(2) Incomplete. The bone is not completely split and part of the bone
(3) Displaced. The bone ends are separated at the fracture line and are
completely out of alignment.
Impacted or compressed. The bone ends are wedged or jammed into
Depressed. A piece of bone is driven inward, as in a skull fracture.
Comminuted. The bone shatters or fragments into several pieces.
(7) Greenstick. An incomplete fracture in which the bone is partially broken
and partially bent. It is similar in appearance to a piece of "green" wood when broken.
d. There are other classification terms associated with fractures, such as
identifying a fracture by its location on the shaft of a bone (distal, midshaft, or proximal),
or identifying fractures by the name of the physician who first identified them (Colles',
Pott's, and so forth). Any of the classification terms may be used together to better
describe a particular fracture. For example: An open, complicated, complete,
comminuted fracture would be one in which the bone is completely broken and
fragmented with an associated break in the skin and involvement of nerves, blood
vessels, and soft tissue. Refer to figure 1-19 to study the illustrations of these
1-46. HEALING OF BONE
a. Bone healing follows an orderly sequence, and it begins the same as wound
healing in any other part of the body. When a bone is fractured, hemorrhage between
and around the bone ends will occur. Within 24 hours, a blood clot will form. This blood
clot is invaded by cells that form granulation tissue. The cells in the newly formed
granulation tissue differentiate and form a union of fibrous tissue known as a soft callus.
This soft callus forms a "bridge" between the broken bone ends. Bone-forming cells
begin to grow within the soft callus and the soft callus is gradually formed into a hard
callus (ossification). There is then a firm bony union between the broken ends of the
bone. In treating a fracture, the bones are brought into proper alignment and
immobilized until X-rays show that a hard callus has formed.
b. Many factors influence the healing time of fractures and certain conditions
may interfere with healing. If the realignment is poor, the bone ends may not meet or
there may be soft tissue interposed between the bone ends. Union will not occur under
such circumstances. Likewise, if the immobilization is inefficient, union may not occur.
The age and physical condition of the patient, as well as dietary deficiencies, will affect
the healing time. Additional factors in healing time are the type of fracture, its location,
and the adequacy of the blood supply to the affected area. Finally, the presence of
infection will severely handicap healing or prevent it altogether.