
[Middle English, from Old French, from Latin frāctūra, from frāctus, past participle of frangere, to break.]
For more information on fracture, visit Britannica.com.
Definition
A fracture is a complete or incomplete break in a bone resulting from the application of excessive force.
Description
A fracture usually results from traumatic injury to a bone, causing the continuity of bone tissues or bony cartilage to be disrupted or broken. Fracture classifications include simple or compound and incomplete or complete. Simple fractures (often called "closed") are not obvious as the skin has not been ruptured and remains intact. Compound fractures (commonly called "open") break the skin, exposing bone and causing additional soft tissue injury and possible infection. A single fracture means that one fracture has occurred, and multiple fractures refer to more than one fracture occurring in the same bone. Fractures are termed complete if the break is completely through the bone and described as incomplete or "greenstick" if the fracture occurs partly across a bone shaft. This latter type of fracture is often the result of bending or crushing forces applied to a bone.
Fractures are also named according to the specific part of the bone involved and the nature of the break. Identification of a fracture line can further classify fractures. Types include linear, oblique, transverse, longitudinal, and spiral fractures. Fractures can be further subdivided by the positions of bony fragments and are described as comminuted, non-displaced, impacted, overriding, angulated, displaced, avulsed, and segmental. Additionally, an injury may be classified as a fracture-dislocation when a fracture involves the bony structures of any joint with associated dislocation of the same joint.
Fractures Line Identification
Linear fractures have a break that runs parallel to the bone's main axis or in the direction of the bone's shaft. For example, a linear fracture of the arm bone could extend the entire length of the bone. Oblique and transverse fractures differ in that an oblique fracture crosses a bone at approximately a 45° angle to the bone's axis. In contrast, a transverse fracture crosses a bone's axis at a 90° angle. A longitudinal fracture is similar to a linear fracture. Its fracture line extends along the shaft but is more irregular in shape and does not run parallel to the bone's axis. Spiral fractures are described as crossing a bone at an oblique angle, creating a spiral pattern. This break usually occurs in the long bones of the body such as the upper arm bone (humerus) or the thigh bone (femur).
Bony Fragment Position Identification
Comminuted fractures have two or more fragments broken into small pieces, in addition to the upper and lower halves of a fractured bone. Fragments of bone that maintain their normal alignment following a fracture are described as being non-displaced. An impacted fracture is characterized as a bone fragment forced into or onto another fragment resulting from a compressive force. Overriding is a term used to describe bony fragments that overlap and shorten the total length of a bone. Angulated fragments result in pieces of bone being at angles to each other. A displaced bony fragment occurs from disruption of normal bone alignment with deformity of these segments separate from one another. An avulsed fragment occurs when bone fragments are pulled from their normal position by forceful muscle contractions or resistance from ligaments. Segmental fragmented positioning occurs if fractures in two adjacent areas occur, leaving an isolated central segment. An example of segmental alignment occurs when the arm bone fractures in two separate places, with displacement of the middle section of bone.
Demographics
The exact number of fractures sustained in the United States each year is not known as many are not treated. Experts estimate the number of fractures at between 10 and 20 million. People of all ages and races experience fractures. Broken bones are slightly more common among children due to their increased level of activity and among older people due to their lack of exercise and inadequate intake of calcium.
Causes and Symptoms
Individuals with high activity levels appear to be at greater risk for fractures. This group includes children and athletes participating in contact sports. Because of an increase in bone brittleness with aging, elderly persons are also included in this high-risk population. Up to the age of 50, more men suffer from fractures than women due to occupational hazards. However, after the age of 50, women are more prone to fractures than men. Specific diseases causing an increased risk for fractures include Paget's disease, rickets, osteogenesis imperfecta, osteoporosis, bone cancer and tumors, and prolonged disuse of a nonfunctional body part such as after a stroke.
