Facial & Skull Fractures

Facial Skull & Fractures: Facial fractures or fractures of the skull can be particularly serious and require immediate medical treatment. Among the most common facial fractures are those of the upper jaw (the maxilla) and the lower jaw (the mandible). Commonly, where there is a “displaced” fracture of either of these bones, invasive treatment to correct the displacement is required, including potentially, wiring the jaw closed for a period of time. Other facial fractures that require immediate treatment include fractures of the the zygomatic bone, which forms the inferior or lower part of the eye socket, or the zygomatic arch, which together with the zygomatic process of temporal bone (a bone extending forward from the side of the skull, over the opening of the ear) forms the cheekbone. Because the facial bones protect vital organs including the eyes, nose, teeth, and brain, facial fractures must be treated immediately.

Tibia & Fibula Fractures. The lower leg is composed of two bones, the thicker tibia bone and the thinner fibula bone. Lower leg fractures are among the most common fractures and can be due to trauma or accidents, congenital abnormalities, bone disorders, and a host of other problems. While most such fractures are not life-threatening, and can be treated with splinting or casting, immediate medical attention is advised in order to promote proper healing.

Femur Fractures The femur, or upper leg, is one of the thickest strongest bones in the human body. Most traumatic accidents require a severe impact in order for one to fracture a femur. Many important blood vessels run close to the upper part of the femur, so these injuries can be particularly dangerous, especially if accompanied by a fracture of the pelvis.

Cracked Ribs. The ribs are the bony structures that protect the body’s internal organs, including the heart, lungs, stomach, liver, spleen, and pancreas. People involved in accidents often suffer cracked or fractured ribs due to direct impact from a car, object, or other person. The first seven sets of ribs, known as “true ribs“, are directly attached to the sternum (or breastbone) through cartilage. The next five sets of ribs are called “false ribs“, because they are not each individually attached to the sternum. The first three sets of “false ribs” share a common cartilage connection to the sternum, while the last two sets of “false ribs” (the eleventh and twelfth ribs) are called floating ribs because they are attached to the vertebrae only, and not to the sternum or to cartilage coming off of the sternum.

Pelvic and Hip Fractures: The pelvis is composed of three bones, the hip bone, the sacrum, and the coccyx. The most common cause of hip or pelvic fractures involve high-energy forces such as a motor vehicle accidents, cycling accidents, or falls from a significant height. Because the pelvis cradles so many vital internal organs, pelvic fractures may produce significant internal bleeding which may or may not be seen externally. Frequently, in cases of severe trauma, pelvic fractures may be associated with severe hemorrhage due to the extensive blood supply to the region and emergency treatment and stabilization is therefore required.

Herniated Discs: Intervertebral discs are the cushions or shcok absorbers between the vertebrae of the spine, which themselves protect the spinal cord which itself carries the nerves from the brain to the body and vice versa. The discs are composed of two parts, an annulus fibrosis, and a nucleus pulposis. The disc can be likened to a doughnut whereby the annulus fibrosis is similar to the dough of the doughnut and the nucleus pulposis is similar to the jelly. When one develops a herniated disc, the jelly part of the disc is forced out of the doughnut and may put pressure on the nerves in the spinal cord or other nerves located near the disc. This can create back pain or sciatica.

As people age, the inner jelly part of the disc, or the nucleus pulposus, may begin to dehydrate, which limits its ability to act as a shock absorber. Similarly, the annulus fibrosus may get weaker with age and begin to tear. This can also create back pain or sciatica.

Sciatica is a set of symptoms including pain that may be caused by general compression or irritation of one or more nerve roots that give rise to the sciatic nerve, which controls the function and sensation of the lower back, buttocks, or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, “pins and needles” or tingling and difficulty in moving or controlling the leg.

Wrist Fractures: The wrist is comprised of eight individual bones that connect the bones of the forearm to the bones of the hand. A scaphoid fracture (a fracture of the scaphoid bone) is the most common type of wrist fracture.Scaphoid fractures usually cause pain at the base of the thumb accompanied by swelling in the same area. Treatment of scaphoid fractures is guided by the location in the bone of the fracture (proximal, waist, distal), displacement (or instability) of the fracture, and patient tolerance for cast immobilization. Avascular necrosis (AVN) is a common complication of a scaphoid fracture. Risk of AVN depends on the location of the fracture.

• Fractures in the proximal 1/3 have a high incidence of AVN (~30%)
• Waist fractures in the middle 1/3 is the most frequent fracture site and has moderate risk of AVN.
• Fractures in the distal 1/3 are rarely complicated by AVN.

Non-union can also occur from undiagnosed or undertreated scaphoid fractures.

Humerus Fractures: the humerus is the bone that connects the elbow joint with the shoulder joint.

Simple Fractures: A closed or simple fracture is a fracture that results in the bones not being displaced or shifted relative to one another and where the skin remains intact.

Compound Fractures: An open or compound fracture is one where the integrity of the skin is disturbed, meaning the bone protrudes out from the skin. These types of fractures may expose bone to air and other outside contamination, and therefore carry a higher risk of infection. Other considerations in fractures are the presence of displacement (i.e., a fracture gap) or angulation. If the displacement or angulation is large, a reduction (manipulation) of the bone may be required and, in adults, frequently requires surgical care. These injuries may take longer to heal than injuries without displacement or angulation.

Stress Fracture A stress fracture is one type of incomplete fracture in bones. It is caused by “unusual or repeated stress” and also heavy continuous weight on the ankle or leg. It is often described as a very small sliver or crack in the bone, which is why such fractures are sometimes dubbed “hairline fractures”. It typically occurs in weight-bearing bones, such as the tibia (bone of the lower leg) and metatarsals (bones of the foot). It is a common sports injury, and most cases are associated with athletics.

Skull Fractures: A skull fracture is a break in one or more of the bones in the skull usually occurring as a result of blunt force trauma. If the force of the impact is excessive the bone may fracture at or near the site of the impact. The force of direct impact may cause damage to the underlying physical structures contained within the skull such as the membranes, blood vessels, and brain, even in the absence of a fracture. While an uncomplicated skull fracture can occur without associated physical or neurological damage and is in itself usually not clinically significant, a fracture in healthy bone indicates that a substantial amount of force has been applied and increases the possibility of associated injury. Any significant blow to the head results in a concussion, with or without loss of consciousness.