Fracture: Types, Diagnosis, and Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"A fracture is a break in the continuity of bone. Types, radiological diagnosis, orthopedic or surgical treatment, and rehabilitation in Quebec.\">\n<meta name=\"keywords\" content=\"fracture traitement, fracture os diagnostic, fracture chirurgie orthop\u00e9die, fracture pl\u00e2tre immobilisation, fracture ost\u00e9oporose, fracture de stress, fracture consolidation Qu\u00e9bec, fracture urgence\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap * { font-family: 'Poppins', sans-serif; box-sizing: border-box; }\n.co-wrap { max-width: 1100px; margin: 0 auto; padding: 30px 0 60px; }\n.co-label { font-family: 'Cinzel', serif; font-size: 14px; font-weight: bold; letter-spacing: 1px; text-transform: uppercase; color: #4D6577; margin-bottom: 14px; display: block; }\n.co-wrap h1 { font-size: 32px; font-weight: 500; color: #323C52; margin: 0 0 22px; line-height: 1.2; }\n.co-intro { font-size: 16px; line-height: 1.75; color: #4D6577; margin-bottom: 36px; padding-bottom: 32px; border-bottom: 1px solid rgba(77,101,119,.2); }\n.co-wrap h2 { font-size: 20px; font-weight: 600; color: #323C52; margin: 32px 0 12px; }\n.co-wrap p { font-size: 15px; color: #4D6577; line-height: 1.7; margin-bottom: 14px; }\n.co-list { list-style: none; padding: 0; margin: 12px 0 24px; }\n.co-list li { font-size: 15px; color: #4D6577; padding: 10px 14px 10px 38px; margin-bottom: 8px; border-radius: 6px; position: relative; background: rgba(77,101,119,.06); border-left: 3px solid #4D6577; }\n.co-list li::before { content: \"\u2713\"; position: absolute; left: 12px; font-weight: 700; color: #4D6577; }\n.co-table { width: 100%; border-collapse: collapse; margin: 14px 0 22px; font-size: 14px; border-radius: 8px; overflow: hidden; table-layout: fixed; }\n.co-table thead tr { background: #323C52; color: #fff; }\n.co-table thead th { padding: 11px 16px; text-align: left; font-weight: 600; font-size: 13px; }\n.co-table tbody tr:nth-child(even) { background: rgba(77,101,119,.06); }\n.co-table tbody tr:nth-child(odd) { background: #fff; }\n.co-table td { padding: 10px 16px; color: #4D6577; border-bottom: 1px solid rgba(77,101,119,.12); font-size: 14px; vertical-align: top; }\n.co-table td:first-child { font-weight: 600; color: #323C52; }\n.co-infobox { display: flex; gap: 12px; background: rgba(77,101,119,.06); border-radius: 8px; border-left: 4px solid #4D6577; padding: 14px 18px; margin: 18px 0 28px; font-size: 14px; color: #4D6577; line-height: 1.65; }\n.co-infobox .ico { font-size: 18px; flex-shrink: 0; }\n.co-urgence { background: #fff8f8; border-left: 5px solid #c0392b; border-radius: 6px; padding: 20px 26px; margin: 24px 0 32px; }\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Orthopedics & Emergency Medicine & Family Medicine<\/span>\n <h1>Fracture<\/h1>\n\n <div class=\"co-intro\">\n A fracture is an interruption of the continuity of a bone, either total or partial, that occurs when a mechanical force exceeds the resistance of bone tissue. It is one of the most common injuries in medicine\u2014an estimated fracture occurs every 3 seconds worldwide\u2014and is a major cause of emergency room visits, hospitalization, and long-term morbidity, particularly in elderly patients with osteoporosis. Bone tissue is a living tissue, continuously remodeled by osteoblasts (formation) and osteoclasts (resorption), and possesses a remarkable healing capacity: bone healing occurs in four phases\u2014the inflammatory phase (days 0\u20137: fracture hematoma + cell recruitment), the soft callus phase (days 7\u201321: fibrocartilaginous callus), the hard callus phase (days 21\u201360: callus ossification), and the remodeling phase (months to years: mineralization + restoration of cortical architecture). The strength and speed of healing depend on the patient's age (children heal faster), the fracture location, the fracture pattern (spiral or oblique fractures heal faster than transverse ones), residual displacement, local vascularization, nutritional status (calcium, vitamin D, proteins), smoking (significantly delays healing), and the presence of osteoporosis or underlying bone disease. Fracture management is based on three fundamental principles: reduction (restoring fragments to proper alignment), containment (maintaining reduction during healing), and rehabilitation (restoring function).\n <\/div>\n\n <h2>Classification, diagnosis, and initial assessment<\/h2>\n <ul class=\"co-list\">\n <li><strong>Fracture Classification \u2014 Essential Clinical Terminology<\/strong> Based on skin integrity: Closed fracture (intact skin \u2013 no communication with the outside) vs. Open fracture (communication between the fracture site and the outside via a skin wound) \u2013 Gustilo-Anderson classification for open fractures: Grade I (wound 10 cm or massive contamination): IIIa (adequate bone coverage) + IIIb (skin and soft tissue loss + exposed bone) + IIIc (associated vascular injury requiring repair) \u2013 an open fracture is a surgical emergency; Based on fracture line: Transverse (perpendicular to the long axis of the bone \u2013 direct trauma) + Oblique (angular force) + Spiral or helical (twisting \u2013 typical of rotational fractures) + Comminuted (multiple fragments \u2013 high-energy trauma) + Impacted or compressed (spongy bone \u2013 vertebrae + talus + tibial plateau) + Greenstick (incomplete fracture in children \u2013 one side of the cortex intact) + Buckle \/ Torus (barrel-shaped deformation of the cortex without rupture \u2013 child); Based on displacement: Non-displaced (al) + Displaced (varus\/valgus + overriding + angulation + rotation) \u2013 displacement influences treatment choice; Based on etiology: Traumatic fracture (high or low energy) + Fatigue or stress fracture (repeated microtrauma without a single trauma \u2013 runners + military personnel + severe osteoporosis) + Pathological fracture (bone weakened by an underlying disease: osteoporosis + metastasis + myeloma + Paget's disease + bone cyst); Specific fractures in children: Greenstick fracture + Torus fracture + Salter-Harris epiphyseal separations (Salter-Harris classification I to V based on physeal plate involvement \u2013 classification influences growth prognosis) \u2013 any fracture in a child should raise suspicion of abuse if the mechanism is inconsistent with the injury.<\/li>\n <li><strong>Clinical and radiological diagnosis:<\/strong> Clinical examination: sharp pain localized at the fracture site (cardinal sign) + visible deformity (angulation + shortening + rotation) + swelling + hematoma + bone crepitus on palpation (do not intentionally reproduce\u2014painful + unnecessary + displaces the fragments) + functional impairment + systematic distal neurovascular assessment (distal pulse + sensation + motor function\u2014always before and after any reduction maneuver); standard X-rays (two mandatory perpendicular views\u2014anterior-posterior + lateral, plus 3\/4 views depending on location): include the joint above and below on X-rays of long bones (risk of associated fracture or unrecognized dislocation) \u2014 non-displaced or greenstick fractures may be difficult to visualize \u2014 repeat on days 8\u201310 if there is strong clinical suspicion with a normal initial X-ray (edema and early bone resorption make the fracture line visible later); additional imaging depending on the context: MRI (gold standard for occult fractures + non-displaced femoral neck fractures + pathological bone lesions + stress fractures) \u2014 CT scan: indicated for complex fractures (pelvis + spine + tibial plateau + calcaneus + acetabulum + intra-articular fractures) + preoperative evaluation + occult fractures if MRI is unavailable + traumatic cervical fractures (NEXUS + Canadian C-Spine Rule) \u2014 bone scintigraphy: stress fractures + metastases + occult fractures if MRI is unavailable; clinical decision rules (to avoid unnecessary X-rays): Ottawa Ankle Rules: X-ray mandatory if malleolar pain + inability to bear weight \u00d7 4 steps or tenderness over the last 6 cm of the malleoli or the posterior edge of the base of the 5th metatarsal or the navicular bone \u2014 sensitivity 97\u2013100 % for significant fracture + allows for the avoidance of 30\u201340 % ankle X-rays<\/li>\n <li><strong>Neurovascular assessment and immediate complications not to be missed:<\/strong> Systematic assessment of distal neurovascular status before and after any procedure: radial pulse (humerus fracture + elbow) + femoral pulse + popliteal pulse + posterior tibial pulse + foot pulse (femur fracture + knee + tibia) + capillary refill time + sensation and motor function in at-risk nerve territories depending on the location; associated nerve injuries depending on location: proximal humerus fracture \u2192 axillary nerve (deltoid test + sensation in the shoulder