injuries and poisoning
Overview of Fractures
Diagnosis of Fractures
A doctor's evaluation X-rays to identify fractures Sometimes magnetic resonance imaging or computed tomography If people think that they may have a broken bone, they should go or be taken to an emergency department. Possible exceptions are some toe or fingertip injuries. People should also be taken to an emergency department, often by ambulance, if any of the following apply: The problem is obviously serious (for example, if it resulted from a car crash or if people cannot use the affected body part). They have several injuries. They have symptoms of a complication—for example, if they lose sensation in the affected body part, they cannot move the affected part normally, the skin feels cool or turns blue, or the affected part is weak. They cannot put any weight on the affected body part. An injured joint feels unstable. If injuries result from a serious accident, the doctor's first priority is To check for severe injuries and complications, such as an open wound, nerve damage, significant blood loss, disrupted blood flow, and Compartment Syndrome None For example, doctors do the following: Measure blood pressure: Blood pressure is low in people who have lost a lot of blood. Check pulses and the color and temperature of the skin: Absent or weak pulses and pale, cool skin may indicate that blood flow is disrupted. These symptoms may mean that an artery is damaged or that compartment syndrome has developed. Check sensation in the skin to determine whether the person can feel normally: Doctors ask whether the person has abnormal sensations, such as a pins-and-needles sensation, tingling, or numbness. Abnormal sensations suggest nerve damage. If any of these injuries and complications are present, doctors treat them as needed, then continue with the evaluation. Doctors ask the person (or a witness) to describe what happened. Often, the person does not remember how an injury occurred or cannot describe it accurately. Knowing how the injury occurred can help doctors determine the type of injury. For example, if a person reports that a snap or pop occurred, the cause may be a fracture (or an injury to a ligament or tendon). Also, doctors ask in which direction the joint was stressed during the injury. This information can help doctors determine which bones and other structures are damaged. Doctors also ask when the pain started and how severe it is: If it started immediately after the injury, the cause may be a fracture or a severe sprain. If the pain began hours to days later, the injury is usually minor. If the pain is more severe than expected for the injury or if the pain steadily worsens during the first hours after the injury, compartment syndrome may have developed or blood flow may be disrupted. The physical examination includes the following (in order of priority): Checking for damage to blood vessels near the injured body part—for example, by checking pulse and skin temperature and color Checking for damage to nerves (for example, checking sensation) near the injured part Examining and moving the injured part Examining the joints above and below the injured part Doctors gently feel the injured part to determine whether bones are in pieces or out of place and whether the area is tender. Doctors also check for swelling and bruising. If no swelling develops within several hours after the injury, a fracture is unlikely. Doctors also ask whether the person can use, put weight on, and move the injured part. Doctors test the stability of a joint by gently moving it, but if a fracture is possible, x-rays are done first to determine whether moving the joint is safe. Doctors check for grating or crackling sounds (crepitus) when the injured part is moved. These sounds may indicate a fracture. Doctors also check the joint above and below the injured joint and check for ligament, tendon, and muscle injuries. If pain or muscle spasms interfere with the examination, the person may be given a pain reliever and/or muscle relaxant by mouth or injection, or a local anesthetic may be injected into the injured area. Or the injured part may be immobilized until the spasms stop, usually for a few days, and then examined. Imaging tests used to diagnosis fractures include X-rays Magnetic resonance imaging (MRI) Computed tomography (CT) X-raysare the most important and usually the first and only test done to diagnose a fracture. However, x-rays are not always needed, depending on which body part is affected and what doctors suspect. For example, if an injured body part (such as the toes, except the big toe) would be treated the same way regardless of whether it is fractured, x-rays are usually not needed. X-rays are usually taken from at least two angles to show how the fragments of bone are aligned. These routine x-rays may not show small fractures when the pieces of broken bone remain in place (that is, they do not separate into fragments). Such fractures are called occult (hidden) fractures. So sometimes additional x-rays are taken from different angles. Occasionally, doctors wait to take x-rays for a few days or even weeks because some occult fractures, such as Rib Fractures , When x-rays do not show a fracture, but doctors still suspect one, doctors may apply a splint and re-examine the person days later. If symptoms are still bothersome, they may take another x-ray. Fractures may be easier to see on x-rays after they have been How bones heal for a while. If x-rays show a fracture in a bone that looks abnormal (for