Symptoms of fractures usually begin with pain that increases with attempted movement or use of the area and swelling at the involved site. The skin in the area may be pale and an obvious deformity may be present. In more severe cases, there may be a loss of pulse below the fracture site, such as in the extremities, accompanied by numbness, tingling, or paralysis below the fracture. An open or compound fracture is often accompanied by bleeding or bruising. If the lower limbs or pelvis are fractured, pain and resistance to movement usually accompany the injury causing difficulty with weight bearing.
When to Call the Doctor
A physician should be called when a child complains of bone pain. This is a deep pain that may be exquisitely tender to the touch.
Diagnosis
Diagnosis begins immediately with an individual's own observation of symptoms. A thorough medical history and physical exam by a physician often reveals the presence of a fracture. An x ray of the injured area is the most common test used to determine the presence of a bone fracture. Any x-ray series performed involves at least two views of the area to confirm the presence of the fracture because not all fractures are apparent on a single x ray. Some fractures are often difficult to see and may require several views at different angles to see clear fracture lines. In some cases, CT, MRI, or other imaging tests are required to demonstrate fracture. Sometimes, especially with children, the initial x ray may not show any fractures, but if it is repeated seven to 14 days later, the x ray may show changes in the bone(s) of the affected area. If a fracture is open and occurs in conjunction with soft tissue injury, further laboratory studies are often conducted to determine if blood loss has occurred.
In the event of exercise-related stress fractures (micro-fractures due to excessive stress), a tuning fork can provide a simple, inexpensive test. The tuning fork is a metal instrument with a stem and two prongs that vibrate when struck. If an individual has increased pain when the tuning fork is placed on a bone, such as the tibia or shinbone, the likelihood of a stress fracture is high. Bone scans also are helpful in detecting stress fractures. In this diagnostic procedure, a radioactive tracer is injected into the bloodstream and images are taken of specific areas or the entire skeleton by CT or MRI.
Treatment
Treatment depends on the type of fracture, its severity, the individual's age, and the person's general health. The first priority in treating any fracture is to address the entire medical status of the patient. Medical personnel are trained not to allow a painful, deformed limb to distract them from potentially life-threatening injury elsewhere or shock. If an open fracture is accompanied by serious soft tissue injury, it may be necessary to control bleeding and the shock that can accompany loss of blood.
First aid is the appropriate initial treatment in emergency situations. It includes proper splinting, control of blood loss, and monitoring vital signs such as breathing and circulation.
Immobilization
Immobilization of a fracture site can be done internally or externally. The primary goal of immobilization is to maintain the realignment of a bone long enough for healing to start and progress. Immobilization by external fixation uses splints, casts, or braces. This may be the primary and only procedure for fracture treatment. Splinting to immobilize a fracture can be done with or without traction. In emergency situations if the injured individual must be moved by someone other than a trained medical person, splinting is a useful form of fracture management. It should be done without causing additional pain and without moving the bone segments. In a clinical environment, plaster of Paris casts are used for immobilization. Braces are useful as they often allow movement above and below a fracture site. Treatments for stress fractures include rest and decreasing or stopping any activity that causes or increases pain.
Fracture Reduction
Fracture reduction is the procedure by which a fractured bone is realigned in normal position. It can be either closed or open. Closed reduction refers to realigning bones without breaking the skin. It is performed with manual manipulation and/or traction and is commonly done with some kind of anesthetic. Open reduction primarily refers to surgery that is performed to realign bones or fragments. Fractures with little or no displacement may not require any form of reduction.
Traction is used to help reposition a broken bone. It works by applying pressure to restore proper alignment. The traction device immobilizes the area and maintains realignment as the bone heals. A fractured bone is immobilized by applying opposing force at both ends of the injured area, using an equal amount of traction and countertraction. Weights provide the traction pull needed or the pull is achieved by positioning the individual's body weight appropriately. Traction is a form of closed reduction and is sometimes used as an alternative to surgery. Since it restricts movement of the affected limb or body part, it may confine a person to bed rest for an extended period of time.
