DRG Category: 480

Mean LOS: 8.9 days

Description SURGICAL: Hip and Femur Procedures, Except Major Joint with Major CC

DRG Category: 507

Mean LOS: 4.8 days

Description SURGICAL: Major Shoulder or Elbow Joint Procedure with CC or Major CC

DRG Category: 562

Mean LOS: 6.1 days

Description MEDICAL: Fracture, Sprain, Strain, and Dislocation Except Femur, Hip, Pelvis, and Thigh with Major CC

classification section:



The bony skeleton provides the supporting framework for the human body. Its 206 bones are subject to many stressors, which may result in fractures. Fractures vary in complexity and potential harm to the body. Simple fractures occur with no break from the bone to the outside of the body, whereas compound fractures have an external wound, thus creating contamination of the fracture. Complete fractures occur when bone continuity is completely interrupted, whereas partial fractures (incomplete) interrupt only a portion of bone continuity. Fractures can be classified by fragment position or fracture line (Table 6).

Types of Fractures

CLASSIFICATION	TYPE	DEFINITION
Fragment position	Angulated	Bone fragments are at an angle to each other
	Avulsed	Bone fragments are pulled from normal position by muscle spasms, muscle contractions, or ligament resistance
	Comminuted	Bone breaks into many small pieces
	Displaced	Bone fragments separate and are deformed
	Impacted	A bone fragment is forced into another bone or bone fragment
	Nondisplaced	After the fracture, two sections of the bone maintain normal alignment
	Overriding	Bone fragments overlap, thereby shortening the total length of the bone
	Segmental	Bone fractures occur in two areas next to each other with an isolated section in the center
Fracture line	Linear	Fracture line is parallel to the axis of the bone
	Longitudinal	Fracture line extends longitudinally but not parallel to the axis of the bone
	Oblique	Fracture line crosses the bone at a 45-degree angle to the axis of the bone
	Spiral	Fracture line coils around the bone
	Transverse	Fracture line forms a 90-degree angle to the axis of the bone

Alcohol consumption is an important cofactor when it is associated with trauma. Acute alcohol intoxication may compound a head or musculoskeletal injury by masking the effects of pain and immobility. In addition, it may modify the patient's ability to tolerate multiple traumas by having a direct cardiodepressant effect. Profound hypotension and bradycardia may result from acute blood loss in the patient with musculoskeletal injury who has been drinking heavily.

Many complications can occur as a result of musculoskeletal trauma. Arterial damage and bleeding can lead to hypovolemic shock. Nonunion of bones, avascular necrosis, bone necrosis, and peripheral nerve damage can lead to lasting deformities and disabilities. Rhabdomyolysis (destruction of skeletal muscle) can lead to renal failure, and bone injury can lead to fat emboli. Infection is the most common complication of trauma and can lead to sepsis and septic shock.