The 15th chapter of Nidanasthana of Sushruta Samhita is named as Bhagna Nidanam Adhyaya. This chapter deals with Fractures and Dislocations.

अथातो भग्नानां निदानं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Bhagna Nidana – diagnosis of Fractures and Dislocations as revealed by the venerable Dhanvantari.

 Nidana- Causes

पतनपीडनप्रहाराक्षेपणव्यालमृगदशनप्रभृतिभिरभिघातविशेषैरनेकविधमस्थ्नां भङ्गमुपदिशन्ति ||३||

Below mentioned are the causes for different kinds of bhagna (fracture of bones) –

• falling from height,
• squeezing the body greatly,
• attack / hitting,
• very vigorous movements,
• bite by wild animals and others assaults / injury

Bheda – Kinds

तत्र भङ्ग(ग्न)जातमनेकविधमनुसार्यमाणं द्विविधमेवोपपद्यते सन्धिमुक्तं, काण्डभग्नं च |
तत्र षड्विधं सन्धिमुक्तं, द्वादशविधं काण्डभग्नं भवति ||४||

There are different kinds of bhagna but all these are (grossly) of two kinds only viz

1. Sandhimukta – it is of six types and
2. Kandabhagna – it is of twelve types

 

1. Sandhimukhta (dislocation of bony joints)

तत्र सन्धिमुक्तम्- उत्पिष्टं, विश्लिष्टं, विवर्तितम्, अवक्षिप्तम्, अतिक्षिप्तं, तिर्यक्क्षिप्तमिति षड्विधम् ||५||

The six types of Sandhimukta are –

1. Utpista,
2. Vislista,
3. Vivartita,
4. Avaksipta,
5. Atiksipta, and
6. Tiryak Ksipta

Samanya Laksana – General signs and Symptoms

तत्र प्रसारणाकुञ्चनविवर्तनाक्षेपणाशक्तिरुग्ररुजत्वं स्पर्शासहत्वं चेति सामान्यं सन्धिमुक्तलक्षणमुक्तम् ||६||

The general symptoms of Sandhimukta – dislocation of joints are –

Inability to perform the below mentioned actions –

• extension,
• contraction,
• rotation and
• quick movements

Other symptoms include –

• Severe pain
• Inability to tolerate touch

Visesa Laksana – Specific symptoms of each kind of Sandhimukta

वैशेषिकं तूत्पिष्टे सन्धावुभयतः शोफो वेदनाप्रादुर्भावो विशेषतश्च नानाप्रकारा वेदना रात्रौ प्रादुर्भवन्ति; विश्लिष्टेऽल्पः शोफो वेदनासातत्यं सन्धिविक्रिया च; विवर्तिते तु सन्धिपार्श्वापगमनाद्विषमाङ्गता वेदना च; अवक्षिप्ते सन्धिविश्लेषस्तीव्ररुजत्वं च; अतिक्षिप्ते द्वयोः सन्ध्यस्थ्नोरतिक्रान्तता वेदना च; तिर्यक्क्षिप्ते त्वेकास्थिपार्श्वापगमनमत्यर्थं वेदना चेति ||७||

 

Type of Sandhimukta	Specific symptoms
Utpista	Swelling on both sides of the joint Pain Different kinds of pain, especially occurring at night time
Vislista	Slight swelling Continuous pain which occurs both at day and night Improper functioning of the joint
Vivartita	Joint shifts to any one side Distortion of that part which has shifted Pain
Avaksipta	Drooping down of the joint pain
Atiksipta	Both bones making up the joint would move apart such that a gap is created between these two bones Pain
Tiryak Ksipta	Any one bone forming the joint alone gets displaced to a side Pain

 

2. Kanda Bhagna – fracture of shafts of bones

काण्डभग्नमत ऊर्ध्वं वक्ष्यामः- कर्कटकम्, अश्वकर्णं, चूर्णितं, पिच्चितम्, अस्थिच्छल्लितं, काण्डभग्नं, मज्जानुगतम्, अतिपातितं, वक्रं, छिन्नं, पाटितं, स्फुटितमिति द्वादशविधम् ||८||

After this, different kinds of Kandabhagna – fracture of the shaft of bones will be explained –

The twelve kinds of Kandabhagna (shaft fractures) are –

• Karkataka,
• Asvakarna,
• Curnita,
• Piccita,
• Asthicchallita,
• Kandabhagana
• Majjanugata,
• Atipatita,
• Vakra,
• Chinna,
• Patita and
• Sphutita

Samanya Laksana – general symptoms-

श्वयथुबाहुल्यं स्पन्दनविवर्तनस्पर्शासहिष्णुत्वमवपीड्यमाने शब्दः स्रस्ताङ्गता विविधवेदनाप्रादुर्भावः सर्वास्ववस्थासु न शर्मलाभ इति समासेन काण्डभग्नलक्षणमुक्तम् ||९||

The general symptoms of fracture of shaft of bones in brief are –

• profound swelling,
• inability to bear tapping, rotating and touching;
• producing sound (at the site) when pulled (or squeezed),
• part of the body hanging down loosely,
• appearance of various kinds of pain, and
• not finding comfort in any position