stump) + diaphyseal humerus fracture \u2192 radial nerve (wrist extension test + finger extensors \u2014 drop hand) + supracondylar humerus fracture (children +++) \u2192 median nerve (distal interphalangeal flexion of the index finger = testing of the anterior interosseous nerve \u2014 OK sign) + radial nerve + humeral artery (vascular emergency) + fracture of the fibular neck \u2192 common peroneal nerve (testing of dorsiflexion + eversion of the foot \u2014 drop foot); compartment syndrome: surgical emergency \u2014 abnormally high pressure within a fascial compartment following post-traumatic edema or a hematoma \u2192 irreversible muscle and nerve ischemia if not treated within 6 hours \u2014 at-risk sites: leg (4 compartments) + forearm (3 compartments) + foot + thigh + arm \u2014 classic signs (5 P\u2019s): Pain (disproportionate pain + worsened by passive stretching of the compartment muscles) + Paresthesias + Pallor + Pulselessness + Paralysis (late-onset) \u2014 treatment: emergency surgical fasciotomy \u2014 measurement of intracompartmental pressure: >30 mmHg or delta P (systolic blood pressure \u2013 compartmental pressure) <30 mmHg = indication for surgery; fat embolism: a rare complication of long bone fractures (femur +++) and pelvic fractures \u2192 fat marrow emboli in the circulation \u2192 triad: acute respiratory failure + neurological symptoms + petechiae (trunk + conjunctiva) \u2192 24\u201372 hours after trauma + treatment: supportive care + early surgical stabilization of fracture sites (reduction of intraosseous bleeding)<\/li>\n <\/ul>\n\n <h2>Management of Major Fractures<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:200px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Type of fracture<\/th><th>Treatment and Techniques<\/th><th>Follow-up, consolidation, and complications<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Orthopedic treatment \u2014 immobilization<br><small style=\"font-weight:400;color:#7a8fa0;\">Plaster cast \u2014 splint \u2014 functional brace<\/small><\/td>\n <td>Orthopedic (non-surgical) treatment is indicated for fractures without displacement or with acceptable displacement after reduction, in locations where immobilization allows for proper healing without major functional risk; manual reduction (closed reduction) under local anesthesia, sedation, or general anesthesia: traction + counter-traction along the axis + specific corrective maneuver depending on the type of displacement \u2192 immediate post-reduction radiographic assessment + post-reduction neurovascular examination; plaster immobilization: circular cast: rigid immobilization + do not apply a circular cast within 24\u201348 hours after acute trauma (risk of compression due to edema \u2192 compartment syndrome) \u2014 emergency plaster splint (back-supported) followed by a circular cast at 48\u201372 hours once edema has stabilized; types of immobilization based on location: wrist fracture (Colles + Pouteau-Colles + Smith): splint followed by an antebrachial-palmar below-elbow cast \u00d7 4\u20136 weeks + position in slight palmar flexion and ulnar deviation (Colles) + radiographic follow-up at days 5\u201310 and day 21 to detect secondary displacement (common); metatarsal fractures (except Jones\u2019 fifth metatarsal): rigid walking shoe (post-op shoe) + weight-bearing permitted + 4\u20136 weeks; clavicle fracture (without displacement or with moderate displacement): simple sling \u00d7 3\u20134 weeks + early pendulum rehabilitation; fracture of the upper humerus (non-displaced, two-part): simple splint + pendulum rehabilitation starting on days 7\u201314; fracture of the radial neck (radial head \u2014 Mason I\u2013II): sling \u00d7 2\u20133 weeks + early mobilization + early pronosupination (to prevent stiffness); functional brace (Sarmiento): removable sleeve made of thermoplastic material \u2014 non-displaced or minimally displaced humeral diaphyseal fracture \u2014 allows for early mobilization of the shoulder and elbow \u2192 union rate 95\u201398% % + excellent functional outcomes<\/td>\n <td>Monitoring of orthopedic treatment: routine follow-up X-rays: Days 5\u201310 (secondary displacement under the cast\u2014common in unstable fractures) + Day 21 (early bone healing\u2014visible callus) + Days 42\u201360 (complete bone healing)\u2014criteria for urgent follow-up while in a cast: severe, unrelenting pain + tingling + numbness + blue or cold skin under the cast \u2192 urgent consultation \u2192 removal and assessment for compartment syndrome; Duration of immobilization depending on location and age: cancellous bone (vertebrae + foot bones + wrist): 4\u20136 weeks + long bones of the upper limbs (forearm + humerus): 6\u20138 weeks + long bones of the lower limbs (tibia + femur): 8\u201312 weeks + children: duration reduced by 30\u201350% (faster healing) + patients with osteoporosis: duration potentially increased + poor healing to be monitored; secondary displacement under cast: high risk within the first 10\u201314 days \u2192 routine radiographic follow-up at 8\u201310 days + if displacement is unacceptable \u2192 discuss surgery (percutaneous nailing + osteosynthesis) + criteria for acceptable residual displacement vary by location: wrist (Colles): dorsal angulation <10\u00b0 + radial shortening <5 mm + radial deviation <5\u00b0; tibia: angulation <5\u00b0 in all planes + shortening <12 mm + rotation <10\u00b0; delayed union and pseudarthrosis: delayed union = absence of radiographic signs of union beyond the usual timeframe (\u00d7 1.5) + pseudarthrosis = absence of union at 9\u201312 months despite proper treatment \u2192 risk factors: smoking (delays union by 4\u20136 weeks) + malnutrition + osteoporosis + infection + insufficient blood supply + residual displacement + instability of the fracture site \u2192 treatment: osteosynthesis + bone grafting + electrical or ultrasound stimulation (LIPUS \u2014 low-intensity pulsed ultrasound)<\/td>\n <\/tr>\n <tr>\n <td>Surgical treatment \u2014 osteosynthesis<br><small style=\"font-weight:400;color:#7a8fa0;\">Nailing \u2014 plate screw \u2014 percutaneous screws<\/small><\/td>\n <td>Surgical treatment is indicated for unstable displaced fractures that cannot be managed with conservative orthopedic treatment, intra-articular fractures requiring anatomical reduction, open fractures, and fractures of the lower extremities in active adults (allowing for early weight-bearing); intramedullary nailing (intramedullary nail \u2014 IMN): the gold standard technique for diaphyseal fractures of long bones (femur, tibia, and humerus)\u2014insertion of a metal nail into the bone\u2019s medullary canal + proximal and distal locking with transverse screws \u2192 rotational and axial stability \u2192 early weight-bearing \u2192 union under physiological stress\u2014diaphyseal femoral fracture: CCM in deferred emergency cases (6\u201324 hours to optimize hemodynamics) \u2014 locked CCM \u2192 partial weight-bearing on Day 1 + full weight-bearing on Days 30\u201345 \u2014 union rate 95\u201398% at 12 months; screw-fixed plate osteosynthesis: indications: metaphyseal + epiphyseal + intra-articular fractures + displaced clavicle fractures + complex proximal humerus fractures + displaced distal radius fractures + bimalleolar ankle fractures + locking compression plates (LCP): dual compression mechanism + angular locking \u2192 superior stability in osteoporotic bone; Percutaneous screws (closed-system osteosynthesis): cross-shaped calcaneal fractures + fractures of the base of the 5th metatarsal + medial malleolar fractures + scaphoid fractures + cannulated screws for the upper femur (non-displaced femoral neck fractures in young patients); external fixator: indicated as an emergency measure for Gustilo grade II\u2013III open fractures (temporary stabilization of the fracture site prior to definitive osteosynthesis) + unstable pelvic fractures + complex lower extremity fractures with soft tissue injuries + multiple trauma (damage control orthopedics)<\/td>\n <td>Fractures requiring urgent or delayed emergency surgery: open fracture: surgical irrigation + debridement + stabilization of the fracture site within 6\u20138 hours (optimal timeframe) \u2192 prophylactic IV antibiotics (cefazolin + gentamicin if Grade III) \u2192 delayed skin closure at 48\u201372 hours unless clean Grade I \u2192 risk of bone infection (osteitis) directly related to the delay in treatment and the Gustilo grade; displaced femoral neck fracture in the elderly (Garden III\u2013IV): hip replacement (hemiarthroplasty or total hip replacement depending on biological age + activity level + life expectancy) within 24\u201348 hours \u2192 reduced 1-year mortality if surgery is performed within 48 hours (1-year mortality: 25\u201330% in adults >80 years old even after optimal surgery) \u2192 systematic postoperative