A person may need open reduction if there is an open, severe, or comminuted fracture. This procedure allows a physician to examine and surgically correct associated soft tissue damage while reducing the fracture and, if necessary, applying internal or external devices. Internal fixation involves the use of metallic devices inserted into or through bone to hold the fracture in a set position and alignment while it heals. Devices include plates, nails, screws, and rods. When healing is complete, the surgeon may or may not remove these devices. Virtually any hip fracture requires open reduction and internal fixation so that the bone will be able to support the patient's weight.
Alternative Treatment
In addition to the importance of calcium for strong bones, many alternative treatment approaches recommend use of mineral supplements to help build and maintain a healthy, resilient skeleton. Some physical therapists use electro-stimulation over a fractured site to promote and expedite healing. Chinese traditional medicine may be helpful by working to reconnect chi (life energy) through the meridian lines along the line of a fracture. Homeopathy can enhance the body's healing process. Two particularly useful homeopathic remedies are arnica (Arnica montana) and symphytum (Symphytum officinalis). If possible, applying contrast hydrotherapy to an extremity (e.g., a hand or foot) of a fractured area can assist healing by enhancing circulation.
Prognosis
Fractures involving joint surfaces almost always lead to some degree of arthritis of the joint. Fractures can normally be cured with proper first aid and appropriate aftercare. If determined necessary by a physician, the fractured site should be manipulated, realigned, and immobilized as soon as possible. Realignment has been shown to be much more difficult after six hours. Healing time varies from person to person with the elderly generally needing more time to heal completely. A non-union fracture may result when a fracture does not heal, such as in the case of an elderly person or an individual with medical complications. Recovery is complete when there is no bone motion at the fracture site, and x-rays indicate complete healing. Open fractures may lead to bone infections, which delay the healing process. Another possible complication is compartment syndrome, a painful condition resulting from the expansion of enclosed tissue and that may occur when a body part is immobilized in a cast.
Prevention
Fractures can be prevented if safety measures are taken seriously. These measures include using seat belts in cars and encouraging children to wear protective sports gear. Weight-bearing exercise also helps to strengthen bones.
Nutritional Concerns
Persons who consume diets that are rich in calcium are less likely to experience a fracture than those who have diets that are deficient in calcium. Good dietary sources of calcium are milk, cheese, and other dairy products.
Parental Concerns
Parents should ensure that their children drink milk to provide an adequate intake of calcium. Children should also participate in regular physical exercise.
Resources
Books
Burr, David B. Musculoskeletal Fatigue and Stress Fracture. Boca Raton, FL: CRC Press, 2001.
Eiff, M. Patrice, et al. Fracture Management for Primary Care, 2nd ed. New York: Elsevier, 2002.
Jupiter, J. Fractures and Dislocations of the Hand. St. Louis: Mosby, 2001.
Koval, Kenneth J., and Joseph D. Zuckerman. Handbook of Fractures, 2nd ed. Philadelphia: Lippincott, 2001.
Moehring, H. David, and Adam Greenspan. Fractures:Diagnosis and Treatment. New York: McGraw Hill, 2000.
Ogden, John A. Skeletal Injury in the Child. New York: Springer Verlag, 2000.
Periodicals
Cameron, I. D. "How to manage musculoskeletal conditions: when is 'Rehabilitation" appropriate?" Best Practice and Research in Clinical Rheumatology 18, no. 4 (2004): 573–86.
Lindsay, R. "Perspectives on osteoporosis prevention: How far have we come?" Journal of Family Practice 53, no. 8 (2004): S3–9.
Minns, J., et al. "Can flooring and underlay materials reduce hip fractures in older people?" Nursing Older People 16, no. 5 (2004): 16–20.
Smith-Adaline, E. A., et al. "Mechanical environment alters tissue formation patterns during fracture repair." Journal of Orthopedic Research 22, no. 5 (2004): 1079–85.
Organizations
American Academy of Emergency Medicine. 611 East Wells Street, Milwaukee, WI 53202. Web site: www.aaem.org/.
American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211–2672. Web site: www.aafp.org/.
American Academy of Orthopedic Surgeons. 6300 North River Road, Rosemont, Illinois 60018–4262. Web site: www.aaos.org/.
