Introduction
A break or loss of continuity in the bone is termed a fracture. It may be a complete or partial fracture or a crack in the bone. The severity of the fracture depends on the force that is caused to break the bone, such as a high-energy or low-energy trauma. High-energy trauma includes motor accidents, sports injuries, a direct blow, etc. Low-energy trauma includes falls from standing height or falls from a ladder; in some cases, fractures may be associated with low bone density or osteoporosis.
What Are the Types of Fractures?
Some of the common types of fractures include :
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Open or Closed Fractures: If the skin is intact following a fracture, it is a closed fracture or a simple fracture, and if the fractured bone fragments pierce and the skin is exposed, it is an open fracture or a compound fracture.
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Complete or Incomplete Fractures: If the bone cracks and bends but does not get completely broken is an incomplete fracture or a greenstick fracture. If the bone breaks and gets separated into fragments, it is a complete fracture.
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Displaced or Nondisplaced Fractures: A fracture that involves only a break, with the fragments in alignment, is a non-displaced fracture; in contrast, if the fracture fragments are out of alignment, it is a displaced fracture.
1. Based on Fracture Pattern:
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Transverse Fracture: The bone breaks at a right angle (90 degrees) to the long axis of the bone.
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Linear Fracture: The bone breaks parallel to the long axis of the bone.
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Spiral Fracture: A part of the bone is twisted at the fractured point.
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Oblique Fracture: The bone breaks obliquely (curved) to the long axis.
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Comminuted Fracture: The bone breaks into several fragments.
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Segmental Fracture: Two fracture lines that isolate a segment of bone.
2. Atypical Fractures Include:
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Compression (Wedge) Fracture: A break or a crack in the bones of the spinal cord (vertebrae).
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Pathological Fracture: A fracture caused due to a disease that weakens the bones.
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Hairline Fracture (Stress Fracture): A tiny crack in the bone caused due to repetitive stress or overuse.
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Torus Fracture (Buckle Fracture): An incomplete fracture of the shaft of a long bone, bent on one side, raising a buckle or a protuberance.
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Impacted Fracture: A fracture in which the bone fragments are jammed together due to the force of the injury.
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Avulsion Fracture: A small block or a fragment of bone that is attached to a ligament or tendon gets separated from the main bone.
What Is an Oblique Fracture?
Fractures that occur at an angle or obliquely to the long axis of the bone are called oblique fractures. It usually occurs in long bones like the humerus (upper arm bone), femur (thigh bone), tibia (shin bone), fibula (calf bone), etc. It can be caused by a direct impact on the bone at an angle or by landing on the bone at an angle due to a fall. The edges of the fractures are usually sharp and may cause skin lacerations, resulting in a compound or an open oblique fracture.
What Are the Causes of Oblique Fractures?
Some of the causes of oblique fractures include:
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High-energy trauma like violence, vehicle accidents, sports injuries, etc.
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Fractures occur due to a fall or a sharp blow that comes at an angle.
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A sudden turn while running or playing.
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Individuals with osteoporosis or low bone density are more prone to fractures.
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Repetitive movements of the muscles can apply pressure on the bones, leading to stress fractures, commonly seen in athletes.
What Are the Signs and Symptoms of Oblique Fractures?
Some of the signs and symptoms include:
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Severe pain and swelling.
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Tenderness of the affected area.
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Skin abrasions, lacerations, and bruises are seen in case of injuries.
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Inability to move the affected part.
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Unusual bump or a significant deformity.
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Bony fragments protruding through the skin, associated with bleeding, in case of open or compound fractures.
How Are Oblique Fractures Diagnosed?
The doctor takes a complete medical history of the patient, followed by a physical examination of the fractured area. The fracture site is examined for bruises, skin abrasions, bleeding, and lacerations, and the area is palpated to check for tenderness. The location and the extent of the fracture are determined, followed by a radiological examination. It includes:
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X-rays: It gives a clear view of the location, type, displaced or non-displaced, and extent of fractures and is also associated with other fractures or bony irregularities.
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Computed Tomography (CT Scan): It provides a detailed view of the fracture, surrounding areas, loose bony fragments, and joint extensions. It also helps in surgical planning.
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Magnetic Resonance Imaging (MRI): It provides a complete image of the fracture and the associated damage to the connective tissues, muscles, and other soft tissues like the ligaments and nerve involvement.
How Are Oblique Fractures Managed?
The treatment of oblique fractures depends on the severity, location, type, associated injuries, and age of the patient. Anti-inflammatory medications and analgesics, such as nonsteroidal anti-inflammatory drugs like Acetaminophen, Ibuprofen, etc., are prescribed to relieve the pain and swelling. Surgical treatment is followed by rehabilitation therapy with physical exercises. Some of the treatment methods for oblique fractures include:
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Immobilization: Simple and nondisplaced fractures are treated by immobilization of the bone with a splint or a cast for around four to six weeks. Periodic monitoring is done with X-rays to prevent displacement.
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Closed Reduction: This procedure is done under local or general anesthesia to realign or set the fractured bones back to normal position by traction and counter traction followed by immobilization to promote healing. It is indicated for simple displaced fractures with or without joint extension. In some cases, it may result in improper union( mal union).
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Open Reduction or Surgery: Open reduction is employed in cases of failed closed reduction, delayed union, severely displaced fractures with joint involvement, avulsion fractures, multiple fractures, pathological fractures, etc. The fractured area is exposed by a suitable approach, and reduction is carried out; the bones are aligned back into the position, and temporary stabilization is done using K-wires (Kirschner wires) or permanent stabilization by metal screws or plates.
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Internal Fixation: This procedure is done following the alignment of bones during surgery to secure the bones in place and prevent displacement. It is done using metal pins, screws, wires, rods, or plates. In some cases, these are left permanently in the bone and monitored periodically.
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External Fixation: This procedure is done in case of grossly comminuted fractures or contaminated fractures, open fractures with severe soft tissue injuries, and acetabular fractures, wherein the fracture fragments are fixed with a cluster of pins or rods connected to external bars or clamps. It helps fix and stabilizes the bones to promote healing.
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Arthroplasty: It is usually done in cases of displaced fractures with joint involvement, in cases of patients with significant osteoarthritis, or in cases of post-traumatic arthritis. It is a surgical procedure during which the joint is realigned, remodeled, or replaced with an artificial joint made of metal or ceramic to restore function.
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Bone Grafting: It is done in cases of severely damaged or diseased bones, which may be a significant risk to the patient. Various methods like allograft (bone tissue transplanted from a donor), autograft (bone tissue from other parts of the body), and synthetic bone grafting (artificial bone-like material) may be done depending on the condition of the patient. The graft is transplanted and secured using metal screws, pins, or plates.
What Are the Complications of Oblique Fractures?
Some of the complications of oblique fractures include:
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Severe swelling may decrease the blood flow, depriving the tissues of oxygen which causes pressure build-up leading to intense pain, called acute compartment syndrome.
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Nonunion or an improper union of the bones may occur in some cases.
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Damage to the nerves and blood vessels may result in permanent deformity.
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Occur in case of open fractures leading to a delay in wound healing.
Conclusion
Fractures that occur at an angle to the long axis of the bone are oblique fractures; they usually affect the long bones and are caused due to falls, vehicle accidents, or sports injuries. It is associated with severe pain, swelling, loss of function, and significant deformity. These fractures are managed, depending on the location, cause, severity, and extent of the injury, by conservative or surgical treatment. With appropriate treatment and rehabilitation, the patient recovers back to normal within a few weeks.
