fracture(redirected from bimalleolar fracture)
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(in medicine), a disruption of the anatomical integrity of bone as a result of injury.
Fractures are extremely rare during the intrauterine life of a fetus. Spontaneous fractures involve a history of bone disease, while traumatic fractures do not; the latter type can be either closed or open, depending on whether there is an external wound. Traumatic fractures are further classified as occurring with or without displacement of fragments and as being oblique, transverse, or comminuted. Fractures usually arise because of extreme mechanical stress at the moment of trauma. Chronic fractures, due to slight, prolonged stress, are less common. Half of all fractures occur in the upper extremities, one fourth in the lower extremities, and the total incidence is three to four times greater in men than in women.
The symptoms of fracture are severe local pain, deformation, abnormal mobility, and functional impairment of the extremity. X-ray diagnosis must be used to determine the site of the fracture, the type of displacement of the fragments, and the method of treatment. The destruction of bone and injury to the surrounding soft tissues cause internal bleeding in closed fractures and external bleeding in open ones. Traumatic shock may follow multiple or severe open fractures of large bones.
The integrity and mechanical function of a broken bone are restored as the bone first forms a central callus and then a definitive one. The time required for bones to heal is affected by the presence of other injuries and by the severity of injury to the soft tissues that surround the fracture; other factors are the extent of displacement of the fragments and the victim’s general physical condition.
First aid for fractures calls for immobilization of the fragments in the fracture zone using special splints or improvised materials. In open fractures and traumatic shock, prompt medical attention is required. Severe bleeding from the wound can be arrested with a tourniquet. The bone fragments should be juxtaposed as closely as possible and immobilized throughout the healing period; this is usually effected with a plaster cast or by skeletal traction. Complications of fractures include injury to large blood vessels and nerves, suppuration in the fracture zone, and failure of the fragments to unite; all of these conditions require special treatment.
With age, bones become increasingly fragile, and this explains the high incidence of fractures after slight injury in the elderly. Because of the greater flexibility of their bones, children often suffer subperiosteal fractures, often close to a joint. Fractures in children are mostly treated by juxtaposition of the fragments with application of a plaster cast; less commonly, skeletal traction is used, and surgery as a therapeutic recourse is very rare.
REFERENCESKaplan, A. V. Zakrytye povrezhdeniia kostei i sustavov, 2nd ed. Moscow, 1967.
Watson-Jones, R. Perelomy kostei i povrezhdeniia sustavov. Moscow, 1972. (Translated from English.)
V. F. POZHARISKII