anticoagulation (LMWH + transition to DOACs \u2014 duration 35 days after hip replacement) + physical therapy on postoperative day 1; displaced supracondylar humeral fracture in children (Gartland type III): emergency percutaneous pinning (2 divergent Kirschner wires) + cast with elbow flexed at 90\u00b0 \u00d7 3 weeks \u2014 feared complication: forearm ischemia (humeral artery) + median nerve (anterior interosseous) \u2192 emergency pin removal + vascular exploration if pallor + loss of radial pulse; acetabular fracture + unstable pelvic fracture (Tile C): elective surgery within 5\u20137 days (after hemodynamic stabilization and patient stabilization) + emergency external fixator if hemodynamic instability due to rupture of the presacral veins; total arthroplasty (prosthesis): femoral neck fracture in the elderly adult + irreducible comminuted fracture of the humeral head + pathological fracture involving a loosened prosthesis<\/td>\n <\/tr>\n <tr>\n <td>Osteoporotic fractures<br><small style=\"font-weight:400;color:#7a8fa0;\">Wrist \u2014 vertebra \u2014 hip \u2014 shoulder<\/small><\/td>\n <td>Osteoporotic fractures\u2014also known as fragility fractures\u2014occur as a result of low-energy trauma (a fall from standing height) to a bone whose mineral density and microarchitectural quality have been compromised by osteoporosis; epidemiology in Quebec: 1 in 3 women and 1 in 5 men over the age of 50 will suffer an osteoporotic fracture during their lifetime\u2014hip fractures result in a mortality rate of 20\u201325% of cases within 1 year + permanent loss of independence in 30\u201340% of cases among the elderly \u2014 a major economic burden for the Quebec healthcare system; most common osteoporotic fractures: distal wrist fracture (Colles \u2014 the most common before age 65 \u2014 fall onto an outstretched palm) + vertebral compression fracture (the most common fracture after age 65 \u2014 often asymptomatic + discovered incidentally on a chest X-ray or bone densitometry) + femoral neck fracture and trochanteric fracture (the most serious\u201480,000 hip fractures\/year in Canada) + proximal humerus fracture (3rd most common); post-fracture evaluation: bone densitometry (DEXA): mandatory after any fragility fracture \u2014 T-score (comparison to a young adult of the same sex): osteoporosis <\u22122.5 + osteopenia \u22122.5 to \u22121.0 + normal >\u22121.0; Laboratory workup: serum calcium + serum phosphorus + 25-OH-vitamin D + PTH + complete blood count (CBC) + TSH + protein electrophoresis (myeloma) + creatinine + alkaline phosphatase + CTX (C-telopeptide \u2014 marker of bone resorption) + testosterone (men) + liver function tests; FRAX (Fracture Risk Assessment Tool \u2014 WHO): calculation of the 10-year absolute risk of major fracture and 10-year risk of hip fracture \u2014 includes: age + sex + BMI + personal and family history of fracture + smoking + alcohol + corticosteroid therapy + rheumatoid arthritis + secondary causes of osteoporosis + femoral T-score \u2014 pharmacological treatment threshold recommended by Osteoporosis Canada: 10-year risk of major fracture >20 % or 10-year risk of hip fracture >3 %<\/td>\n <td>Treatment of osteoporosis following a fragility fracture \u2014 FLS (Fracture Liaison Service) program: calcium + vitamin D supplementation: calcium 1,200 mg\/day (diet + supplement if intake is insufficient) + vitamin D 800\u20132,000 IU\/day (target 25-OH-D >75 nmol\/L) \u2014 bisphosphonates (first-line anti-osteoporotic treatment): alendronate (Fosamax) 70 mg\/week PO \u2014 risedronate (Actonel) 35 mg\/week or 150 mg\/month PO \u2014 zoledronate (Aclasta \u2014 Reclast) 5 mg IV annually (first-line option if gastrointestinal intolerance or oral non-compliance) \u2014 duration of treatment: 3\u20135 years + benefit\/risk reassessment (discontinuation of bisphosphonate therapy if moderate risk after 5 years + continuation if high risk) + rare adverse effects: osteonecrosis of the jaw (very low risk <0.001 per 10,000 patients \u2014 to be distinguished from higher doses used in oncology) + atypical femoral fracture (subtrochanteric diaphyseal \u2014 warning sign: bilateral thigh pain + thickened lateral cortex on X-ray); denosumab (Prolia): anti-RANKL monoclonal antibody \u2014 60 mg SC every 6 months \u2014 second-line treatment or if bisphosphonates are contraindicated (renal failure \u2014 eGFR <30) + do not stop abruptly (rebound cascade of vertebral fractures if stopped without bisphosphonate bridging therapy); risedronate or zoledronate IV in cases of hip fracture: start within 2\u201312 weeks post-surgery (after healing); teriparatide (Forteo): recombinant PTH \u2014 20 \u00b5g SC\/day \u00d7 24 months \u2014 bone anabolic agent \u2014 reserved for severe osteoporosis with multiple vertebral fractures or inadequate response to anti-osteoclastics \u2014 reimbursed by RAMQ under exceptional criteria; FLS program in Quebec: fracture liaison service (FLS) \u2014 nurse coordinators at the university hospital + automatic communication between the emergency department and the attending physician following a fragility fracture \u2192 initiation of anti-osteoporotic treatment within 3 months post-fracture (post-fracture treatment rate in Canada without FLS: 20% % \u2192 with FLS: 70\u201380% %)<\/td>\n <\/tr>\n <tr>\n <td>Stress fractures and pathological fractures<br><small style=\"font-weight:400;color:#7a8fa0;\">Overwork \u2014 neoplasm \u2014 loading prohibited<\/small><\/td>\n <td>Stress (fatigue) fractures: occur without a single traumatic event\u2014result from repeated microtrauma exceeding the bone\u2019s remodeling capacity\u2014two mechanisms: overuse of normal bone (fatigue fracture\u2014athletes, military personnel, dancers) and normal stress on weakened bone (insufficiency fracture\u2014osteoporosis, corticosteroid therapy); common sites of stress fractures: metatarsals (2nd and 3rd \u2014 excessive walking + beginning of training) + calcaneus (military recruits) + tibia (runners \u2014 progressive medial tibial pain) + fibula + femoral neck (do not miss \u2014 risk of progression to a displaced complete fracture if not unloaded) + sacral vertebrae (osteoporotic insufficiency \u2014 gluteal pain) + navicular bone (sports); diagnosis: initial X-ray often normal in the first 2\u20133 weeks (sensitivity 50\u201370% in the early stage) \u2192 MRI (gold standard \u2014 sensitivity and specificity >90% from day 3\u2013day 7) + bone scan (sensitive but not very specific) + CT scan (visualizes the line if MRI is unavailable); treatment of stress fractures: low risk (metatarsals + fibula + tibia, low-energy): partial weight-bearing + rigid shoe + cessation of sports activity for 4\u20136 weeks + gradual return to activity; high risk (femoral neck + navicular bone + base of the 5th metatarsal + sesamoid bones + anterior tibial isthmus): no weight-bearing + urgent MRI + orthopedic consultation \u2192 surgery if complete fracture or high risk of displacement (percutaneous screws in the femoral neck for fatigue fractures of the neck); factors contributing to stress fractures: the female athlete triad: energy deficit + amenorrhea + osteoporosis \u2014 RED-S (relative energy deficiency in sport): screening and nutritional + hormonal + psychological management; Pathological fractures: definition: a fracture occurring in a pathologically weakened bone (neoplasm + multiple myeloma + Paget\u2019s disease + bone cyst + fibrous dysplasia + severe osteomalacia) following minimal or no trauma; suggestive signs: fracture from disproportionate trauma + osteolytic lesion visible on X-ray + pre-existing chronic bone pain + known neoplastic history or risk factors (smoking + breast\/prostate\/lung\/kidney\/thyroid cancer \u2014 the 5 cancers most likely to metastasize to bone); workup: CT scan + MRI of the bone segment + whole-body bone scan (to detect multiple lesions) + FDG-PET + laboratory workup (complete blood count + serum protein electrophoresis + PSA + CA15-3 + other markers as clinically indicated) + biopsy of the lesion if histology is unknown<\/td>\n <td>Management of pathological fractures: prophylactic osteosynthesis: indicated before a complete fracture occurs if the lesion presents a high risk of imminent fracture \u2014 Mirels criteria (score of 0 to 12, including location, nature, and size of the lesion, plus pain): score \u22659 \u2192 prophylactic surgery; established pathological fracture: surgical stabilization (intramedullary nailing + endoprosthesis) to allow mobility + improve quality of life + facilitate locoregional radiation therapy (radiation therapy on an unstable bone metastasis cannot precede surgery\u2014risk of intraoperative fracture); palliative radiotherapy: after surgical stabilization \u2192 control of bone pain (efficacy 70\u201380% %) + reduction in the risk of local progression; systemic