, but contact sports are not advisable for at least 2–3 months, depending on the extent of injury. It is recommended that when participating in sports a face guard should be worn for at least 6 weeks post-injury.
Calcaneal fractures are often attributed to shearing stress adjoined with compressive forces combined with a rotary direction (Soeur, 1975). These forces are typically linked to injuries in which an individual falls from a height, involvement in an automobile accident, or muscular stress where the resulting forces can lead to the trauma of fracture. Overlooked aspects of what can lead to a calcaneal fracture are the roles of osteoporosis and diabetes.
Unfortunately, the prevention of falls and automobile accidents is limited and applies to unique circumstances that should be avoided. The risk of muscular stress fractures can be reduced through stretching and weight-bearing exercise, such as strength training. In addition, footwear can influence forces that may cause a calcaneal fracture and can prevent them as well. A 2012 study conducted by Salzler showed that the increasing trend toward minimalist footwear or running barefoot can lead to a variety of stress fractures including that of the calcaneus.
The majority of hip fractures are the result of a fall, particularly in the elderly. Therefore, identifying why the fall occurred, and implementing treatments or changes, is key to reducing the occurrence of hip fractures. Multiple contributing factors are often identified. These can include environmental factors and medical factors (such as postural hypotension or co-existing disabilities from disease such as Stroke or Parkinson's Disease which cause visual and/or balance impairments). A recent study has identified a high incidence of undiagnosed cervical spondylotic myelopathy (CSM) amongst patients with a hip fracture. This is relatively unrecognised consequent of CSM.
Additionally, there is some evidence to systems designed to offer protection in the case of a fall. Hip protectors, for example appear to decrease the number of hip fractures among the elderly. They; however, are not often used.
Jefferson fracture is often caused by an impact or load on the back of the head, and are frequently associated with diving into shallow water, impact against the roof of a vehicle and falls, and in children may occur due to falls from playground equipment. Less frequently, strong rotation of the head may also result in Jefferson fractures.
Jefferson fractures are extremely rare in children, but recovery is usually complete without surgery.
The greenstick fracture pattern occurs as a result of bending forces. Activities with a high risk of falling are risk factors. Non-accidental injury more commonly causes spiral (twisting) fractures but a blow on the forearm or shin could cause a green stick fracture. The fracture usually occurs in children and teens because their bones are flexible, unlike adults whose more brittle bones usually break.
The following risk factors have been identified for coccyx fracture:
- Lack of/reduced muscle mass
- Advanced age
- Osteoporosis
- Being of the female sex (due to the wider pelvis typically found in females)
- Violence
Symptoms of coccyx fracture include:
- Pain that increases in when sitting or getting up from a chair, or when experiencing bowel movement
- Provoked pain over the tailbone
- Nausea
- Bruising or swelling in the tailbone area
A coccyx fracture is a fracture of the coccyx, commonly called a 'broken tailbone'.
The coccyx is located at the base of the spine, under the sacrum. It is the last section of the ape vertebral column. Most commonly in humans it comprises 3 to 5 fused (or, more rarely, separate) vertebrae, and is approximately 4 to 10 cm in length. The coccyx is attached to the sacrum by a fibrocartilaginous joint, called the sacrococcygeal symphysis, allowing for some (but little) .
Considerable force is needed to cause a cervical fracture. Vehicle collisions and falls are common causes. A severe, sudden twist to the neck or a severe blow to the head or neck area can cause a cervical fracture.
Sports that involve violent physical contact carry a risk of cervical fracture, including American football, Goalkeeper (association football), ice hockey, rugby, and wrestling. Spearing an opponent in football or rugby, for instance, can cause a broken neck. Cervical fractures may also be seen in some non-contact sports, such as gymnastics, skiing, diving, surfing, powerlifting, equestrianism, mountain biking, and motor racing.
Certain penetrating neck injuries can also cause cervical fracture which can also cause internal bleeding among other complications.
Hanging also incurs a cervical fracture.
In children the outcome of distal radius fracture treatment in casts is usually very successful with healing and return to normal function expected. Some residual deformity is common but this often remodels as the child grows. In the elderly, distal radius fractures heal and may result in adequate function following non-operative treatment. A large proportion of these fractures occur in elderly people that may have less requirement for strenuous use of their wrists. Some of these patients tolerate severe deformities and minor loss of wrist motion very well even without reduction of the fracture. In this low demand group only a short period of immobilization is indicated as rapid mobilization improves functional outcome.
In younger patients the injury requires greater force and results in more displacement particularly to the articular surface. Unless an accurate reduction of the joint surface is obtained, these patients are very likely to have long term symptoms of pain, arthritis, and stiffness.
It occurs in older children at the end of growth. Variability in fracture pattern is due to progression of physeal closure as anterolateral part of distal tibial physis is the last to close. When the lateral physis is the only portion not fused, external rotation may lead to Tillaux or Triplane fractures.
A study of 2000 cases of back pain referred to hospital found that 2.7% were diagnosed as coccydynia. This type of pain occurs five times more frequently in women than in men. It can occur at any age, the mean age of onset being around 40. There are no ethnicity or race associations with coccydnia.
The etiology of the Galeazzi fracture is thought to be a fall that causes an axial load to be placed on a hyperpronated forearm. However, researchers have been unable to reproduce the mechanism of injury in a laboratory setting.
After the injury, the fracture is subject to deforming forces including those of the brachioradialis, pronator quadratus, and thumb extensors, as well as the weight of the hand. The deforming muscular and soft-tissue injuries that are associated with this fracture cannot be controlled with plaster immobilization.
The healing time for a routine mandible fractures is 4–6 weeks whether MMF or rigid internal fixation (RIF) is used. For comparable fractures, patients who received MMF will lose more weight and take longer to regain mouth opening, whereas, those who receive RIF have higher infection rates.
The most common long-term complications are loss of sensation in the mandibular nerve, malocclusion and loss of teeth in the line of fracture. The more complicated the fracture (infection, comminution, displacement) the higher the risk of fracture.
Condylar fractures have higher rates of malocclusion which in turn are dependent on the degree of displacement and/or dislocation. When the fracture is intracapsular there is a higher rate of late-term osteoarthritis and the potential for ankylosis although the later is a rare complication as long as mobilization is early. Pediatric condylar fractures have higher rates of ankylosis and the potential for growth disturbance.
Rarely, mandibular fracture can lead to Frey's syndrome.