American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098. Web site: www.aap.org/default.htm.
American Academy of Physical Medicine and Rehabilitation. One IBM Plaza, Suite 2500, Chicago, IL 60611–3604. Web site: www.aapmr.org/.
American College of Foot and Ankle Surgeons. 515 Busse Highway, Park Ridge, Illinois 60068–3150. Web site: www.acfas.org/index.html.
American College of Sports Medicine. 401 W. Michigan St., Indianapolis, IN 46202–3233. Web site: www.acsm.org/.
American College of Surgeons. 633 North St. Clair Street, Chicago, IL 60611–32311. Web site: www.facs.org/.
Web Sites
American Academy of Orthopaedic Surgeons. "Fractures." Your Orthopedic Connection. Available online at
"Falls and Hip Fractures among Older Adults." National Center for Injury Prevention and Control. Available online at www.cdc.gov/ncipc/factsheets/falls.htm accessed November 19, 2004).
"Fracture Information." About. Available online at
"Fractures." National Library of Medicine, October 21, 2004. Available online at www.nlm.nih.gov/medlineplus/fractures.html (accessed November 19, 2004).
[Article by: L. Fleming Fallon, Jr., MD, DrPH]
1. the breaking of a part, especially a bone.
2. a break in the continuity of bone. Fractures may be caused by trauma, by twisting due to muscle spasm, or indirect loss of leverage or by disease that results in decalcification of the bone.
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This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (September 2010) |
A fracture is the (local) separation of an object or material into two, or more, pieces under the action of stress.
The word fracture is often applied to bones of living creatures (that is, a bone fracture), or to crystals or crystalline materials, such as gemstones or metal. Sometimes, in crystalline materials, individual crystals fracture without the body actually separating into two or more pieces. Depending on the substance which is fractured, a fracture reduces strength (most substances) or inhibits transmission of light (optical crystals).
A detailed understanding of how fracture occurs in materials may be assisted by the study of fracture mechanics.
A fracture is also the term used for a particular mask data preparation procedure within the realm of integrated circuit design that involves transposing complex polygons into simpler shapes such as trapezoids and rectangles.
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Fracture strength, also known as breaking strength, is the stress at which a specimen fails via fracture.[1] This is usually determined for a given specimen by a tensile test, which charts the stress-strain curve (see image). The final recorded point is the fracture strength.
Ductile materials have a fracture strength lower than the ultimate tensile strength (UTS), whereas in brittle materials the fracture strength is equivalent to the UTS.[1] If a ductile material reaches its ultimate tensile strength in a load-controlled situation,[Note 1] it will continue to deform, with no additional load application, until it ruptures. However, if the loading is displacement-controlled,[Note 2] the deformation of the material may relieve the load, preventing rupture.
If the stress-strain curve is plotted in terms of true stress and true strain the curve will always slope upwards and never reverse, as true stress is corrected for the decrease in cross-sectional area. The true stress on the material at the time of rupture is known as the breaking strength. This is the maximum stress on the true stress-strain curve, given by point 3 on curve B.
In brittle fracture, no apparent plastic deformation takes place before fracture. In brittle crystalline materials, fracture can occur by cleavage as the result of tensile stress acting normal to crystallographic planes with low bonding (cleavage planes). In amorphous solids, by contrast, the lack of a crystalline structure results in a conchoidal fracture, with cracks proceeding normal to the applied tension.
The theoretical strength of a crystalline material is (roughly)

where: -
is the Young's modulus of the material,
is the surface energy, and
is the equilibrium distance between atomic centers.On the other hand, a crack introduces a stress concentration modeled by
(For sharp cracks)where: -
is the loading stress,
is half the length of the crack, and
is the radius of curvature at the crack tip.Putting these two equations together, we get

Looking closely, we can see that sharp cracks (small
) and large defects (large
) both lower the fracture strength of the material.
Recently, scientists have discovered supersonic fracture, the phenomenon of crack motion faster than the speed of sound in a material [2]. This phenomenon was recently also verified by experiment of fracture in rubber-like materials.