treatments: IV bisphosphonates (zoledronic acid 4 mg IV every 3\u20134 weeks) + denosumab (Xgeva \u2014 120 mg SC every 4 weeks) \u2192 reduction in skeletal events (fractures, spinal cord compression, and need for bone surgery) in bone metastases from solid carcinomas and multiple myeloma + monitoring: serum calcium + creatinine before each dose of zoledronic acid (risk of nephrotoxicity) + dental evaluation before initiation (osteonecrosis of the jaw is more common at oncological doses than at anti-osteoporotic doses); pathological vertebral fracture with imminent or established spinal cord compression: neurosurgical emergency \u2192 decompression + stabilization + corticosteroids (dexamethasone 10 mg IV bolus + 4 mg \u00d7 4\/day) + stereotactic (SBRT) or conventional radiation therapy according to the oncology protocol<\/td>\n <\/tr>\n <tr>\n <td>Consolidation, rehabilitation, and late complications<br><small style=\"font-weight:400;color:#7a8fa0;\">Physical therapy \u2014 osteitis \u2014 malunion<\/small><\/td>\n <td>Functional rehabilitation is an integral part of fracture treatment\u2014it should ideally begin within the first few days of care to prevent complications from immobilization and optimize functional outcomes; Principles of post-fracture rehabilitation: early mobilization of non-immobilized joints (prevention of joint stiffness + stimulation of circulation) + isometric muscle contractions while in a cast (prevention of muscle atrophy) + progressive weight-bearing under the supervision of a physical therapist based on the type of fracture and the treatment performed + objectives: restoration of full joint range of motion + muscle strength + proprioception + functional endurance; timing of weight-bearing based on treatment: diaphyseal femur fracture under CCM: walking with partial weight-bearing on Days 1\u20133 + full weight-bearing on Days 30\u201360 + tibial fracture under CCM: partial weight-bearing on Days 7\u201314 + full weight-bearing on Days 30\u201345 + hip fracture under total prosthesis: full weight-bearing on postoperative Day 1 (RAAC protocol \u2014 enhanced recovery after surgery) + wrist fracture in a cast: mobilization of the fingers starting on Day 1 + of the adjacent joints upon cast removal (Days 42\u201360); late complications of bone healing: malunion: union in an anatomically incorrect position (angulation + shortening + rotation) \u2192 consequences: leg length discrepancy (shortening >2 cm \u2192 gait disturbance) + early osteoarthritis if intra-articular malunion + functional impairment \u2192 treatment: corrective osteotomy (recuts the bone to realign it) if significant functional impairment; pseudarthrosis (nonunion): lack of union at 9\u201312 months \u2014 Weber-Cech classification: hypertrophic (preserved vascularization \u2014 mechanical instability \u2192 rigid osteosynthesis) + atrophic (insufficient vascularization \u2192 osteosynthesis + bone graft + growth factors) + ultrasound stimulation (LIPUS) or electrostimulation; osteitis (post-fracture bone infection): primary risk associated with open fractures + bone surgeries \u2192 Staphylococcus aureus predominant + MRSA in nosocomial settings \u2192 prolonged antibiotic therapy (6\u201312 weeks) guided by culture + surgical debridement + removal of osteosynthesis hardware if possible (after union) + reconstruction (bone graft + bone transport \u2014 Ilizarov method \u2014 if significant bone loss)<\/td>\n <td>Complex Regional Pain Syndrome (CRPS \u2014 formerly reflex sympathetic dystrophy): a feared complication of fractures (wrist+++): disproportionate pain + allodynia + edema + trophic disorders (smooth shiny skin or hyperpigmented skin + abnormal sweating) + local osteoporosis on scintigraphy (CRPS type I \u2014 without identifiable nerve lesion) \u2014 risk factors: prolonged immobilization + anxiety + smoking + wrist fracture in menopausal women \u2014 treatment: physical therapy in balneotherapy + gentle desensitizing mobilization + medications: gabapentin + NSAIDs + calcitonin (nasal spray 200 IU\/day \u00d7 4 weeks \u2014 limited data) + IV bisphosphonates (pamidronate 30 mg \u00d7 3 infusions \u2014 some positive studies) + sympathectomy or stellate ganglion blocks if refractory CRPS; prevention of post-fracture thromboembolic complications: deep vein thrombosis + pulmonary embolism \u2192 high risk for lower limb and pelvic fractures \u2192 prophylactic LMWH (enoxaparin 40 mg SC\/day) upon admission + until full weight-bearing + duration: 10\u201314 days for surgically treated fractures + 35 days for hip or knee replacement; elastic compression stockings + early mobilization + ankle exercises + hydration; nutrition and bone healing: protein 1.2\u20131.5 g\/kg\/day (essential for collagen matrix formation) + calcium 1,200 mg\/day + vitamin D 800\u20132,000 IU\/day + zinc + vitamin C (co-factor for collagen synthesis) + smoking cessation (significantly improves healing); Quebec resources: orthopedic emergencies at university hospitals + private orthopedic clinics + certified physical therapists in orthopedic rehabilitation + ERAS programs at university hospitals for arthroplasties<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span><strong>Fatigue fracture of the femoral neck \u2014 overlooked emergency:<\/strong> A stress fracture of the femoral neck is a serious injury that is often overlooked because the initial X-ray is normal in more than 50% of cases. It primarily affects long-distance runners, military personnel, and women with the "athlete's triad." Weight-bearing must be immediately prohibited upon clinical suspicion (groin pain \u00b1 pain with hip internal rotation), and an MRI must be performed urgently. Failure to provide prompt treatment can lead to a displaced comminuted fracture requiring a hip replacement, with all the associated long-term functional consequences.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations requiring urgent care<\/div>\n <p><strong>Open fracture (bone visible or communicating wound)<\/strong> \u2192 orthopedic emergencies \u2192 irrigation + surgical debridement + IV antibiotics within 6\u20138 hours.<\/p>\n <p><strong>Fracture + absent distal pulse or disproportionate pain + paresthesias + tense compartment<\/strong> \u2192 vascular lesion or compartment syndrome \u2192 immediate surgery (fasciotomy or vascular repair).<\/p>\n <p><strong>Spinal fracture with neurological deficit (limb weakness + sphincter dysfunction)<\/strong> \u2192 Spinal cord compression \u2192 Neurosurgical emergency \u2192 Spine MRI + IV dexamethasone + surgery or radiotherapy depending on etiology.<\/p>\n <p><strong>Thigh or hip pain in a runner + normal X-ray<\/strong> \u2192 Stress fracture of the femoral neck to rule out \u2192 MRI urgently + immediate weight bearing.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron physicians assess bone trauma, refer to orthopedic emergencies if necessary, and provide follow-up care for fractures undergoing orthopedic treatment (radiological check-ups, cast monitoring, prescription of physical therapy). The investigation and treatment of osteoporosis following a fragility fracture\u2014including bone densitometry, FRAX score calculation, and prescription of anti-osteoporotic agents\u2014are an integral part of the care provided at several service points in Quebec and via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is for informational purposes only and does not replace the evaluation of a doctor or orthopedic surgeon. Any suspected fracture requires medical consultation and an X-ray.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Fracture : types, diagnostic et traitement | Clinique Omicron Orthop\u00e9die & M\u00e9decine d’urgence & M\u00e9decine de famille Fracture Une fracture est une interruption de la continuit\u00e9 d’un os, totale ou partielle, survenant lorsqu’une force m\u00e9canique d\u00e9passe la r\u00e9sistance du tissu osseux. Elle constitue l’une des blessures les plus fr\u00e9quentes en m\u00e9decine \u2014 on estime qu’une… <a href=\"https:\/\/cliniqueomicron.ca\/en\/fracture\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Fracture: Types, Diagnosis, and Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Fracture : types, diagnostic et | Brossard | Clinique Omicron","_metasync_otto_description":"Une fracture est une rupture de la continuit\u00e9 osseuse. 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\n\t\t\t\t\t\n\n\n\n\nFracture: Types, Diagnosis, and Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"A fracture is a break in the continuity of bone. Types, radiological diagnosis, orthopedic or surgical treatment, and rehabilitation in Quebec.