i. Í T-
49. Axial rotation (a): A third type of deformity may be present: this is when one fragment rotates on its long axis, with or without accompanying displacement or angulation. This type of deformity may be overlooked unless precautions are taken and the possibility of its occurrence kept in mind.
50. Axial rotation (b): Radiographs which fail to show both ends of the bone frequently prevent any pronouncement on the presence of axial rotation (I). When both ends of the fractured bone arc fully visualised on one film rotation may be obvious (2). The moral is that in any fracture both the joint above and the one below should be included in the examination.
51. Axial rotation (c): Axial rotation may also be detected in the radiographs by noting ( I ) the position of interlocking fragments (displaced fracture with 90° axial rotation illustrated). If a bone is not perfectly circular in cross-section at the fracture site, differences in the relative diameters of the fragments may be suggestive of axial rotation (2). Axial rotation is of particular importancc in forearm fractures.
52. Open fractures: Open (compound) fractures are of two types: those which are open from within out. and others which are open from without in. In fractures which are open front within out. the skin is broached by the sharp edge of one of the bone ends. This may occur at the time of the initial injury, or later from unguarded handling of a closed fracture.
53. Fractures open from within out: (I)
The case may be lirsi seen with bone-obviously still penetrating the skin which may be tightly stretched round it. (2) More commonly, the fracture, having once broken the skin, promptly spontaneously reduces, so that what is seen is a wound at the level of the fracture.
54. Technically open fracture:
Occasionally the skin damage is minimal, with a small area of early bruising, in the centre of which is a tiny tell-tale bead of blood issuing from a puncture wound: this bead of bl<x>d reappears as soon as it is swabbed. The risks of infection are much less in open from within out fractures than in those from without in. This is especially so in the technically open fracture just described.
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