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After a humerus fracture, pain is immediate, enduring, and exacerbated with the slightest movements. The affected region swells, with bruising appearing a day or two after the fracture. The fracture is typically accompanied by a discoloration of the skin at the site of the fracture. A crackling or rattling sound may also be present, caused by the fractured humerus pressing against itself. In cases in which the nerves are affected, then there will be a loss of control or sensation in the arm below the fracture. If the fracture affects the blood supply, then the patient will have a diminished pulse at the wrist. Displaced fractures of the humerus shaft will often cause deformity and a shortening of the length of the upper arm. Distal fractures may also cause deformity, and they typically limit the ability to flex the elbow.
People usually present with a history of an injury and localized pain. There is often a deformity in the wrist with associated swelling. Numbness of the hand can occur because of compression on the median nerve across the wrist (carpal tunnel syndrome). The wrist deformity often limits motion of the fingers.
Swelling, deformity, tenderness and loss of wrist motion are normal features on examination of a person with a distal radius fracture. Examination should rule out a skin wound which might suggest an open fracture. It is imperative to check for loss of sensation, loss of circulation to the hand, and more proximal injuries to the forearm, elbow and shoulder. The most common associated neurological finding is decreased sensation over the thenar eminence due to associated median nerve injury.
A classic "dinner fork" deformity may be seen in dorsally angulated fractures due to dorsal displacement of the carpus. The reverse deformity may be seen in volarly angulated fractures.
The classic clinical presentation of a hip fracture is an elderly patient who sustained a low-energy fall and now has groin pain and is unable to bear weight. Pain may be referred to the supracondylar knee. On examination, the affected extremity is often shortened and unnaturally, externally rotated compared to the unaffected leg.
Usually, a SCFE causes groin pain, but it may cause pain in only the thigh or knee, because the pain may be referred along the distribution of the obturator nerve. The pain may occur on both sides of the body (bilaterally), as up to 40 percent of cases involve slippage on both sides. After a first SCFE, when a second SCFE occurs on the other side, it typically happens within one year after the first SCFE. About 20 percent of all cases include a SCFE on both sides at the time of presentation.
Signs of a SCFE include a waddling gait, decreased range of motion. Often the range of motion in the hip is restricted in internal rotation, abduction, and flexion. A person with a SCFE may prefer to hold their hip in flexion and external rotation.
A humerus fracture is a break of the humerus bone in the upper arm. Fractures of the humerus may be classified by the location into proximal region, which is near the shoulder, the middle region or shaft, and the distal region, which is near the elbow. These locations can further be divided based on the extent of the fracture and the specific areas of each of the three regions affected. Humerus fractures usually occur after physical trauma, falls, excess physical stress, or pathological conditions such as tumors. Falls are the most common cause of proximal and shaft fractures, and those who experience a fracture from a fall usually have an underlying risk factor for bone fracture. Distal fractures occur most frequently in children who attempt to break a fall with an outstretched hand.
Symptoms of fracture are pain, swelling, and discoloration of the skin at the site of the fracture. Bruising appears a few days after the fracture. The neurovascular bundle of the arm may be affected in severe cases, which will cause loss of nerve function and diminished blood supply beneath the fracture. Proximal and distal fractures will often cause a loss of shoulder or elbow function. Displaced shaft and distal fractures may cause deformity, and such shaft fractures will often shorten the length of the upper arm. Most humerus fractures are nondisplaced and will heal within a few weeks if the arm is immobilized. Severe displaced humerus fractures and complications often require surgical intervention. In most cases, normal function to the arm returns after the fracture is healed. In severe cases, however, function of the arm may be diminished after recovery.
People with olecranon fractures present with intense elbow pain after a direct blow or fall. Swelling over the bone site is seen and an inability to straighten the elbow is common. Due to the proximity of the olecranon to the ulnar nerve, the injury and swelling may cause numbness and tingling at the 4th and 5th fingers. Examination can bring out a palpable defect at the site of the fracture.