\">\n<meta name=\"keywords\" content=\"fracture traitement, fracture os diagnostic, fracture chirurgie orthop\u00e9die, fracture pl\u00e2tre immobilisation, fracture ost\u00e9oporose, fracture de stress, fracture consolidation Qu\u00e9bec, fracture urgence\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap * { font-family: 'Poppins', sans-serif; box-sizing: border-box; }\n.co-wrap { max-width: 1100px; margin: 0 auto; padding: 30px 0 60px; }\n.co-label { font-family: 'Cinzel', serif; font-size: 14px; font-weight: bold; letter-spacing: 1px; text-transform: uppercase; color: #4D6577; margin-bottom: 14px; display: block; }\n.co-wrap h1 { font-size: 32px; font-weight: 500; color: #323C52; margin: 0 0 22px; line-height: 1.2; }\n.co-intro { font-size: 16px; line-height: 1.75; color: #4D6577; margin-bottom: 36px; padding-bottom: 32px; border-bottom: 1px solid rgba(77,101,119,.2); }\n.co-wrap h2 { font-size: 20px; font-weight: 600; color: #323C52; margin: 32px 0 12px; }\n.co-wrap p { font-size: 15px; color: #4D6577; line-height: 1.7; margin-bottom: 14px; }\n.co-list { list-style: none; padding: 0; margin: 12px 0 24px; }\n.co-list li { font-size: 15px; color: #4D6577; padding: 10px 14px 10px 38px; margin-bottom: 8px; border-radius: 6px; position: relative; background: rgba(77,101,119,.06); border-left: 3px solid #4D6577; }\n.co-list li::before { content: \"\u2713\"; position: absolute; left: 12px; font-weight: 700; color: #4D6577; }\n.co-table { width: 100%; border-collapse: collapse; margin: 14px 0 22px; font-size: 14px; border-radius: 8px; overflow: hidden; table-layout: fixed; }\n.co-table thead tr { background: #323C52; color: #fff; }\n.co-table thead th { padding: 11px 16px; text-align: left; font-weight: 600; font-size: 13px; }\n.co-table tbody tr:nth-child(even) { background: rgba(77,101,119,.06); }\n.co-table tbody tr:nth-child(odd) { background: #fff; }\n.co-table td { padding: 10px 16px; color: #4D6577; border-bottom: 1px solid rgba(77,101,119,.12); font-size: 14px; vertical-align: top; }\n.co-table td:first-child { font-weight: 600; color: #323C52; }\n.co-infobox { display: flex; gap: 12px; background: rgba(77,101,119,.06); border-radius: 8px; border-left: 4px solid #4D6577; padding: 14px 18px; margin: 18px 0 28px; font-size: 14px; color: #4D6577; line-height: 1.65; }\n.co-infobox .ico { font-size: 18px; flex-shrink: 0; }\n.co-urgence { background: #fff8f8; border-left: 5px solid #c0392b; border-radius: 6px; padding: 20px 26px; margin: 24px 0 32px; }\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Orthopedics & Emergency Medicine & Family Medicine<\/span>\n <h1>Fracture<\/h1>\n\n <div class=\"co-intro\">\n A fracture is an interruption of the continuity of a bone, either total or partial, that occurs when a mechanical force exceeds the resistance of bone tissue. It is one of the most common injuries in medicine\u2014an estimated fracture occurs every 3 seconds worldwide\u2014and is a major cause of emergency room visits, hospitalization, and long-term morbidity, particularly in elderly patients with osteoporosis. Bone tissue is a living tissue, continuously remodeled by osteoblasts (formation) and osteoclasts (resorption), and possesses a remarkable healing capacity: bone healing occurs in four phases\u2014the inflammatory phase (days 0\u20137: fracture hematoma + cell recruitment), the soft callus phase (days 7\u201321: fibrocartilaginous callus), the hard callus phase (days 21\u201360: callus ossification), and the remodeling phase (months to years: mineralization + restoration of cortical architecture). The strength and speed of healing depend on the patient's age (children heal faster), the fracture location, the fracture pattern (spiral or oblique fractures heal faster than transverse ones), residual displacement, local vascularization, nutritional status (calcium, vitamin D, proteins), smoking (significantly delays healing), and the presence of osteoporosis or underlying bone disease. Fracture management is based on three fundamental principles: reduction (restoring fragments to proper alignment), containment (maintaining reduction during healing), and rehabilitation (restoring function).\n <\/div>\n\n <h2>Classification, diagnosis, and initial assessment<\/h2>\n <ul class=\"co-list\">\n <li><strong>Fracture Classification \u2014 Essential Clinical Terminology<\/strong> Based on skin integrity: Closed fracture (intact skin \u2013 no communication with the outside) vs. Open fracture (communication between the fracture site and the outside via a skin wound) \u2013 Gustilo-Anderson classification for open fractures: Grade I (wound 10 cm or massive contamination): IIIa (adequate bone coverage) + IIIb (skin and soft tissue loss + exposed bone) + IIIc (associated vascular injury requiring repair) \u2013 an open fracture is a surgical emergency; Based on fracture line: Transverse (perpendicular to the long axis of the bone \u2013 direct trauma) + Oblique (angular force) + Spiral or helical (twisting \u2013 typical of rotational fractures) + Comminuted (multiple fragments \u2013 high-energy trauma) + Impacted or compressed (spongy bone \u2013 vertebrae + talus + tibial plateau) + Greenstick (incomplete fracture in children \u2013 one side of the cortex intact) + Buckle \/ Torus (barrel-shaped deformation of the cortex without rupture \u2013 child); Based on displacement: Non-displaced (al) + Displaced (varus\/valgus + overriding + angulation + rotation) \u2013 displacement influences treatment choice; Based on etiology: Traumatic fracture (high or low energy) + Fatigue or stress fracture (repeated microtrauma without a single trauma \u2013 runners + military personnel + severe osteoporosis) + Pathological fracture (bone weakened by an underlying disease: osteoporosis + metastasis + myeloma + Paget's disease + bone cyst); Specific fractures in children: Greenstick fracture + Torus fracture + Salter-Harris epiphyseal separations (Salter-Harris classification I to V based on physeal plate involvement \u2013 classification influences growth prognosis) \u2013 any fracture in a child should raise suspicion of abuse if the mechanism is inconsistent with the injury.<\/li>\n <li><strong>Clinical and radiological diagnosis:<\/strong> Clinical examination: sharp pain localized at the fracture site (cardinal sign) + visible deformity (angulation + shortening + rotation) + swelling + hematoma + bone crepitus on palpation (do not intentionally reproduce\u2014painful + unnecessary + displaces the fragments) + functional impairment + systematic distal neurovascular assessment (distal pulse + sensation + motor function\u2014always before and after any reduction maneuver); standard X-rays (two mandatory perpendicular views\u2014anterior-posterior + lateral, plus 3\/4 views depending on location): include the joint above and below on X-rays of long bones (risk of associated fracture or unrecognized dislocation) \u2014 non-displaced or greenstick fractures may be difficult to visualize \u2014 repeat on days 8\u201310 if there is strong clinical suspicion with a normal initial X-ray (edema and early bone resorption make the fracture line visible later); additional imaging depending on the context: MRI (gold standard for occult fractures + non-displaced femoral neck fractures + pathological bone lesions + stress fractures) \u2014 CT scan: indicated for complex fractures (pelvis + spine + tibial plateau + calcaneus + acetabulum + intra-articular fractures) + preoperative evaluation + occult fractures if MRI is unavailable + traumatic cervical fractures (NEXUS + Canadian C-Spine Rule) \u2014 bone scintigraphy: stress fractures + metastases + occult fractures if MRI is unavailable; clinical decision rules (to avoid unnecessary X-rays): Ottawa Ankle Rules: X-ray mandatory if malleolar pain + inability to bear weight \u00d7 4 steps or tenderness over the last 6 cm of the malleoli or the posterior edge of the base of the 5th metatarsal or the navicular bone \u2014 sensitivity 97\u2013100 % for significant fracture + allows for the avoidance of 30\u201340 % ankle X-rays<\/li>\n <li><strong>Neurovascular assessment and immediate complications not to be missed:<\/strong> Systematic assessment of distal neurovascular status before and after any procedure: radial pulse (humerus fracture + elbow) + femoral pulse + popliteal pulse + posterior tibial pulse + foot pulse (femur fracture + knee + tibia) + capillary refill time + sensation and motor function in at-risk nerve territories depending on the location; associated nerve injuries depending on location: proximal humerus fracture \u2192 axillary nerve (deltoid test + sensation in the shoulder stump) + diaphyseal humerus fracture \u2192 radial nerve (wrist extension test + finger extensors \u2014 drop hand) + supracondylar humerus fracture (children +++) \u2192 median nerve (distal interphalangeal flexion of the index finger = testing of the anterior interosseous nerve \u2014 OK sign) + radial nerve + humeral artery (vascular emergency) + fracture of the fibular neck \u2192 common peroneal nerve (testing of dorsiflexion + eversion of the foot \u2014 drop foot); compartment syndrome: surgical emergency \u2014 abnormally high pressure within a fascial compartment following post-traumatic edema or a hematoma \u2192 irreversible muscle and nerve ischemia if not treated within 6 hours \u2014 at-risk sites: leg (4 compartments) + forearm (3 compartments) + foot + thigh + arm \u2014 classic signs (5 P\u2019s): Pain (disproportionate pain + worsened by passive stretching of the compartment muscles) + Paresthesias + Pallor + Pulselessness + Paralysis (late-onset) \u2014 treatment: emergency surgical fasciotomy \u2014 measurement of intracompartmental pressure: >30 mmHg or delta P (systolic blood pressure \u2013 compartmental pressure) <30 mmHg = indication for surgery; fat embolism: a rare complication of long bone fractures (femur +++) and pelvic fractures \u2192 fat marrow emboli in the circulation \u2192 triad: acute respiratory failure + neurological symptoms + petechiae (trunk + conjunctiva) \u2192 24\u201372 hours after trauma + treatment: supportive care + early surgical stabilization of fracture sites (reduction of intraosseous bleeding)<\/li>\n <\/ul>\n\n <h2>Management of Major Fractures<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:200px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Type of fracture<\/th><th>Treatment and Techniques<\/th><th>Follow-up, consolidation, and complications<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Orthopedic treatment \u2014 immobilization<br><small style=\"font-weight:400;color:#7a8fa0;\">Plaster cast \u2014 splint \u2014 functional brace<\/small><\/td>\n <td>Orthopedic (non-surgical) treatment is indicated for fractures without displacement or with acceptable displacement after reduction, in locations where immobilization allows for proper healing without major functional risk; manual reduction (closed reduction) under local anesthesia, sedation, or general anesthesia: traction + counter-traction along the axis + specific corrective maneuver depending on the type of displacement \u2192 immediate post-reduction radiographic assessment + post-reduction neurovascular examination; plaster immobilization: circular cast: rigid immobilization + do not apply a circular cast within 24\u201348 hours after acute trauma (risk of compression due to edema \u2192 compartment syndrome) \u2014 emergency plaster splint (back-supported) followed by a circular cast at 48\u201372 hours once edema has stabilized; types of immobilization based on location: wrist fracture (Colles + Pouteau-Colles + Smith): splint followed by an antebrachial-palmar below-elbow cast \u00d7 4\u20136 weeks + position in slight palmar flexion and ulnar deviation (Colles) + radiographic follow-up at days 5\u201310 and day 21 to detect secondary displacement (common); metatarsal fractures (except Jones\u2019 fifth metatarsal): rigid walking shoe (post-op shoe) + weight-bearing permitted + 4\u20136 weeks; clavicle fracture (without displacement or with moderate displacement): simple sling \u00d7 3\u20134 weeks + early pendulum rehabilitation; fracture of the upper humerus (non-displaced, two-part): simple splint + pendulum rehabilitation starting on days 7\u201314; fracture of the radial neck (radial head \u2014 Mason I\u2013II): sling \u00d7 2\u20133 weeks + early mobilization + early pronosupination (to prevent stiffness); functional brace (Sarmiento): removable sleeve made of thermoplastic material \u2014 non-displaced or minimally displaced humeral diaphyseal fracture \u2014 allows for early mobilization of the shoulder and elbow \u2192 union rate 95\u201398% % + excellent functional outcomes<\/td>\n <td>Monitoring of orthopedic treatment: routine follow-up X-rays: Days 5\u201310 (secondary displacement under the cast\u2014common in unstable fractures) + Day 21 (early bone healing\u2014visible callus) + Days 42\u201360 (complete bone healing)\u2014criteria for urgent follow-up while in a cast: severe, unrelenting pain + tingling + numbness + blue or cold skin under the cast \u2192 urgent consultation \u2192 removal and assessment for compartment syndrome; Duration of immobilization depending on location and age: cancellous bone (vertebrae + foot bones + wrist): 4\u20136 weeks + long bones of the upper limbs (forearm + humerus): 6\u20138 weeks + long bones of the lower limbs (tibia + femur): 8\u201312 weeks + children: duration reduced by 30\u201350% (faster healing) + patients with osteoporosis: duration potentially increased + poor healing to be monitored; secondary displacement under cast: high risk within the first 10\u201314 days \u2192 routine radiographic follow-up at 8\u201310 days + if displacement is unacceptable \u2192 discuss surgery (percutaneous nailing + osteosynthesis) + criteria for acceptable residual displacement vary by location: wrist (Colles): dorsal angulation <10\u00b0 + radial shortening <5 mm + radial deviation <5\u00b0; tibia: angulation <5\u00b0 in all planes + shortening <12 mm + rotation <10\u00b0; delayed union and pseudarthrosis: delayed union = absence of radiographic signs of union beyond the usual timeframe (\u00d7 1.5) + pseudarthrosis = absence of union at 9\u201312 months despite proper treatment \u2192 risk factors: smoking (delays union by 4\u20136 weeks) + malnutrition + osteoporosis + infection + insufficient blood supply + residual displacement + instability of the fracture site \u2192 treatment: osteosynthesis + bone grafting + electrical or ultrasound stimulation (LIPUS \u2014 low-intensity pulsed ultrasound)<\/td>\n <\/tr>\n <tr>\n <td>Surgical treatment \u2014 osteosynthesis<br><small style=\"font-weight:400;color:#7a8fa0;\">Nailing \u2014 plate screw \u2014 percutaneous screws<\/small><\/td>\n <td>Surgical treatment is indicated for unstable displaced fractures that cannot be managed with conservative orthopedic treatment, intra-articular fractures requiring anatomical reduction, open fractures, and fractures of the lower extremities in active adults (allowing for early weight-bearing); intramedullary nailing (intramedullary nail \u2014 IMN): the gold standard technique for diaphyseal fractures of long bones (femur, tibia, and humerus)\u2014insertion of a metal nail into the bone\u2019s medullary canal + proximal and distal locking with transverse screws \u2192 rotational and axial stability \u2192 early weight-bearing \u2192 union under physiological stress\u2014diaphyseal femoral fracture: CCM in deferred emergency cases (6\u201324 hours to optimize hemodynamics) \u2014 locked CCM \u2192 partial weight-bearing on Day 1 + full weight-bearing on Days 30\u201345 \u2014 union rate 95\u201398% at 12 months; screw-fixed plate osteosynthesis: indications: metaphyseal + epiphyseal + intra-articular fractures + displaced clavicle fractures + complex proximal humerus fractures + displaced distal radius fractures + bimalleolar ankle fractures + locking compression plates (LCP): dual compression mechanism + angular locking \u2192 superior stability in osteoporotic bone; Percutaneous screws (closed-system osteosynthesis): cross-shaped calcaneal fractures + fractures of the base of the 5th metatarsal + medial malleolar fractures + scaphoid fractures + cannulated screws for the upper femur (non-displaced femoral neck fractures in young patients); external fixator: indicated as an emergency measure for Gustilo grade II\u2013III open fractures (temporary stabilization of the fracture site prior to definitive osteosynthesis) + unstable pelvic fractures + complex lower extremity fractures with soft tissue injuries + multiple trauma (damage control orthopedics)<\/td>\n <td>Fractures requiring urgent or delayed emergency surgery: open fracture: surgical irrigation + debridement + stabilization of the fracture site within 6\u20138 hours (optimal timeframe) \u2192 prophylactic IV antibiotics (cefazolin + gentamicin if Grade III) \u2192 delayed skin closure at 48\u201372 hours unless clean Grade I \u2192 risk of bone infection (osteitis) directly related to the delay in treatment and the Gustilo grade; displaced femoral neck fracture in the elderly (Garden III\u2013IV): hip replacement (hemiarthroplasty or total hip replacement depending on biological age + activity level + life expectancy) within 24\u201348 hours \u2192 reduced 1-year mortality if surgery is performed within 48 hours (1-year mortality: 25\u201330% in adults >80 years old even after optimal surgery) \u2192 systematic postoperative anticoagulation (LMWH + transition to DOACs \u2014 duration 35 days after hip replacement) + physical therapy on postoperative day 1; displaced supracondylar humeral fracture in children (Gartland type III): emergency percutaneous pinning (2 divergent Kirschner wires) + cast with elbow flexed at 90\u00b0 \u00d7 3 weeks \u2014 feared complication: forearm ischemia (humeral artery) + median nerve (anterior