 Visesa Laksana – special symptoms of each kind

विशेषस्तु सम्मूढमुभयतोऽस्थि मध्ये भ(ल)ग्नं ग्रन्थिरिवोन्नतं कर्कटकम्, अश्वकर्णवदुद्गतमश्वकर्णकं, स्पृश्यमानं शब्दवच्चूर्णितमवगच्छेत्, पिच्चितं पृथुतां गतमनल्पशोफं, पार्श्वयोरस्थि हीनोद्गतमस्थिच्छलितं, वेल्लते प्रकम्पमानं काण्डभग्नम्, अस्थ्यवयवोऽस्थिमध्यमनुप्रविश्य मज्जानमुन्नह्यतीति मज्जानुगतम्, अस्थि निःशेषतश्छिन्नमतिपातितम्, आभुग्नमविमुक्तास्थि वक्रम्, अन्यतरपार्श्वावशिष्टं छिन्नं, पाटितमणुबहुविदारितं वेदनावच्च, शूकपूर्णमिवाध्मातं विपुलं विस्फुटितं स्फुटितमिति ||१०||

Type of Kandabhagna	Specific symptoms
Karkataka	The two broken ends of the bone have moved apart Bulging in the middle, resembling a tumor
Asvakarna	Ends of the bones are raised up Raised parts resemble ear of the horse
Curnita	The broken bones produce sounds as though broken into pieces, when felt by hands
Piccita	The bone becomes thick and has profound swelling at the site of fracture
Asthicchallita	One part of the bone has dropped below and the other part is raised above at the site of fracture
Kanda Bhagna	The fractured bone has tremors / trembles (shaking movements) when shaken
Majjanugata	A part of piece of the bone or middle portion of the bone gets into (pierces into) the bone marrow and displaces it.
Atipatita	Entire bone is broken into pieces, without any part remaining intact
Vakra	The bone is bent inwards / has become curved without getting detached
Chinna	Bone has moved to the other side
Patita	Bone is split into many pieces Pain
Sphutita	Bone is more swollen Feels as if the bone is filled with thorns Bone is greatly split (chopped off)

Sadhyasadhyata – prognosis

तेषु चूर्णितच्छिन्नातिपातितमज्जानुगतानि कृच्छ्रसाध्यानि, कृशवृद्धबालानां क्षतक्षीणकुष्ठिश्वासिनां सन्ध्युपगतं चेति ||११||

The below mentioned kinds of fractures are difficult to cure –

• Curnita
• Chinna
• Atipatita
• Majjanugata

Fractures are also incurable in –

• emaciated, old aged persons and children,
• those emaciated,
• old aged people and children,
• those suffering from injury to lungs, skin disorders and dyspnea,
• those which occur near bony joints

भवन्ति चात्र:-

भिन्नं कपालं कट्यां तु सन्धिमुक्तं तथा च्युतम् |
जघनं प्रति पिष्टं च वर्जयेत्तच्चिकित्सकः ||१२||
असंश्लिष्टं कपालं तु ललाटे चूर्णितं च यत् |
भग्नं स्तनान्तरे शङ्खे पृष्ठे मूर्ध्नि च वर्जयेत् ||१३||
आदितो यच्च दुर्जातमस्थि सन्धिरथापि वा |
सम्यग्यमितमप्यस्थि दुर्न्यासाद्दुर्निबन्धनात् [२] ||१४||
सङ्क्षोभाद्वाऽपि यद्गच्छेद्विक्रियां तच्च वर्जयेत् |१५|
मध्यस्य वयसोऽवस्थास्तिस्रो याः परिकीर्तिताः ||१५||
तत्र स्थिरो भवेज्जन्तुरुपक्रान्तो विजानता [१] |१६|

Some more verses here

Below mentioned conditions shall be rejected by the physician since they are incurable –

• fracture of bones or dislocation of joints and displacement of flat bones of the head and pelvis
• crushed pubic bone
• fractured pieces of the flat bones of the head not well unified
• forehead bone crushed into pieces
• fractures occurring in between the breasts
• fractures in temples, back and head
• fracture occurring in the bone which has not formed properly right from the beginning of his life,
• dislocation occurring in the joint which has not formed properly right from the beginning of his life
• fractures occurring in bones or dislocation occurring in joints which have developed properly but currently not performing their function properly because of improper placing or bandaging or due to vigorous movement

Among the three stages of life, the person will be strong and stable in the middle age. The treatment of fractures and dislocations should be undertaken after considering this.

तरुणास्थीनि नम्यन्ते भज्यन्ते नलकानि तु ||१६||
कपालानि विभिद्यन्ते स्फुटन्ति रुचकानि च ||१७||

Below mentioned are the effect of assault on different structures –

• young bones bend
• hollow bones break
• flat bones get punctured
• teeth become cracked

इति सुश्रुतसंहितायां निदानस्थाने भग्ननिदानं नाम पञ्चदशोऽध्यायः ||१५||

Thus ends the fifteenth chapter by name Bhagna nidana in Nidana Sthana of Susruta Samhita.