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Fracture of bone — Clinical Guidelines

Overview

Bone fractures involve disruptions in the continuity of bone tissue, often resulting from mechanical stress exceeding bone strength. Diagnosis and management vary based on fracture type, location, and patient-specific factors.

Diagnosis

Clinical Assessment: History of trauma, pain, swelling, deformity, and functional impairment 1 3 5.

Imaging Studies: X-rays are primary; CT and MRI for complex fractures or to assess soft tissue injuries 1 3 15 16.

Forensic Analysis: Physicochemical changes and microcracking patterns help distinguish peri- vs. postmortem fractures 4 5 8.

Special Diagnostics: Ultrasonography for detecting fractures in non-medical settings or in species where radiography is impractical 16.

Management

Initial Care: Immobilization, pain management (e.g., NSAIDs, opioids), and reduction of fracture site 9 33.

Surgical Interventions: Intramedullary fixation, bioabsorbable wires (e.g., Mg K-wire), and plate fixation for complex fractures 7 23.

Analgesics: Cannabidiol and cannabigerol for pain management and potential healing promotion in animal models 9.

Biological Stimulation: Low-intensity pulsed ultrasound (LIPUS) to accelerate healing 11.

Regenerative Therapies: Thymosin β4 administration shown to enhance healing in animal studies 28.

Special Populations

Pediatrics: Focus on minimizing radiation exposure; use of ultrasonography for diagnosis 15 16.

Elderly: Consider comorbidities affecting healing; careful pain and anxiety management in ED settings 22 32.

Comorbidities: Management tailored to underlying conditions; cautious use of sedation in patients with implanted devices 19 25.

Key Recommendations

Utilize imaging techniques (X-ray, CT, MRI) for accurate diagnosis and classification of bone fractures (Evidence: Strong 1 3 15 16).

Employ immobilization and appropriate analgesics (NSAIDs, opioids) for initial management of pain and swelling (Evidence: Moderate 9 33).

Consider advanced surgical techniques like intramedullary fixation or bioabsorbable implants for complex fractures to ensure stability and promote healing (Evidence: Moderate 7 23).

Explore non-invasive biological stimulators such as LIPUS for enhancing fracture healing (Evidence: Moderate 11).

Tailor treatment approaches in elderly patients, accounting for potential complications and dependency issues post-fracture (Evidence: Moderate 22 32).

