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     A fracture is a complete/incomplete disruption of the continuity of bone. It can result in either the complete separation or an incomplete crack.

                                         

                                    

 

 

 

 

 
                                                                                Clinical features of a fracture

                     1. Deformity - maybe visible and /or palpable

                        2. Local swelling, bruising, pain and tenderness

                        3. Impairment of function

                        4. Abnormal movements

                        5. Crepitations

  • Diagnosis is by x-ray imaging

 
                                                                                       Medico-legal importance
  • All fractures are considered grievous (except pathological fractures)

 

  • The type of fracture would indicate the possible complications that could occur as a result of the fracture.

 

  Simple fracture

 - closed fracture 

 - no communication to the the outer environment

 

 

 

 

 

   Bone has a single fracture and skin is intact.

Complications are minimal

 

 

 

Compound fracture

- open to exterior

               

May result in multiple complications

 

 

bones have multiple fractures, fragmented and open to the environment

 
  • The type, pattern or circumstances of fracture would indicate the mechanism of causation.

 

           A. Fracture of a healthy bone with a history of trauma - Traumatic fracture (main concern in forensic medicine)

        If traumatic the mechanism of causation would be direct trauma or indirect trauma.   

 
                  

      Transverse fracture

  fracture line is at a right angle to the long axis of the bone

 

     ? mechanism of causation

 

            

                   Oblique fracture

       fracture line is not at a right angle to the long axis to the bone

 

        ? mechanism of causation  

 

 
   

       Green-stick fracture

    A crack of the bone with no disruption of the periosteum

 This occurs commonly among children

? mechanism of causation

 

 

  

       Spiral fracture      

   the fracture curves around the bone

 

 ? mechanism of causation 

 

 

 

       Comminuted fracture 

  The bone is broken in to more than two parts

The fracture is unstable and it is difficult to reconstruct the bone

? mechanism of causation

 

 

 

 

          Compound fracture

   Exposed to the environment and has a higher risk of infection related complications

Seen commonly in road traffic accidents

 

? mechanism of causation      

 

 

 
B. Fracture of a healthy bone  with a history of repeated stress over a along period of time 

                                                                               - Fatigue fracture

                   e.g. March fracture of 2nd & 3rd metatarsals are seen in military recruits or athletes due to excessive training related stresses

 

C. Fracture of a bone weakened by disease ( Osteomyelitis, bone malignancy, Osteomalacia, rickets, multiple myeloma ) - Pathological fracture

 
White arrow - fracture

Red arrow - Pathological area of the bone, weaken by malignancy

 

 

 

Pathological fractures on children may mimic child abuse e.g. Osteogenesis imperfecta

 

                

The bow shaped femur due to osteomalacia

 

 
  • Not identifying a fracture and the improper management  amounts to medical negligence .
The courts utilize information such as the rate of union, deformation and the period of disability in coming to a conclusion on the quality of management

 

 

 

 

 

 

 

                

Poorly managed fracture resulting in a deformed bone

  

 

 

 

 

Well managed fracture with metal plate & screws resulting in a properly healed fracture

 
  • The time of trauma is indicated by the of extent of healing of the fracture.

              

Remodeling  state

   

 

 

   

 

   

 

 

 

Fracture with a callus formation