interosseous) \u2192 emergency pin removal + vascular exploration if pallor + loss of radial pulse; acetabular fracture + unstable pelvic fracture (Tile C): elective surgery within 5\u20137 days (after hemodynamic stabilization and patient stabilization) + emergency external fixator if hemodynamic instability due to rupture of the presacral veins; total arthroplasty (prosthesis): femoral neck fracture in the elderly adult + irreducible comminuted fracture of the humeral head + pathological fracture involving a loosened prosthesis<\/td>\n <\/tr>\n <tr>\n <td>Osteoporotic fractures<br><small style=\"font-weight:400;color:#7a8fa0;\">Wrist \u2014 vertebra \u2014 hip \u2014 shoulder<\/small><\/td>\n <td>Osteoporotic fractures\u2014also known as fragility fractures\u2014occur as a result of low-energy trauma (a fall from standing height) to a bone whose mineral density and microarchitectural quality have been compromised by osteoporosis; epidemiology in Quebec: 1 in 3 women and 1 in 5 men over the age of 50 will suffer an osteoporotic fracture during their lifetime\u2014hip fractures result in a mortality rate of 20\u201325% of cases within 1 year + permanent loss of independence in 30\u201340% of cases among the elderly \u2014 a major economic burden for the Quebec healthcare system; most common osteoporotic fractures: distal wrist fracture (Colles \u2014 the most common before age 65 \u2014 fall onto an outstretched palm) + vertebral compression fracture (the most common fracture after age 65 \u2014 often asymptomatic + discovered incidentally on a chest X-ray or bone densitometry) + femoral neck fracture and trochanteric fracture (the most serious\u201480,000 hip fractures\/year in Canada) + proximal humerus fracture (3rd most common); post-fracture evaluation: bone densitometry (DEXA): mandatory after any fragility fracture \u2014 T-score (comparison to a young adult of the same sex): osteoporosis <\u22122.5 + osteopenia \u22122.5 to \u22121.0 + normal >\u22121.0; Laboratory workup: serum calcium + serum phosphorus + 25-OH-vitamin D + PTH + complete blood count (CBC) + TSH + protein electrophoresis (myeloma) + creatinine + alkaline phosphatase + CTX (C-telopeptide \u2014 marker of bone resorption) + testosterone (men) + liver function tests; FRAX (Fracture Risk Assessment Tool \u2014 WHO): calculation of the 10-year absolute risk of major fracture and 10-year risk of hip fracture \u2014 includes: age + sex + BMI + personal and family history of fracture + smoking + alcohol + corticosteroid therapy + rheumatoid arthritis + secondary causes of osteoporosis + femoral T-score \u2014 pharmacological treatment threshold recommended by Osteoporosis Canada: 10-year risk of major fracture >20 % or 10-year risk of hip fracture >3 %<\/td>\n <td>Treatment of osteoporosis following a fragility fracture \u2014 FLS (Fracture Liaison Service) program: calcium + vitamin D supplementation: calcium 1,200 mg\/day (diet + supplement if intake is insufficient) + vitamin D 800\u20132,000 IU\/day (target 25-OH-D >75 nmol\/L) \u2014 bisphosphonates (first-line anti-osteoporotic treatment): alendronate (Fosamax) 70 mg\/week PO \u2014 risedronate (Actonel) 35 mg\/week or 150 mg\/month PO \u2014 zoledronate (Aclasta \u2014 Reclast) 5 mg IV annually (first-line option if gastrointestinal intolerance or oral non-compliance) \u2014 duration of treatment: 3\u20135 years + benefit\/risk reassessment (discontinuation of bisphosphonate therapy if moderate risk after 5 years + continuation if high risk) + rare adverse effects: osteonecrosis of the jaw (very low risk <0.001 per 10,000 patients \u2014 to be distinguished from higher doses used in oncology) + atypical femoral fracture (subtrochanteric diaphyseal \u2014 warning sign: bilateral thigh pain + thickened lateral cortex on X-ray); denosumab (Prolia): anti-RANKL monoclonal antibody \u2014 60 mg SC every 6 months \u2014 second-line treatment or if bisphosphonates are contraindicated (renal failure \u2014 eGFR <30) + do not stop abruptly (rebound cascade of vertebral fractures if stopped without bisphosphonate bridging therapy); risedronate or zoledronate IV in cases of hip fracture: start within 2\u201312 weeks post-surgery (after healing); teriparatide (Forteo): recombinant PTH \u2014 20 \u00b5g SC\/day \u00d7 24 months \u2014 bone anabolic agent \u2014 reserved for severe osteoporosis with multiple vertebral fractures or inadequate response to anti-osteoclastics \u2014 reimbursed by RAMQ under exceptional criteria; FLS program in Quebec: fracture liaison service (FLS) \u2014 nurse coordinators at the university hospital + automatic communication between the emergency department and the attending physician following a fragility fracture \u2192 initiation of anti-osteoporotic treatment within 3 months post-fracture (post-fracture treatment rate in Canada without FLS: 20% % \u2192 with FLS: 70\u201380% %)<\/td>\n <\/tr>\n <tr>\n <td>Stress fractures and pathological fractures<br><small style=\"font-weight:400;color:#7a8fa0;\">Overwork \u2014 neoplasm \u2014 loading prohibited<\/small><\/td>\n <td>Stress (fatigue) fractures: occur without a single traumatic event\u2014result from repeated microtrauma exceeding the bone\u2019s remodeling capacity\u2014two mechanisms: overuse of normal bone (fatigue fracture\u2014athletes, military personnel, dancers) and normal stress on weakened bone (insufficiency fracture\u2014osteoporosis, corticosteroid therapy); common sites of stress fractures: metatarsals (2nd and 3rd \u2014 excessive walking + beginning of training) + calcaneus (military recruits) + tibia (runners \u2014 progressive medial tibial pain) + fibula + femoral neck (do not miss \u2014 risk of progression to a displaced complete fracture if not unloaded) + sacral vertebrae (osteoporotic insufficiency \u2014 gluteal pain) + navicular bone (sports); diagnosis: initial X-ray often normal in the first 2\u20133 weeks (sensitivity 50\u201370% in the early stage) \u2192 MRI (gold standard \u2014 sensitivity and specificity >90% from day 3\u2013day 7) + bone scan (sensitive but not very specific) + CT scan (visualizes the line if MRI is unavailable); treatment of stress fractures: low risk (metatarsals + fibula + tibia, low-energy): partial weight-bearing + rigid shoe + cessation of sports activity for 4\u20136 weeks + gradual return to activity; high risk (femoral neck + navicular bone + base of the 5th metatarsal + sesamoid bones + anterior tibial isthmus): no weight-bearing + urgent MRI + orthopedic consultation \u2192 surgery if complete fracture or high risk of displacement (percutaneous screws in the femoral neck for fatigue fractures of the neck); factors contributing to stress fractures: the female athlete triad: energy deficit + amenorrhea + osteoporosis \u2014 RED-S (relative energy deficiency in sport): screening and nutritional + hormonal + psychological management; Pathological fractures: definition: a fracture occurring in a pathologically weakened bone (neoplasm + multiple myeloma + Paget\u2019s disease + bone cyst + fibrous dysplasia + severe osteomalacia) following minimal or no trauma; suggestive signs: fracture from disproportionate trauma + osteolytic lesion visible on X-ray + pre-existing chronic bone pain + known neoplastic history or risk factors (smoking + breast\/prostate\/lung\/kidney\/thyroid cancer \u2014 the 5 cancers most likely to metastasize to bone); workup: CT scan + MRI of the bone segment + whole-body bone scan (to detect multiple lesions) + FDG-PET + laboratory workup (complete blood count + serum protein electrophoresis + PSA + CA15-3 + other markers as clinically indicated) + biopsy of the lesion if histology is unknown<\/td>\n <td>Management of pathological fractures: prophylactic osteosynthesis: indicated before a complete fracture occurs if the lesion presents a high risk of imminent fracture \u2014 Mirels criteria (score of 0 to 12, including location, nature, and size of the lesion, plus pain): score \u22659 \u2192 prophylactic surgery; established pathological fracture: surgical stabilization (intramedullary nailing + endoprosthesis) to allow mobility + improve quality of life + facilitate locoregional radiation therapy (radiation therapy on an unstable bone metastasis cannot precede surgery\u2014risk of intraoperative fracture); palliative radiotherapy: after surgical stabilization \u2192 control of bone pain (efficacy 70\u201380% %) + reduction in the risk of local progression; systemic treatments: IV bisphosphonates (zoledronic acid 4 mg IV every 3\u20134 weeks) + denosumab (Xgeva \u2014 120 mg SC every 4 weeks) \u2192 reduction in skeletal events (fractures, spinal cord compression, and need for bone surgery) in bone metastases from solid carcinomas and multiple myeloma + monitoring: serum calcium + creatinine before each dose of zoledronic acid (risk of nephrotoxicity) + dental evaluation