Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.

by Alexis Thomson; Alexander Miles

Clinical Varieties of Fractures.—The most important subdivision of fractures is that into simple and compound.

In a simple or subcutaneous fracture there is no communication, directly or indirectly, between the broken ends of the bone and the surface of the skin. In a compound or open fracture, on the other hand, such a communication exists, and, by furnishing a means of entrance for bacteria, may add materially to the gravity of the injury.

A simple fracture may be complicated by the existence of a wound of the soft parts, which, however, does not communicate with the broken bone.

Fractures, whether simple or compound, fall into other clinical groups, according to (1) the degree of damage done to the bone, (2) the direction of the break, and (3) the relative position of the fragments.

(1) According to the Degree of Damage done to the Bone.—A fracture may be incomplete, for example in greenstick fractures, which occur only in young persons—usually below the age of twelve—while the bones are still soft and flexible. They result from forcible bending of the bone, the osseous tissue on the convexity of the curve giving way, while that on the concavity is compressed. The clavicle and the bones of the forearm are those most frequently the seat of greenstick fracture ([Fig. 41]). Fissures occur on the flat bones of the skull, the pelvic bones, and the scapula; or in association with other fractures in long bones, when they often run into joint surfaces. Depressions or indentations are most common in the bones of the skull.

The bone at the seat of fracture may be broken into several pieces, constituting a comminuted fracture. This usually results from severe degrees of direct violence, such as are sustained in railway or machinery accidents, and in gun-shot injuries ([Fig. 2]).

Fig. 2.—Radiogram of Comminuted Fracture of both Bones of Forearm.

Sub-periosteal fractures are those in which, although the bone is completely broken across, the periosteum remains intact. These are common in children, and as the thick periosteum prevents displacement, the existence of a fracture may be overlooked, even in such a large bone as the femur.