FRACTURE is a medical condition in which there is a break in the continuity of the bone.

. A bone fracture can be the result of high force impact orstress, or trivial injury as a result of certain medical conditions that weaken the bones, such asosteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

All fractures can be broadly described as: Closed (simple) fractures are those in which the skin is intact Open (compound) fractures involve wounds that communicate with the fracture, or where fracture hematoma is exposed, and may thus expose bone to contamination. Open injuries carry a higher risk of infection.

Other considerations in fracture care are displacement (fracture gap) and angulation. If angulation or displacement is large, reduction (manipulation) of the bone may be required and, in adults, frequently requires surgical care. These injuries may take longer to heal than injuries withoutdisplacement or angulation. Compression fractures usually occurs in the vertebrae, for example when the front portion of a vertebra in the spine collapses due to osteoporosis (a medical condition which causes bones to become brittle and susceptible to fracture, with or without trauma).

Other types of fracture are: Complete fracture: A fracture in which bone fragments separate completely. Incomplete fracture: A fracture in which the bone fragments are still partially joined. In such cases, [1] there is a crack in the osseous tissue that does not completely traverse the width of the bone. Linear fracture: A fracture that is parallel to the bone's long axis. Transverse fracture: A fracture that is at a right angle to the bone's long axis. Oblique fracture: A fracture that is diagonal to a bone's long axis. Spiral fracture: A fracture where at least one part of the bone has been twisted. Comminuted fracture: A fracture in which the bone has broken into a number of pieces. Impacted fracture: A fracture caused when bone fragments are driven into each other.

signs and symptoms

Bleeding
is the loss of blood or blood escape from the circulatory system. Bleeding can occur internally, where blood leaks from blood vesselsinside the body, or externally, either through a natural opening such as the vagina, mouth, nose,ear or anus, or through a break in the skin.

Classification
Blood loss
Hemorrhaging is broken down into four classes by the American College of Surgeons' Advanced Trauma Life Support (ATLS). Class I Hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary. Class II Hemorrhage involves 15-30% of total blood volume. A patient is often tachycardic (rapid heart beat) with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient may exhibit slight changes in behavior. Volume resuscitation with crystalloids (Saline solution or Lactated Ringer's solution) is all that is typically required. Blood transfusion is not typically required. Class III Hemorrhage involves loss of 30-40% of circulating blood volume. The patient's blood pressure drops, the heart rate increases, peripheral hypoperfusion (shock), such ascapillary refill worsens, and the mental status worsens. Fluid resuscitation with crystalloid and blood transfusion are usually necessary. Class IV Hemorrhage involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death.

This system is basically the same as used in the staging of hypovolemic shock. The World Health Organization made a standardized grading scale to measure the severity of bleeding.
[5]

Grade 0 no bleeding

Grade 1 petechial bleeding;

Grade 2 mild blood loss (clinically significant);

Grade 3 gross blood loss, requires transfusion (severe);

Grade 4 debilitating blood loss, retinal or cerebral associated with fatalit

Traumatic Injury
Traumatic bleeding is caused by some type of injury. There are different types of wounds which may cause traumatic bleeding. These include: Abrasion - Also called a graze, this is caused by transverse action of a foreign object against the skin, and usually does not penetrate below the epidermis Excoriation - In common with Abrasion, this is caused by mechanical destruction of the skin, although it usually has an underlying medical cause Hematoma - Caused by damage to a blood vessel that in turn causes blood to collect under the skin. Laceration - Irregular wound caused by blunt impact to soft tissue overlying hard tissue or tearing such as in childbirth. In some instances, this can also be used to describe an incision. Incision - A cut into a body tissue or organ, such as by a scalpel, made during surgery. Puncture Wound - Caused by an object that penetrated the skin and underlying layers, such as a nail, needle or knife Contusion - Also known as a bruise, this is a blunt trauma damaging tissue under the surface of the skin Crushing Injuries - Caused by a great or extreme amount of force applied over a period of time. The extent of a crushing injury may not immediately present itself. Ballistic Trauma - Caused by a projectile weapon, this may include two external wounds (entry and exit) and a contiguous wound between the two

Major
Major burns are defined as: Age 10-50yrs: partial thickness burns >25% of total body surface area Age <10 or >50: partial thickness burns >20% of total body surface area Full thickness burns >10% Burns involving the hands, face, feet or perineum Burns that cross major joints Circumferential burns to any extremity Any burn associated with inhalational injury
[8]

Electrical burns Burns associated with fractures or other trauma Burns in infants and the elderly Burns in persons at high-risk of developing complications

These burns typically require referral to a specialised burn treatment center. [edit]Moderate Moderate burns are defined as: Age 10-50yrs: partial thickness burns involving 15-25% of total body surface area Age <10 or >50: partial thickness burns involving 10-20% of total body surface area Full thickness burns involving 2-10% of total body surface area

Persons suffering these burns often need to be hospitalised for burn care. [edit]Minor Minor burns are: Age 10-50yrs: partial thickness burns <15% of total body surface area Age <10 or >50: partial thickness burns involving <10% of total body surface area Full thickness burns <2% of total body surface area, without associated injuries

These burns usually do not require hospitalization.

Stages
At or below 0 C (32 F), blood vessels close to the skin start to constrict, and blood is shunted away from the extremities via the action of glomus bodies. The same response may also be a result of exposure to high winds. This constriction helps to preserve core body temperature. In extreme cold, or when the body is exposed to cold for long periods, this protective strategy can reduce blood flow in some areas of the body to dangerously low levels. This lack of blood leads to the eventual freezing and death of skin tissue in the affected areas. There are four degrees of frostbite. Each of these degrees has varying degrees of [2] pain. First degree

This is called frostnip and this only affects the surface skin, which is frozen. On the onset, there is itching and pain, and then the skin develops white, red, and yellow patches and becomes numb. The area affected by frostnip usually does not become permanently damaged as only the skin's top layers are affected. Long-term sensitivity to both heat and cold can sometimes happen after suffering from frostnip. Second degree

If freezing continues, the skin may freeze and harden, but the deep tissues are not affected and remain soft and normal. Second-degree injury usually blisters 12 days after becoming frozen. The blisters may become hard and blackened, but usually appear worse than they are. Most of the injuries heal in one month, but the area may become permanently insensitive to both heat and cold.

Third and Fourth degrees

If the area freezes further, deep frostbite occurs. The muscles, tendons, blood vessels, and nerves all freeze. The skin is hard, feels waxy, and use of the area is lost temporarily, and in severe cases, permanently. The deep frostbite results in areas of purplish blisters which turn black and which are generally blood-filled. Nerve damage in the area can result in a loss of feeling. This extreme frostbite may result in fingers and toes being amputated if the area becomes infected with gangrene. If the frostbite has gone on untreated, they may fall off. The extent of the damage done to the area by the freezing process of the frostbite may take several months to assess, and this often delays surgery to remove the dead tissue