Surgery, with Special Reference to Podiatry

by Maximilian Stern; Edward Adams

Articular Fracture (joint fractures). Like epiphyseal separations, recognition and proper treatment of these fractures have assumed great importance.

Articular fractures may be divided into three classes:

1. Intra-articular. In these the line of fracture lies entirely within the joint. Such fractures are most frequently found in the elbow and knee joint.

2. Para articular. In these the line of fracture extends close to the joint but not into it. An example of this class is the supracondyloid fracture of the humerus.

3. Articular fractures proper. The majority of joint fractures belong to this class. The line of fracture either extends into the joint from without or it extends from the joint outward. As example, the ankle joint; the majority of the typical supramalleolar, malleolar, and spiral fractures of the tibia and fibula.

Etiology. Fractures may be divided into two groups: the traumatic and the pathologic or spontaneous. In the traumatic, the fracture is the result of violence acting upon a bone which is either normal or shows slight changes due to the physiologic causes mentioned. A pathologic or spontaneous fracture is one which occurs in a bone, the strength of which has been diminished by some preceding abnormal or pathologic changes. In this variety the degree of force which produced the fracture would not be sufficient to cause a fracture in a healthy bone.

The causes of traumatic fractures may be either predisposing or exciting.

Predisposing Causes. The bones of the human body attain their greatest strength toward middle age. From infancy up to that time the bones are very elastic and yielding. Toward old age an interstitial atrophy occurs. It causes a thinning of the cortex of the shafts and of the trabeculae of the spongy portions of the long and short bones. It is an actual diminution of the bone substance and a corresponding increase of the fat. This is especially seen in the neck of the femur. When it occurs in old age, it acts as a predisposing cause, but when it occurs prematurely or reaches an extreme degree, it must be considered as pathologic.