before initiation (osteonecrosis of the jaw is more common at oncological doses than at anti-osteoporotic doses); pathological vertebral fracture with imminent or established spinal cord compression: neurosurgical emergency \u2192 decompression + stabilization + corticosteroids (dexamethasone 10 mg IV bolus + 4 mg \u00d7 4\/day) + stereotactic (SBRT) or conventional radiation therapy according to the oncology protocol<\/td>\n <\/tr>\n <tr>\n <td>Consolidation, rehabilitation, and late complications<br><small style=\"font-weight:400;color:#7a8fa0;\">Physical therapy \u2014 osteitis \u2014 malunion<\/small><\/td>\n <td>Functional rehabilitation is an integral part of fracture treatment\u2014it should ideally begin within the first few days of care to prevent complications from immobilization and optimize functional outcomes; Principles of post-fracture rehabilitation: early mobilization of non-immobilized joints (prevention of joint stiffness + stimulation of circulation) + isometric muscle contractions while in a cast (prevention of muscle atrophy) + progressive weight-bearing under the supervision of a physical therapist based on the type of fracture and the treatment performed + objectives: restoration of full joint range of motion + muscle strength + proprioception + functional endurance; timing of weight-bearing based on treatment: diaphyseal femur fracture under CCM: walking with partial weight-bearing on Days 1\u20133 + full weight-bearing on Days 30\u201360 + tibial fracture under CCM: partial weight-bearing on Days 7\u201314 + full weight-bearing on Days 30\u201345 + hip fracture under total prosthesis: full weight-bearing on postoperative Day 1 (RAAC protocol \u2014 enhanced recovery after surgery) + wrist fracture in a cast: mobilization of the fingers starting on Day 1 + of the adjacent joints upon cast removal (Days 42\u201360); late complications of bone healing: malunion: union in an anatomically incorrect position (angulation + shortening + rotation) \u2192 consequences: leg length discrepancy (shortening >2 cm \u2192 gait disturbance) + early osteoarthritis if intra-articular malunion + functional impairment \u2192 treatment: corrective osteotomy (recuts the bone to realign it) if significant functional impairment; pseudarthrosis (nonunion): lack of union at 9\u201312 months \u2014 Weber-Cech classification: hypertrophic (preserved vascularization \u2014 mechanical instability \u2192 rigid osteosynthesis) + atrophic (insufficient vascularization \u2192 osteosynthesis + bone graft + growth factors) + ultrasound stimulation (LIPUS) or electrostimulation; osteitis (post-fracture bone infection): primary risk associated with open fractures + bone surgeries \u2192 Staphylococcus aureus predominant + MRSA in nosocomial settings \u2192 prolonged antibiotic therapy (6\u201312 weeks) guided by culture + surgical debridement + removal of osteosynthesis hardware if possible (after union) + reconstruction (bone graft + bone transport \u2014 Ilizarov method \u2014 if significant bone loss)<\/td>\n <td>Complex Regional Pain Syndrome (CRPS \u2014 formerly reflex sympathetic dystrophy): a feared complication of fractures (wrist+++): disproportionate pain + allodynia + edema + trophic disorders (smooth shiny skin or hyperpigmented skin + abnormal sweating) + local osteoporosis on scintigraphy (CRPS type I \u2014 without identifiable nerve lesion) \u2014 risk factors: prolonged immobilization + anxiety + smoking + wrist fracture in menopausal women \u2014 treatment: physical therapy in balneotherapy + gentle desensitizing mobilization + medications: gabapentin + NSAIDs + calcitonin (nasal spray 200 IU\/day \u00d7 4 weeks \u2014 limited data) + IV bisphosphonates (pamidronate 30 mg \u00d7 3 infusions \u2014 some positive studies) + sympathectomy or stellate ganglion blocks if refractory CRPS; prevention of post-fracture thromboembolic complications: deep vein thrombosis + pulmonary embolism \u2192 high risk for lower limb and pelvic fractures \u2192 prophylactic LMWH (enoxaparin 40 mg SC\/day) upon admission + until full weight-bearing + duration: 10\u201314 days for surgically treated fractures + 35 days for hip or knee replacement; elastic compression stockings + early mobilization + ankle exercises + hydration; nutrition and bone healing: protein 1.2\u20131.5 g\/kg\/day (essential for collagen matrix formation) + calcium 1,200 mg\/day + vitamin D 800\u20132,000 IU\/day + zinc + vitamin C (co-factor for collagen synthesis) + smoking cessation (significantly improves healing); Quebec resources: orthopedic emergencies at university hospitals + private orthopedic clinics + certified physical therapists in orthopedic rehabilitation + ERAS programs at university hospitals for arthroplasties<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span><strong>Fatigue fracture of the femoral neck \u2014 overlooked emergency:<\/strong> A stress fracture of the femoral neck is a serious injury that is often overlooked because the initial X-ray is normal in more than 50% of cases. It primarily affects long-distance runners, military personnel, and women with the "athlete's triad." Weight-bearing must be immediately prohibited upon clinical suspicion (groin pain \u00b1 pain with hip internal rotation), and an MRI must be performed urgently. Failure to provide prompt treatment can lead to a displaced comminuted fracture requiring a hip replacement, with all the associated long-term functional consequences.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations requiring urgent care<\/div>\n <p><strong>Open fracture (bone visible or communicating wound)<\/strong> \u2192 orthopedic emergencies \u2192 irrigation + surgical debridement + IV antibiotics within 6\u20138 hours.<\/p>\n <p><strong>Fracture + absent distal pulse or disproportionate pain + paresthesias + tense compartment<\/strong> \u2192 vascular lesion or compartment syndrome \u2192 immediate surgery (fasciotomy or vascular repair).<\/p>\n <p><strong>Spinal fracture with neurological deficit (limb weakness + sphincter dysfunction)<\/strong> \u2192 Spinal cord compression \u2192 Neurosurgical emergency \u2192 Spine MRI + IV dexamethasone + surgery or radiotherapy depending on etiology.<\/p>\n <p><strong>Thigh or hip pain in a runner + normal X-ray<\/strong> \u2192 Stress fracture of the femoral neck to rule out \u2192 MRI urgently + immediate weight bearing.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron physicians assess bone trauma, refer to orthopedic emergencies if necessary, and provide follow-up care for fractures undergoing orthopedic treatment (radiological check-ups, cast monitoring, prescription of physical therapy). The investigation and treatment of osteoporosis following a fragility fracture\u2014including bone densitometry, FRAX score calculation, and prescription of anti-osteoporotic agents\u2014are an integral part of the care provided at several service points in Quebec and via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is for informational purposes only and does not replace the evaluation of a doctor or orthopedic surgeon. Any suspected fracture requires medical consultation and an X-ray.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Fracture : types, diagnostic et traitement | Clinique Omicron Orthop\u00e9die & M\u00e9decine d’urgence & M\u00e9decine de famille Fracture Une fracture est une interruption de la continuit\u00e9 d’un os, totale ou partielle, survenant lorsqu’une force m\u00e9canique d\u00e9passe la r\u00e9sistance du tissu osseux. Elle constitue l’une des blessures les plus fr\u00e9quentes en m\u00e9decine \u2014 on estime qu’une… <a href=\"https:\/\/cliniqueomicron.ca\/en\/fracture\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Fracture: Types, Diagnosis, and Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Fracture : types, diagnostic et | Brossard | Clinique Omicron","_metasync_otto_description":"Une fracture est une rupture de la continuit\u00e9 osseuse. Types, diagnostic radiologique, traitement orthop\u00e9dique ou chirurgical et r\u00e9habilitation au Qu\u00e9bec.","_metasync_otto_keywords":"","_metasync_otto_og_title":"Fracture : types, diagnostic et | Brossard | Clinique Omicron","_metasync_otto_og_description":"","_metasync_otto_twitter_title":"Fracture : types, diagnostic et | Brossard | Clinique Omicron","_metasync_otto_twitter_description":"Une fracture est une rupture de la continuit\u00e9 osseuse. Types, diagnostic radiologique, traitement orthop\u00e9dique ou chirurgical et r\u00e9habilitation au Qu\u00e9bec.","rank_math_title":"","rank_math_description":"","_yoast_wpseo_title":"","_yoast_wpseo_metadesc":"","_aioseo_title":"Fracture : types, diagnostic et traitement | Clinique Omicron","_aioseo_description":"Une fracture est une rupture de la continuit\u00e9 osseuse. 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