FRACTURE
F
The pimples of Fox-Fordyce disease are
caused by the obstruction and rupture
of apocrine ducts in the
epidermis
(the
outermost layer of the skin). Treatment
with topical retinoids (derivatives of
vitamin A
)
and
antibiotic drugs
may help
to relieve symptoms in patients who
have
suffered
from
the
disease
in
the long term.
fracture
A break in a bone. Fractures most often
occur across the w idth of a bone, but
can be lengthwise, oblique, or spiral.
TYPES
There are two main types of fracture:
closed (simple) or open (compound).
In a closed fracture, the broken bone
ends remain beneath the skin and little
of the surrounding tissue is damaged;
in an open fracture, one or both of the
bone ends project through the skin. If
the ends of the bone have moved out
of alignment,
w hich
can
occur
in
either a closed or an open fracture, the
fracture is termed “displaced” .
Fractures
may
be
further
divided
according to the pattern of the break:
for example, transverse or spiral frac-
tures of long bones. In a greenstick
fracture, the break is not through the
full width of the bone. This type of frac-
ture occurs only in children because
their bones are more pliable. In an avul-
sion fracture, a small piece of bone is
pulled off by a tendon.
CAUSES
Most fractures are the result of a sud-
den injury that exerts more force on
the bone than it can withstand. The
force may be direct, for example when
a finger is hit by a hammer, or in d i-
rect, for example when twisting the
foot exerts severe stress on the shin.
In some diseases, such as
osteopor-
osis
and certain cancers, the bone is
weakened to such an extent that even a
m inor injury, or occasionally no injury
at all, can cause the bone to break; this
is known as a pathological fracture.
Compression fractures of the vertebrae
are common in people suffering from
osteoporosis. Elderly people are most
prone to fractures because they are
more likely to fall and their bones
are very fragile.
SYMPTOMS AND SIGNS
Common sites of fracture include the
hand, w rist (see
Colles’ fracture
) ,
ankle
joint
,
clavicle
(collarbone), and the neck
of the femur
(see
femur, fracture of
) .
There is usually swelling and tender-
ness at the fracture site. The pain is
often severe and is usually made worse
by movement.
DIAGNOSIS AND TREATMENT
X-rays
can confirm the presence of a
fracture. Bone begins to heal soon after
it has broken, so the first aim of treat-
ment is to ensure that the bone ends
are aligned. Displaced bone ends are
moved back into position, under gen-
eral anaesthesia, by manipulation either
through the skin or through an inci-
sion. The bone is then immobilized. In
some cases, the ends of the bone may
be fixed with metal pins or plates.
RECOVERY AND COMPLICATIONS
Most fractures heal without any prob-
lems. Healing is sometimes
delayed
because the blood supply to the affec-
ted bone is inadequate (as a result of
damaged blood vessels) or because the
bone ends are not sufficiently close
together. If the fracture fails to unite,
internal fixation or a
bone graft
may be
needed.
Osteomyelitis
(infection
of
bone tissue) is a possible complication
of open fractures.
Physiotherapy
plays an important part
in rehabilitation following a fracture
because
complete
im m obility
of a
bone for a prolonged period can result
in loss of muscle bulk in that area and
stiffness in nearby joints.
(See
also
fracture, dental
;
humerus,
fracture of
;
jaw, fractured
;
march fracture
;
Pott’s fracture
;
radius, fracture of
;
rib, frac-
ture of
;
skull, fracture of
;
Smith’s fracture
;
stress fracture
;
ulna, fracture of
. )
fracture, dental
A break in a tooth (see
teeth
)
most
commonly caused by falling onto a
hard surface or by being hit in the
mouth w ith a hard object. Fractures
may involve the crown or the root of a
tooth, or both.
Fractures of the enamel can usually
be repaired by bonding (see
bonding
,
dental
) ;
in some cases, a replacement
crown may be fitted (see
crown, dental
).
Pulpotomy
(removal of part of the pulp
of the tooth)
may be performed in
cases where the pulp is damaged. Root
fractures may be treated by splinting
(see
splinting, dental
) ,
root-canal treat-
ment
,
or removal of the tooth
(see
extraction, dental
) .
fragile X syndrome
An inherited defect of the
X chromosome
that causes learning difficulties. The dis-
order occurs w ithin families according
to an unusual X-linked recessive pattern
of inheritance (see
genetic disorders
) .
Al-
though fragile X syndrome principally
affects males, females can also inherit
the disorder. Both men and women can
be carriers without having any signs of
the disorder.
In addition to having learning diffi-
culties,
affected people may have a
prominent nose and jaw, and increased
ear
length;
they are also
prone
to
epileptic seizures and behavioural dif-
ficulties.
Males
tend
to
have
large
testes. Some carriers may also show
intellectual impairment.
The condition cannot be treated, but
affected
children
may
benefit
from
speech therapy,
specialist
education,
and help from a psychologist for any
accompanying behavioural problems.
Life expectancy is normal, but affected
boys usually need lifelong care. Cou-
ples w ho have a family history
of
fragile X syndrome may w ish to seek
genetic counselling when planning to
have a child.
Fragmin
A brand name for dalteparin, w hich is
a low molecular weight
heparin
(an
anticoagulant drug
that is used in the
prevention and treatment of abnormal
blood clotting
).
Fraley’s syndrome
A rare condition in w hich the upper-
most renal calyces in the
kidney
(part
of the central region where urine col-
lects before passing out of the kidney)
are compressed; this is usually caused
by some of the blood vessels that sup-
ply the area. Abdominal pain, back
pain in the area of the kidney, and
blood in the urine are usually the main
symptoms. Possible complications of
this syndrome include recurrent u ri-
nary tract infections and kidney stones
formation (see
calculus, urinary tract
) .
Franceschetti’s syndrome
A rare genetic disorder, also known as
Treacher-Collins syndrome, that causes
severe facial malformations. The con-
dition
is
congenital
(present
from
birth). The nose, cheek bones, lower
jaw, and chin are deformed, and the
child may have a receding chin (see
micrognathia
) .
There is a pronounced
droop to the outer corners of the eyes.
Surgery to reconstruct abnormal fea-
tures results in significant improvement
in appearance and function.
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