Types of fractures, Mechanism of fracture, Healing of Bones in fracture, Dislocation of joints, Physiotherapy and rehabilitation, Arthiritis , Orthopedics, Rickets and steomalacia
The adult human skeleton consists of 206 bones. The bones along with approximately 700 skeletal muscles, account for 50% of our body weight. Bones provide protection and support. When two or more bones join together, a joint or articulation is formed. Through several types of joints, they help in movements.
Fracture is defined as a break or crack in the bone. Trauma or injury to the bones of human body is getting increased with the development of industry and transportation. Trauma is the biggest killer and maimer of human beings all over the world. Hippocrates in the 14th century B.C. described the treatment of fractures and injuries to limbs. In India, the treatment of fractures to limbs is still carried out by traditional bonesetters. Modern methods of treatments are available. They are more scientific and appropriate.
1.Green stick fracture : - This fracture occurs in the young bones of children. This fracture break is incomplete leaving one side of the cortex intact.
2. Closed fracture :- A closed fracture is the one where the haematoma (blood clot)does not communicate with the outside.
3. Open fracture (Compound fracture ) :- In this type, the fracture haematoma communicates with the outside through an open wound. It is a serious injury through which infectious germs may enter into the body.
4. Pathological fracture :-This type of fracture occurs, due to pathological lesions after a trivial violence in a weak bone. It may be due to hyperparathyroidism.
5. Stress fracture :- It is a fracture occurring at a site in the bone, due to repeated minor stresses over a long period of time.
6. Birth fracture :- It is a fracture occuring in the newborn babies due to injury during delivery.
A fracture can be caused either by direct violence or indirect violence. Direct violence causes a fracture at the site of impact of the force. Indirect violence fracture is one that is transmitted to a bone away from the site of impact and producing the fracture there.
Torsion produces spiral or oblique fracture. It is important to understand the mechanism of fracture as it helps in deciding the manoeuvres
for reducing further damages. When a man falls down from a building or from a coconut tree he sustains a fracture on bones and the spine. The fracture of bone is caused by direct violence and the fracture spine is caused by indirect violence.
It involves three phases, viz.,
1. Inflammatory phase 2. Reparative phase and 3. Remodelling phase.
1. Inflammatory Phase : - When a fracture occurs, at the site of fracture the blood vessels get broken and the blood fills up the gap of the bone. This blood clots to form a haematoma. This process takes place in one to two days. The soft tissue of this region undergoes inflammation.
2. Repairative Phase : - A stage of callus is formed. It bridges the gap and establishes contact between the ends of fractured bone. The callus is nothing but granulation of tissues around the site of fracture. This phase takes place about eight to twelve weeks.(Fig. 1.7)
3. Remodelling phase : - Once the fracture is bridged by the callus tissue, the site of fracture undergoes remodelling by muscular and weight bearing stresses and slight deformity gets corrected by moulding. This remodelling takes up to one year.
Physiotherapy is the therapaeutic exercise to make the limbs work normally. Therapaeutic exercise is carried out by physiotherapists under the supervision of orthopaedic surgeon. The commom problem at the end of fracture treatment is the wasting of muscles and stiffness of joints. These two problems can be rectified by physiotherapy, by gradual exercises.
Dislocation is the total displacement of the articular end of the bone from the joint cavity. The normal alignment of the bones becomes altered. Various factors are attributed for bone and joint dislocations.
Dislocations are classified as 1. Congenital, 2. Traumatic, 3. Pathological and 4. Paralytic. Congenital deformities are due to genetic factors or factors operating on the developing foetus. These are also called teratogenic or teratologic disorder.
Traumatic dislocation is due to a serious violence. It occurs in the shoulder, elbow and hip.
Pathological dislocation is caused by some diseases like tuberculosis. Tuberculosis of the hip may cause dislocation of the acetabulum.
Paralytic dislocation occurs when a remarkable imbalance occurs on the muscle power. e.g. Poliomyelitis.
Arthiritis is the inflammation of all the components and structures of the joints. It involves synovium, articular surfaces and capsule.
Several etiological factors are attributed to the origin of arthirits (arthritogenesis). They are diet, psycho-somatic illness, infections, diseases and metabolic abnormalities, etc., Types of arthritis include.
1. Infective arthiritis :- Infections such as Staphylococcal, Streptococcal, Gonococcal, Rheumatic, Small Pox, Tuberculosis, Syphilitic, Guinea worms, etc., can cause damages at the joints. It produces pain in joints.
2. Rheumatic arthiritis :- It is a generalized disease affecting the connective tissues, of the whole body. It focalizes the involvement of
musculoskeletal system. It is an inflammation of synovial membrane. Rheumatic disease is considered to be of auto immune origin. It is due to immunological disorder against an unknown antigen..
3.Osteoarthiritis (Osteoarthrosis) : - It is a degenerative condition of the joints, without any inflammatory process. Osteoarthiritis is a progressive process affecting the articular cartilage of aging joints. It is characterized by focal degeneration of the articular cartilage. In the later stage, the cartilage gets eroded and exposing the sclerosed bone.
4.Metabolic arthiritis :- Metabolic arthiritis is due to metabolic disorders. This is a disease due to an inborn error of Purine metabolism. It is commonly called gout. This condition is characterized by the deposition of Sodium Urate crystals (uric acid) on the articular cartilage, synovial membrane and in the periarticular tissues. Gout is characterized by onset of pain swelling and reddening of joints.
Rickets and Osteomalacia are caused due to inadequate mineralisation of the bones. Our skeletal system stores 98% of the calcium in the human body and hence calcium metabolism has a major influence on the structure and growth of bone.
Rickets :- In this case, mineralization of bones is defective. The rickets caused by nutritional deficiency is called Nutritional rickets . In India, it is a common problem among the population below the poverty line. It is due to Vitamin D deficiency. It occurs in children below four years. But it can afflict all age groups who have calcium and D deficiency. Vitamin D is associated with calcium absorption and deposition. Lack of calcium and vitamin D causes softening of bones and pliable deformity. In children the symptoms of rickets are bowed legs, knock knees, pigeon chest, broadening of wrist and ankles, protruberant abdomen, etc.,
The primary prevention of the Rickets, in the child begins by better nutrient of the pregnant mother, followed by supply of Vitamin D. Cod and shark liver oil are very good sources of Vitamin D.
Osteomalacia : - In adults Vitamin D and Calcium deficiency leads to osteomalacia. This is characterized by bone pain and tenderness. It causes brittleness in the bones.
Orthopedics deals with all bone deformities occurring in children as well as adults. The deformities may either be congenital or acquired. The former is caused by developmental abnormalities (teratogenic), the latter is caused by trauma or infections or by metabolic disorders. The corrective measures in the management of these disorders involve physiotherapy, splinting and use of appliances, traction procedure, plaster cast and wedging, manipulation under anaesthesia, surgical and neurological examination.