In ductile fracture, extensive plastic deformation (necking) takes place before fracture. The terms rupture or ductile rupture describe the ultimate failure of tough ductile materials loaded in tension. Rather than cracking, the material "pulls apart," generally leaving a rough surface. In this case there is slow propagation and an absorption of a large amount energy before fracture.[citation needed]
Many ductile metals, especially materials with high purity, can sustain very large deformation of 50–100% or more strain before fracture under favorable loading condition and environmental condition. The strain at which the fracture happens is controlled by the purity of the materials. At room temperature, pure iron can undergo deformation up to 100% strain before breaking, while cast iron or high-carbon steels can barely sustain 3% of strain.[citation needed]
Because ductile rupture involves a high degree of plastic deformation, the fracture behavior of a propagating crack as modeled above changes fundamentally. Some of the energy from stress concentrations at the crack tips is dissipated by plastic deformation before the crack actually propagates.
The basic steps are: void formation, void coalescence (also known as crack formation), crack propagation, and failure, often resulting in a cup-and-cone shaped failure surface.
There are three ways of applying a force to enable a crack to propagate:
For more information, see fracture mechanics.
Crack initiation and propagation accompany fracture. The manner through which the crack propagates through the material gives great insight into the mode of fracture. In ductile materials (ductile fracture), the crack moves slowly and is accompanied by a large amount of plastic deformation. The crack will usually not extend unless an increased stress is applied. On the other hand, in dealing with brittle fracture, cracks spread very rapidly with little or no plastic deformation. The cracks that propagate in a brittle material will continue to grow and increase in magnitude once they are initiated. Another important mannerism of crack propagation is the way in which the advancing crack travels through the material. A crack that passes through the grains within the material is undergoing transgranular fracture. However, a crack that propagates along the grain boundaries is termed an intergranular fracture.
This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)
Dansk (Danish)
n. - brud, fraktur
v. tr. - brække, imponere, genere
v. intr. - blive brækket
Nederlands (Dutch)
fractuur, breuk, breukvlak, scheur, vervanging van twee klinkers door een, (ver) breken, (ver)scheuren, verdelen, schenden, door de war maken, gebroken/ gescheurd worden
Français (French)
n. - (gén, Méd) fracture
v. tr. - fracturer, (fig) se fissurer
v. intr. - se fracturer, se fissurer
Deutsch (German)
n. - Bruch, Fraktur
v. - brechen
Ελληνική (Greek)
n. - (ιατρ.) κάταγμα, θλάση
v. - σπάζω, θρυμματίζω/-ομαι, κατακερματίζω/-ομαι, θραύω, τσακίζω, υφίσταμαι ή προξενώ κάταγμα ή θλάση, ραγίζω
Português (Portuguese)
n. - fratura (f)
v. - fraturar
Русский (Russian)
трещина, излом, перелом, раскалываться
Español (Spanish)
n. - fractura
v. tr. - fracturar
v. intr. - fracturarse
Svenska (Swedish)
n. - brytning, fraktur (kir.)
v. - bryta(s)
中文(简体)(Chinese (Simplified))
破碎, 骨折, 使破裂, 使折断, 使断裂, 使骨折, 破裂, 折断, 断裂
中文(繁體)(Chinese (Traditional))
n. - 破碎, 骨折
v. tr. - 使破裂, 使折斷, 使斷裂, 使骨折
v. intr. - 破裂, 折斷, 斷裂
한국어 (Korean)
n. - 부서짐, 분열, 골절
v. tr. - 부수다, 무시하다
v. intr. - 부서지다, 삐다
日本語 (Japanese)
n. - 割れ目, 骨折
v. - 割る, 砕く, 折る
العربيه (Arabic)
(الاسم) كسر العظم (فعل) يكسر , يمزق
עברית (Hebrew)
n. - סדק (בעצם), שבר, הפיכת תנועה כפולה לרגילה (בלשנות)
v. tr. - שבר
v. intr. - נסדק
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