Symptoms of Bennett fracture are instability of the CMC joint of the thumb, accompanied by pain and weakness of the pinch grasp. Characteristic signs include pain, swelling, and ecchymosis around the base of the thumb and thenar eminence, and especially over the CMC joint of the thumb. Physical examination demonstrates instability of the CMC joint of the thumb. The patient will often manifest a weakened ability to grasp objects or perform such tasks as tying shoes and tearing a piece of paper. Other complaints include intense pain experienced upon catching the thumb on an object, such as when reaching into a pants pocket.
Supracondylar humerus fractures typically result from a fall on to an outstretched arm, usually leading to a forced hyperextension of the elbow. Typically, this is an isolated injury to the elbow (no injuries elsewhere). Children with this injury present with pain and swelling about the elbow. Motion at the elbow and at the wrist make the pain worse. With mild or moderate fracture displacement, there may be deformity at the elbow.
This classification incorporates all fractures of the proximal ulna and radius into one group, subdivided into three patterns:
- Type A: Extra-articular fractures of the metadiaphysis of either the radius or the ulna
- Type B: Intra-articular fractures of either the radius or ulna
- Type C: Complex fractures of both the proximal radius and ulna
A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. In children, many of these fractures are non-displaced and can be treated with casting. Some are angulated or displaced and are best treated with surgery. In children, most of these fractures can be treated effectively with expectation for full recovery. Some of these injuries can be complicated by poor healing or by associated blood vessel or nerve injuries with serious complications.
The term "Colles fracture" is classically used to describe a fracture at the distal end of the radius, at its cortico-cancellous junction. However, now the term tends to be used loosely to describe any fracture of the distal radius, with or without involvement of the ulna, that has dorsal displacement of the fracture fragments. Colles himself described it as a fracture that “takes place at about an inch and a half (38mm) above the carpal extremity of the radius” and “the carpus and the base of metacarpus appears to be thrown backward”. The fracture is sometimes referred to as a "dinner fork" or "bayonet" deformity due to the shape of the resultant forearm.
Colles' fractures can be categorized according to several systems including Frykman, Gartland & Werley, Lidström, Nissen-Lie and the Older's classifications.
Failure to treat a SCFE may lead to: death of bone tissue in the femoral head (avascular necrosis), degenerative hip disease (hip osteoarthritis), gait abnormalities and chronic pain. SCFE is associated with a greater risk of arthritis of the hip joint later in life. 17-47 percent of acute cases of SCFE lead to the death of bone tissue (osteonecrosis) effects.
Patients with tibial shaft fractures present with pain and localized swelling. Due to the pain they are unable to bear weight. There may be deformity, angulation, or malroation of the leg. Fractures that are open (bone exposed or breaking the skin) are common.
The fracture is most commonly caused by people falling onto a hard surface and breaking their fall with outstretched hand (FOOSH)–falling with wrists flexed would lead to a Smith's fracture. Originally it was described in elderly and/or post-menopausal women. It usually occurs about three to five centimetres proximal to the radio-carpal joint with posterior and lateral displacement of the distal fragment resulting in the characteristic "dinner fork" or "bayonet" like deformity. Colles fracture is a common fracture in people with osteoporosis, second only to vertebral fractures.
The onset is not dramatic. When the boot or shoes are taken off, there is a cramp-like pain in the affected forefoot, and moderate local edema appears on the dorsal aspect. On moving each toe in turn, that of the involved metatarsal causes pain, and when the bone is palpated from the dorsal surface, a point of tenderness is found directly over the lesion. Radiography at this stage is negative, but the condition is diagnosed correctly by military surgeons without the aid of x-rays. In civil life, it is seldom diagnosed correctly for a week or two, when, because of lack of immobilization, there is an excessive deposit of callus (which may be palpable) around the fracture.
A hip fracture is a break that occurs in the upper part of the femur (thigh bone). Symptoms may include pain around the hip particularly with movement and shortening of the leg. Usually the person cannot walk.
They most often occur as a result of a fall. Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic cancer. Diagnosis is generally by X-rays. Magnetic resonance imaging, a CT scan, or a bone scan may occasionally be required to make the diagnosis.