example, if areas of bone look unusually thin), the fracture probably occurred because a disease (such as osteoporosis) weakened the bone. CTorMRImay be done when Results of the examination strongly suggest a fracture but x-rays do not show one. A specialist needs more detailed views of the fracture to determine the best way to treat it. CT and MRI may also be done to provide more detail about fractures than routine x-rays can show. CT can show the fine details of a fractured joint surface and areas of a fracture that are covered by undamaged bone. CT and particularly MRI can show soft tissues, which are not usually visible on x-rays. MRI shows the tissues around the bone and thus helps detect injury to nearby tendons, ligaments, cartilage, and muscle. It can show changes caused by cancer. MRI also shows injury (swelling or bruising) within the bone and can thus detect small fractures before they appear on x-rays. Other testsmay be done to check for related injuries: Angiography (x-rays or CT scans taken after a contrast agent, which can be seen on x-rays, is injected into arteries) to check for damaged blood vessels Nerve conduction studies to check for damaged nerves Imaging tests enable doctors to identify the type of fracture and describe it precisely. Type Type Description Description Angulated The broken pieces of bone are not in a straight line. One is at an angle in relation to the other. Avulsion A piece of bone is pulled off from the main part of the bone. A ligament may pull off a piece of bone if the external force is strong enough, as may occur in a fall. A tendon may pull off a piece of bone if the attached muscle contracts forcefully enough, as may occur in young athletes. Avulsion fractures usually occur in the hand, foot, ankle, knee, or shoulder. Closed The skin over the fractured bone is not torn. Comminuted The bone is broken into three or more pieces. Often, the bone is broken into many very small pieces. These fractures are often caused by a great force, as occurs in a car crash. They can also occur in people with Osteoporosis , which weakens bone. Compression Fractures of the Spine None The bone collapses into itself. These fractures usually occur in older people (particularly those with osteoporosis). The backbones (vertebrae) are often affected (called vertebral crush fractures). Displaced Some parts or pieces of the broken bone are separated and not in correct alignment. Greenstick The bone is partly cracked and/or bent but not completely broken through. Greenstick fractures occur only in children. Growth Plate Fractures None These fractures occur in the growth plate, which is made of cartilage. Growth plates enable bones to lengthen until children reach their full height. When growth is completed, growth plates are replaced by bone. When a growth plate is fractured, the bone may stop growing or grow crookedly. Growth plate fractures occur only in children and adolescents. Impacted One end of the broken bone is jammed into the other. As a result, the bone appears shortened. Joint (intra-articular) Fractures may extend into the cartilage at the ends of bones that form a joint (called joint surfaces). Normally, this cartilage reduces the amount of friction that occurs when bones in a joint rub against each other. When this cartilage is fractured, people cannot move the joint as well, and osteoarthritis is more likely to develop in the joint. Nondisplaced The pieces of broken bone are still in place (aligned normally), and there is no space between them. Oblique The bone is broken in a straight line diagonally across the long middle part (shaft) of the bone. Occult These small fractures are difficult or impossible to see on x-rays, but they may be seen on other imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI). After a few days or weeks, changes occur in the new bone that forms as the bone heals. Then occult fractures may be seen on x-rays. Some stress fractures are occult. Open The skin and tissues covering the fractured bone are torn, and the bone may be sticking out of the skin. Dirt, debris, or bacteria can easily contaminate the wound and may cause an infection in the broken bone. Osteoporotic Osteoporotic fractures result from Osteoporosis (progressive loss of bone density), which weakens bones and makes them more likely to break. Osteoporotic fractures (sometimes called fragility fractures) occur in older people, usually in the hips, wrists, spine, shoulders, or pelvis. Pathologic Pathologic fractures are caused by a disorder that weakens a bone, such as osteoporosis, certain bone infections, or bone tumors (including metastases to the bone from cancers elsewhere in the body to the bone). Segmental There are two separate breaks in a bone. Segmental fractures are a type of comminuted fracture. Spiral (torsion) Spiral fractures occur when the bone is twisted apart. As a result, the ends of the bone may be sharp, jagged, and slanted. Stress Fractures of the Foot None A stress fracture occurs when force is repeatedly applied to a bone during certain activities, such as walking with a heavy pack or running. Stress fractures are often small cracks in bone (sometimes called hairline fractures). Stress fractures commonly occur in bones that bear weight, such as those of the foot or lower leg. Torus The bone buckles rather than breaks. Torus fractures usually occur only in children. Bones in children can buckle rather than break because their bones are more rubbery than those in adults. Transverse The bone is broken straight across. 