Medical & Clinical Reviews

Description

A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfect, where the fracture is then properly termed a pathologic fracture although bone tissue contains no pain receptors, a bone fracture is painful for several reasons. Breaking in the continuity of the periosteum, with or without similar discontinuity in endosteum, as both contain multiple pain receptors. Edema and hematoma of nearby soft tissues caused by ruptured bone marrow evokes pressure pain. Involuntary muscle spasms trying to hold bone fragments in place. The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed, forming a fracture hematoma. The blood coagulates to form a blood clot situated between the broken fragments. Within a few days, blood vessels grow into the jelly-like matrix of the blood clot. The new blood vessels bring phagocytes to the area, which gradually removes the non-viable material.

Mineralization of the Collagen

The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fiber’s. In this way, the blood clot is replaced by a matrix of collagen. Collagen's rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied. At this stage, some of the fibroblasts begin to lay down bone matrix in the form of collagen monomers. These monomers spontaneously assemble to form the bone matrix, for which bone crystals (calcium hydroxyapatite) are deposited in amongst, in the form of insoluble crystals. This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone is a mineralized collagen matrix if the mineral is dissolved out of bone, it becomes rubbery. Healing bone callus on average is sufficiently mineralized to show up on X-ray within six weeks in adults and less in children. This initial "woven" bone does not have the strong mechanical properties of mature bone. By a process of remodeling, the woven bone is replaced by mature "lamellar" bone. The whole process may take up to months, but in adults, the strength of the healing bone is usually 80% of normal by three months after the injury. Both high and low-force trauma can cause bone fracture injuries. Preventive efforts to reduce motor vehicle crashes, the most common cause of highforce trauma, include reducing distractions while driving. Common distractions are driving under the influence and texting or calling while driving, both of which lead to an approximate increase in crashes. Wearing a seatbelt can also reduce the likelihood of injury in a collision serious injury and even death in crashes between motor vehicles and humans. Vision zero aims to reduce traffic deaths to zero through better traffic design and other measures and to drastically reduce traffic injuries which would prevent many bone fractures.

Bone Fragility and Fractures

A common cause of low-force trauma is an at-home fall. When considering preventative efforts, the National Institute of Health (NIH) examines ways to reduce the likelihood of falling, the force of the fall and bone fragility. To prevent at home falls they suggest keeping cords out of high traffic areas where someone could trip, installing handrails and keeping stairways well lit and installing an assistive bar near the bathtub in the washroom for support. To reduce the impact of a fall the NIH recommends to try falling straight down on your buttocks or onto your hands. Some sports have a relatively high risk of bone fractures as a common sports injury. Preventive measures depend to some extent on the specific sport, but learning proper technique, wearing protective gear and having a realistic estimation of one's own capabilities and limitations can all help reduce the risk of bone fracture. In contact sports rules have been put in place to protect athlete health, such as the prohibition of unnecessary roughness in American football. Taking calcium and vitamin D supplements can help strengthen your bones. Vitamin D supplements combined with additional calcium marginally reduces the risk of hip fractures and other types of fracture in older adults however, vitamin D supplementation alone did not reduce the risk of fractures