Pain management may occur with opioids or a nerve block. If a person's health is sufficient, surgery is generally recommended within two days. Options for surgery may include a total hip replacement or screws. Efforts to prevent deep vein thrombosis following surgery are recommended.
About 15% of women break their hip at some point in their life. Women are more often affected than men. Hip fractures become more common with age. The risk of death in the year following a fracture is about 20% in older people.
In orthopedic medicine, fractures are classified in various ways. Historically they are named after the physician who first described the fracture conditions, however, there are more systematic classifications in place currently.
A person with a Jones fracture may not realize that a fracture has occurred. Diagnosis includes the palpation of an intact peroneus brevis tendon, and demonstration of local tenderness distal to the tuberosity of the fifth metatarsal, and localized over the diaphysis of the proximal metatarsal. Bony crepitus is unusual.
This injury should be differentiated from the developmental apophysis (5th metatarsal tuberosity) commonly and normally occurring at this site in adolescents. Differentiation is possible by characteristics such as absence of sclerosis of the fractured edges (in acute cases) and orientation of the lucent line: transverse (at 90 degrees) to the metatarsal axis for the fracture (due to avulsion pull by the peroneus brevis muscle inserting at the proximal tip) - and parallel to the metatarsal axis in the case of the apophysis. Diagnostic x-rays include anteroposterior, oblique, and lateral views and should be made with the foot in full flexion.
Elbow fractures are any broken bone around the elbow joint.
They include among others:
- Olecranon fractures
- Supracondylar humerus fractures
- Radial head fractures
The terrible triad of the elbow (not to be confused with the terrible triad of the knee) is a combination of:
- A fracture of the head of radius
- A fracture of the coronoid process of the ulna
- Humeroulnar dislocation (generally posterior or posterolateral)
The "terrible triad of the elbow" is confers joint instability and a major risk of developing osteoarthritis.
Bennett fracture is a fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint. This intra-articular fracture is the most common type of fracture of the thumb, and is nearly always accompanied by some degree of subluxation or frank dislocation of the carpometacarpal joint.
Tibia shaft fracture is a fracture of the proximal (upper) third of the tibia (lower leg bone). Due to the location of the tibia, it is frequently injured. Thus it is the most commonly fractured long bone in the body.
Stress fractures are typically discovered after a rapid increase in exercise. They most commonly present as pain with weight bearing that increases with activity. The pain usually subsides with rest but may be constantly present with a more serious bone injury. There is usually an area of localized tenderness on or near the bone and generalized swelling to the area. Percussion or palpation to the bone may reproduce symptoms. Anterior tibial stress fractures elicit focal tenderness on the anterior tibial crest, while posterior medial stress fractures can be tender at the posterior tibial border.
A Jones fracture is a break between the base and middle part of the fifth metatarsal of the foot. It result in pain near the midportion of the foot on the outside. There may also be bruising and difficulty walking. Onset is generally sudden.
The fracture typically occurs when the toes are pointed and the foot bends inwards. This movement may occur when changing direction while the heel is off the ground such in dancing, tennis, or basketball. Diagnosis is generally suspected based on symptoms and confirmed with X-rays.
Initial treatment is typically in a cast, without any walking on it, for at least six weeks. If after this period of time healing has not occurred a further six weeks of casting may be recommended. Due to poor blood supply in this area, the break sometimes does not heal and surgery is required. In athletes or if the pieces of bone are separated surgery may be considered sooner. The fracture was first described in 1902 by orthopedic surgeon Robert Jones who sustained the injury while dancing.
March fracture, also known as fatigue fracture or stress fracture of metatarsal bone, is the fracture of the distal third of one of the metatarsals occurring because of recurrent stress. It is more common in soldiers, but also occurs in hikers, organists, and even those, like hospital doctors, whose duties entail much standing. March fractures most commonly occur in the second and third metatarsal bones of the foot. It is a common cause of foot pain, especially when people suddenly increase their activities.