Types of Bone Fractures The most common way to classify bone fractures is on the basis of different features of a fracture.

This is known as orthopedic classification. Here is a list of the different types of bone fractures according to the orthopedic classification. Open fracture: An open fracture is a fracture where the broken bone is exposed. That is dangerous because of increased chances of infection. It is also called compound fracture. Closed fracture: Also known as simple fracture, a closed fracture is a fracture where the bone is broken, but the skin is intact. Complete fracture: The two pieces of the bone, resulting from the fracture, completely separate from each other. Incomplete fracture: In this, the two pieces of bone, resulting from the fracture do not completely separate from each other; the bone pieces are still joined to some extent. This happens when the crack (or fracture) does not traverse along the entire width of the bone. Multi-fragmentary fracture: In this the bone splits into multiple pieces. Compression fracture: A compression fracture is a closed fracture that occurs when two or more bones are forced against each other. It commonly occurs to the bones of the spine and may be caused by falling into a standing or sitting position, or a result of advanced osteoporosis. Avulsion fracture: An avulsion fracture is a closed fracture where a piece of bone is broken off by a sudden, forceful contraction of a muscle. This type of fracture is common in athletes and can occur when muscles are not properly stretched before activity. This fracture can also because of an injury. Impacted fracture: An impacted fracture is similar to a compression fracture, yet it occurs within the same bone. It is a closed fracture which occurs when pressure is applied to both ends of the bone, causing it to split into two fragments that jam into each other. This type of fracture is common in car accidents and falls. Stress fracture: It is a common overuse injury. It is most often seen in athletes who run and jump on hard surfaces such as runners, ballet dancers and basketball players. Linear fracture: In this the fracture is parallel to the bone's long axis.

Transverse fracture: In this the fracture is at a right angle to the bone's long axis. Oblique fracture: In this the fracture is diagonal to a bone's long axis. Spiral fracture: In this at least one part of the bone has been twisted. Comminuted fracture: In this the fracture results in several fragments. Compacted fracture: In this the fracture is caused when bone fragments are driven into each other. Compartment Syndrome Compartment syndrome is elevation of interstitial pressure in closed fascial compartment that results in microvascular compromise; a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow. - as duration & magnitude of interstitial pressure increase, myoneural function is impaired & necrosis of soft tissues eventually develops; - intracompartmental pressure: - necrosis of tissue may begin at interstitial pressure as low as 30 mm - while others have suggested that it begins at higher level; - w/ periods of hypotension and trauma to limb, interstitial tissue pressure of 30 mm of mercury has been suggested as threshold at which diagnosis of compartment syndrome should be considered; - diastolic pressure: (Whiteside' Theory): - development of a compartment syndrome depends not only on intra-compartment pressure but also depends on systemic blood pressure; - DBP - CP should be greater than 30

Causes: - prolonged compression over a compartment (drug over dose) - Owen, et al, measured intramuscular pressure by inserting wick catheters into 10 volar forearms and 10 anterior tibial compartments of adult volunteers. - placed the subjects in positions in which victims of drug overdose are commonly found - intramuscular pressures in the area of direct compression on hard surfaces ranged from 26 to 240 mm Hg, and averaged 101 mm Hg. - reference: - Intramuscular pressures with limb compression clarification of the pathogenesis of the drug-induced muscle-compartment syndrome. - fractures (both open and closed) - improper casting of fractures

- burns - infiltration of IV medications (chemotherapy) - intra compartment hemorrhage (direct arterial injury, Coumadin, hemophilia) - tumors - improper positioning of the well leg on the frx table

To confirm the diagosis, the doctor or nurse may need to directly measure the pressure in the compartment. This is done using a needle attached to a pressure meter, which is placed into the body area. The test must be done during and after an activity that causes pain. Treatment Surgery is needed immediately. Delaying surgery can lead to permanent damage. Long surgical cuts are made through the muscle tissue to relieve the pressure. The wounds can be left open (covered with a sterile dressing) and closed during a second surgery, usually 48 - 72 hours later. Skin grafts may be needed to close the wound. If a cast or bandage is causing the problem, the dressing should be loosened or cut down to relieve the pressure. Expectations (prognosis) With prompt diagnosis and treatment, the outlook is excellent for recovery of the muscles and nerves inside the compartment. However, the overall prognosis will be determined by the injury leading to the syndrome. Permanent nerve injury and loss of muscle function can result if the diagnosis is delayed. This is more common when the injured person is unconscious or heavily sedated and cannot complain of pain. Permanent nerve injury can occur after 12 - 24 hours of compression. Complications Complications include permanent injury to nerves and muscles that can dramatically impair function. (See: Volkmann's ischemia)

Causes, incidence, and risk factors Thick layers of tissue, called fascia, separate groups of muscles in the arms and legs from each other. Inside each layer of fascia is a confined space, called a compartment. The compartment includes the muscle tissue, nerves, and blood vessels. Fascia surrounds these structures, similar to the way in which insulation covers wires. Fascia do not expand. Any swelling in a compartment will lead to increased pressure in that area, which will press on the muscles, blood vessels, and nerves. If this pressure is high enough, blood flow to the compartment will be blocked. This can lead to permanent injury to the muscle and nerves. If the pressure lasts long enough, the muscles may die and the arm or leg will not work any more. It may need to be amputated. Swelling that leads to compartment syndrome occurs from trauma such as a car accident or crush injury, or surgery. Swelling can also be caused by complex fractures or soft tissue injuries due to trauma. Long-term (chronic) compartment syndrome can be caused by repetitive activities, such as running. The pressure in a compartment only increases during that activity. Compartment syndrome is most common in the lower leg and forearm, although it can also occur in the hand, foot, thigh, and upper arm. Symptoms Compartment syndrome causes severe pain that does not go away when you take pain medicine or raise the affected area. In more severe cases, symptoms may include: Decreased sensation Numbness and tingling Paleness of skin Severe pain that gets worse Weakness Signs and tests A physical exam will reveal: Pain when the area is squeezed Extreme pain when you move the affected area (for example, a person with compartment syndrome in the foot or lower leg will have severe pain when moving the toes up and down) Swelling in the area