Chapter CXCI - The Nidanam of fractures

Dhanvantari said:—Now hear me, O Sushruta, discourse on the Nidanam of fractures of bone-joints (Bhagnas (Bhangas?)), which may be divided into six kinds such as, the Utpishtam (Fractures brought about through the friction of two bones), Vishlishtam (dislocation), Vivartitam (Retroversion), Tirjakgatam (obliquely turned up), Kshiptam (displacement from sockets) and Adhah-kshiptam (such displacement in a downward direction). Bone-shafts lying between two bone-joints are called Kandas, and twelve different kinds of fractures of bone-shafts (Kanda-Bhagnas) have been recognised in practice, which are called Karkataka (crab-like), Ashvakarna (horse-ear), Vichurnita (Smashed), Pichchhita (flattened) Chhallika (splintered), Kanda-bhagna (bone-fractures), Atipatitam (hung down), Majjagatam, Sphutitam, Vakra (bent) and the two kinds of Chhinnam.

Incapacity of stretching or flexing the affected limb and its inability to bear the least touch (extreme sensitiveness) form the general characteristics of all kinds of fractured bone-joints.

The fracture of a bone-joint owing to the friction between its parts is called Utpishtam, which is marked by swellings on its both sides and a constant pain, which is aggravated in the night. An excruciating pain about each side of the fractured joint forms the specific trait of a case of the Vivartitam type. An excruciating pain is experienced about the bone-joint where a bone is dislodged from its joint and remains in an oblique position (Tirjakgatam). An aching pain is experienced in the case where a bone is severed from its joint and is directed upward. An intolerable pain is felt about the affected bone-joint, and the two shafts of the bone are felt to be uneven and unequal in length in the Kshipta type of fractured bone-joint. Similarly, a broken bone, hanging down from its socket, furnishes the example of one of the Adhahkshiptam type. An aching pain is felt about the affected part and the one bone of the broken joint can be rubbed against the other.

The names of the twelve different kinds of fractured bones signify the shape and nature of the fracture in each. Looseness of the affected limb, pain and swelling about the fractured bone, a creaking sound on pressing the seat of the fracture, together with an aching, pricking pain in its inside, form the general features of all types of fractures. Impairment of digestion in a fracture-patient of a nervous temperament, fever, tympanites, suppression of the stool and urine, and want of proper care in reducing the fracture at the outset are the factors, which hinder the cure in fracture cases. Dislocation and fracture of the bones of the sacrum, as well as smashing of the bones of the thighs should be regarded as irremediable. Cases where the fractured bones have been wrongly reduced and reset at the outset should be likewise regarded as beyond all cure. The Bhanga (lit, fracture) of a bone of the Taruna class (gristle) consists in its bending or curvature, that of a bone of the Nalaka kind (hollow like tibial bones) consists in its bursting, that of a bone of the Kapala kind (like that of the forehead) consists in its breaking, while that of one of the Ruchaka kind (as a tooth) consists in its cracking or splintering.