 DEFINITION:  A Fracture is an interruption in the continuity of Bone.  The symbol # represents a Fracture.

 1. PAIN: This is immediate from local inflammatory reaction. Marked tenderness over fracture site.  2.DEFORMITY: Due to displacement of bony fragments, Eg. Dinner fork deformity in distal Radius Fracture.  3.OEDEMA: Immediately after Injury. Commonly temporary Posterior cast is first applied and then the plaster is reapplied as soon as the swelling subsides  4.MUSCLE SPASM: It is a protective reflex in Muscle to prevent the worsening of Injury.

 5.LOSS OF FUNCTION:  Complete loss of function in severe fractures. Some activity may be possible in less severe injury.  6.ABNORMAL MOVEMENTS/CREPITUS:  Friction between broken ends of bones. Do not try to elicit it, it may further worsen the injury.

 7. SHOCK: Hypovolaemic shock due to severe blood loss, In shaft of Femur fracture (1.7 litres of blood may be loosed)  8.LIMITATION OF JOINT MOVEMENT: Joint mobility can be affected due to,pain, spasm,fear, swelling,mechanical obstruction.  9.MUSCLE ATROPHY: There will be loss of strength in disused muscles.It is found after few weeeks of Injury.

 HEALING OF COMPACT BONE:  Starts within few seconds of Fracture. The process of Fracture Healing takes place through five stages ().  I STAGE: HAEMATOMA FORMATION  As a result of tearing of Blood vessels during injury, Haematoma forms at the fracture site.

 II STAGE: PERIOSTEAL AND ENDOSTEAL PROLIFERATION:  Proliferation of cells from deep surface of periosteum adjacent to fracture site. These cells are the precursors of Osteoblasts, At the same time cell proliferate from endosteum in each fragment and it forms a bridge between bone ends and Haematoma is gradually reabsorbed.

 III STAGE : CALLUS FORMATION  The proliferating cells mature as osteoblast or chondroblast. Chondroblast forms cartilage. The osteoblast lays down a intercellular matrix of collagen and Polysaccharides which then impregnated with Calcium salts forming immature bone called CALLUS or Woven bone (1 st Radiological sign).  IV STAGE : CONSOLIDATION:  The Osteoblastic activity results in change of primary Callus to bone which has lamellar structure and at the end of range union is complete. New Bone forms as a thickened mass at fracture site and obliterates the Medullary cavity.

 V STAGE : REMODELLING  The Lamellar structure is changed and bone adapts by strengthening along the line of stress imposed upon it. The excess bone is removed and original shape reappears

 Haematoma is formed, Since no medullary cavity the second stage differ.  Cancellous bone has greater area of contact between fragments of bone, bone forming tissue is facilitated by open arrangement of Trabeculae as it grows from both fragments.  Osteogenic cells lays down intercellular matrix which calcifies to form woven bone.

Clinical tests of union:  Absence of pain in Weight bearing, Lifting or movement  Absence of tenderness on firm palpation at fracture site  Absence of mobility between the fragments Radiological criteria of union:  Visible callus bridging the #.  Continuity of bone trabeculae across the #

zClinically Upper limbLower limb Adult6-8 weeks12-16 weeks Child3-4 weeks6-8 weeks yRadiologically xBridging callus formation xRemodelling yBiomechanically: Full or near full Functional ability

Depends on number of factors.  Type Of Bone: Cancellous bone heals more quickly than compact bone. Healing of long bones depends on their size so that bones of the upper limb unite earlier (3-12 weeks) than do those of the lower limb (12-18) weeks.  Revascularization of devitalized bone and soft tissues adjacent to the fracture site.  BLOOD SUPPLY: Adequate blood supply is essential for normal healing  FIXATION: If a Fracture is rigidly immobilized, the stimulus for callus is lost, so a small amount of movement at Fracture site encourage healing

 AGE. Union of a fracture is quicker in children and consolidation may occur at between 4 and 6 weeks. Age makes little difference to union in adults unless there is accompanying pathology.  Certain drugs such as non-steroidal anti-inflammatory drugs may interfere with fracture healing as they have an impact upon the inflammatory process.  Smoking: There are increased rates of delayed union and non-union in smokers.  Ultrasound: low intensity Ultrasound may accelerate Fracture healing

IMMEDIATE COMPLICATIONS  Haemorrage  Damage to arteries  Damage to surrounding soft tissues.

 Wound Infection  Fat embolism ( ARDS- Acute Respiratory distress syndrome)  Shock  Chest Infection  Compartment syndrome  Nerve Injury

 Deformity  Osteoarthritis  Aseptic necrosis  Traumatic Chondromalacia  Reflex Sympathetic Dystrophy