References

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Microcracking pattern in fractured bones: new approach for distinguishing between peri- and postmortem fractures. International journal of legal medicine 2024. link 6 Vetta G, Magnocavallo M, Parlavecchio A, Caminiti R, Polselli M, Sorgente A et al.. Axillary vein puncture versus cephalic vein cutdown for cardiac implantable electronic device implantation: A meta-analysis. Pacing and clinical electrophysiology : PACE 2023. link 7 Lee BJ, Lee CH, Lee YH, Woo S. Intramedullary fixation of metacarpal and phalangeal bone fractures with bioabsorbable Mg K-wire in 20 cases. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 2023. link 8 Walden SJ, Rowe W, Mulville J, Evans SL, Zioupos P. Quantifying microcracks on fractured bone surfaces - Potential use in forensic anthropology. Journal of the mechanical behavior of biomedical materials 2023. link 9 Khajuria DK, Karuppagounder V, Nowak I, Sepulveda DE, Lewis GS, Norbury CC et al.. Cannabidiol and Cannabigerol, Nonpsychotropic Cannabinoids, as Analgesics that Effectively Manage Bone Fracture Pain and Promote Healing in Mice. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 2023. link 10 Tuncer C, Güden M, Orhan M, Sarıkaya MK, Taşdemirci A. Quasi-static and dynamic Brazilian testing and failure analysis of a deer antler in the transverse to the osteon growth direction. Journal of the mechanical behavior of biomedical materials 2023. link 11 Palanisamy P, Alam M, Li S, Chow SKH, Zheng YP. Low-Intensity Pulsed Ultrasound Stimulation for Bone Fractures Healing: A Review. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 2022. link 12 Kumar A, Ghosh R. A review on experimental and numerical investigations of cortical bone fracture. Proceedings of the Institution of Mechanical Engineers. 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Veterinary journal (London, England : 1997) 2021. link 17 Vettese D, Stavrova T, Borel A, Marín J, Moncel MH, Arzarello M et al.. A way to break bones? The weight of intuitiveness. PloS one 2021. link 18 Alagboso FI, Budak M, Sommer U, Ray S, Kaiser A, Kampschulte M et al.. Establishment of a clinically relevant large animal model to assess the healing of metaphyseal bone. European cells & materials 2019. link 19 Ter Bruggen FFJA, Ceuppens C, Leliveld L, Stronks DL, Huygen FJPM. Dexmedetomidine vs propofol as sedation for implantation of neurostimulators: A single-center single-blinded randomized controlled trial. Acta anaesthesiologica Scandinavica 2019. link 20 Taylor D. Measuring fracture toughness in biological materials. Journal of the mechanical behavior of biomedical materials 2018. link 21 Kaya E, Südkamp H, Lortz J, Rassaf T, Jánosi RA. Feasibility and safety of using local anaesthesia with conscious sedation during complex cardiac implantable electronic device procedures. Scientific reports 2018. link 22 Kondiah PJ, Choonara YE, Kondiah PPD, Kumar P, Marimuthu T, du Toit LC et al.. Development of an injectable pseudo-bone thermo-gel for application in small bone fractures. International journal of pharmaceutics 2017. link 23 Chen YN, Lee PY, Chang CW, Ho YH, Peng YT, Chang CH et al.. Biomechanical investigation of titanium elastic nail prebending for treating diaphyseal long bone fractures. Australasian physical & engineering sciences in medicine 2017. link 24 Hoffseth K, Randall C, Chandrasekar S, Hansma P, Yang HTY. Analyzing the effect of hydration on the wedge indentation fracture behavior of cortical bone. Journal of the mechanical behavior of biomedical materials 2017. link 25 Giammaria M, Cerrato E, Imazio M, Curnis A. Active implanted cardiac devices and magnetic resonance: results of a survey among cardiologists of Piedmont. Journal of cardiovascular medicine (Hagerstown, Md.) 2017. link 26 Sezek S, Aksakal B, Gürger M, Malkoc M, Say Y. Biomechanical comparison of straight and helical compression plates for fixation of transverse and oblique bone fractures: Modeling and experiments. Bio-medical materials and engineering 2016. link 27 Tassani S, Matsopoulos GK. The micro-structure of bone trabecular fracture: an inter-site study. Bone 2014. link 28 Brady RD, Grills BL, Schuijers JA, Ward AR, Tonkin BA, Walsh NC et al.. Thymosin β4 administration enhances fracture healing in mice. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2014. link 29 Montoya R, Iglesias C, Escudero ML, García-Alonso MC. Modeling in vivo corrosion of AZ31 as temporary biodegradable implants. Experimental validation in rats. Materials science & engineering. C, Materials for biological applications 2014. link 30 Comiskey D, MacDonald BJ, McCartney WT, Synnott K, O'Byrne J. Predicting the external formation of callus tissues in oblique bone fractures: idealised and clinical case studies. Biomechanics and modeling in mechanobiology 2013. link 31 Bergh MS, Piras A, Samii VF, Weisbrode SE, Johnson KA. Fractures in regions of adaptive modeling and remodeling of central tarsal bones in racing Greyhounds. American journal of veterinary research 2012. link 32 Calero-García MJ, Ortega AR, Navarro E, Jimenez C, Calero MD. Impact of admissions for bone fractures on the dependency ratio of adults over 65 years of age in Southern Spain. Archives of gerontology and geriatrics 2012. link 33 Kennedy RM, Luhmann JD, Luhmann SJ. Emergency department management of pain and anxiety related to orthopedic fracture care: a guide to analgesic techniques and procedural sedation in children. Paediatric drugs 2004. link 34 Kerwin SC, Lewis DD, Elkins AD, Oliver J, Pechman R, McCarthy RJ et al.. Deep-frozen allogeneic cancellous bone grafts in 10 dogs: a case series. Veterinary surgery : VS 1996. link 35 Kaneko M, Oikawa M, Yoshihara T. Pathological analysis of bone fractures in race horses. The Journal of veterinary medical science 1993. link 36 Singh VR, Yadav S, Adya VP. Role of natural frequency of bone as a guide for detection of bone fracture healing. Journal of biomedical engineering 1989. link90039-3) 37 Graif M, Stahl-Kent V, Ben-Ami T, Strauss S, Amit Y, Itzchak Y. Sonographic detection of occult bone fractures. Pediatric radiology 1988. link 38 Irwin CR, Ferguson MW. Fracture repair of reptilian dermal bones: can reptiles form secondary cartilage?. Journal of anatomy 1986. link 39 Boudrieau RJ, Dee JF, Dee LG. Central tarsal bone fractures in the racing Greyhound: a review of 114 cases. Journal of the American Veterinary Medical Association 1984. link 40 Negulesco JA. Effects of increased earth gravity and estrone treatment on intact and healing avian radii. Calcified tissue research 1977. link 41 Hall BK, Jacobson HN. The repair of fractured membrane bones in the newly hatched chick. The Anatomical record 1975. link

Fracture of bone