Fracture
Meaning of fracture: For the purposes of this Statement of Principles, fracture: (a) means an acquired break of bone as a result of an applied force that ordinarily would cause bone breakage in a healthy bone; and (b) includes: (i) acute vascular shock, acute compartment syndrome, or fat embolism resulting from the fractured bone; (ii) avulsion, crush, comminuted, burst, or blowout fracture; (iii) closed or compound/open fracture; (iv) fracture of bone contiguous with an orthopaedic implant; and (v) growth plate fractures; (vi) periosteal, muscular, fascial, skin, nerve or vascular damage directly caused by the displaced fractured bone; (vii) stress fracture of the fatigue type; (viii) torsion or spiral fracture; and (ix) wound infection as a result of penetration of the skin by bony fracture fragments (compound fracture); (c) excludes: (i) pathological fracture; (ii) bone stress injury/bone marrow oedema not being a stress fracture; (iii) stress fracture of the insufficiency type; (iv) osteonecrosis; (v) periostitis; (vi) fracture of teeth; (vii) fracture of cartilage; (viii) fracture of an orthopaedic implant including a screw, nail, fixation plate or prosthesis; and (ix) spondylolysis.
Reasonable Hypothesis (RH) — Statement of Principles No. 62 of 2024
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting fracture or death from fracture with the circumstances of a person's relevant service:
- (1)having significant physical force applied to or through the affected bone at the time of clinical onset;
- (2)for stress fracture only, having significant repetitive loading stress to the affected bone prior to clinical onset;
Note: Examples of situations involving significant repetitive loading stress includes military training, weight training, athletics or running.
- (3)for stress fracture only, having significant chronic repetitive loading stress to the affected bone due to abnormal force intensity or direction of application, at the time of clinical onset;
Note: An example of chronic repetitive stress due to changed force intensity or force direction would be an uncorrected substantial leg length inequality, or a substantial valgus or varus joint malalignment.
- (4)smoking at least 5 cigarettes per day, or the equivalent thereof in other tobacco products, during treatment for fracture prior to fracture non- union;
Note: One gram of tobacco is considered to be equivalent to one cigarette.
Note: Fracture non-union is considered to be a clinical worsening of the fracture.
- (5)having diabetes mellitus at the time of the fracture non-union;
Note: Fracture non-union is considered to be a clinical worsening of the fracture.
- (6)having osteoporosis at the time of the fracture non-union;
Note: Fracture non-union is considered to be a clinical worsening of the fracture.
- (7)having vitamin D deficiency, with a serum 25(OH)D level of less than 50 nanomoles per litre at the time of the fracture non-union;
Note: Fracture non-union is considered to be a clinical worsening of the fracture.
- (8)having a Body Mass Index (BMI) of 40 or greater at the time of the fracture non-union;
Note: BMI is defined in the Schedule 1 - Dictionary.
Note: Fracture non-union is considered to be a clinical worsening of the fracture.
- (9)inability to obtain appropriate clinical management for fracture before clinical worsening;
Balance of Probabilities (BoP) — Statement of Principles No. 63 of 2024
6 factors
At least one of the following factors must exist before it can be said that, on the balance of probabilities, fracture or death from fracture is connected with the circumstances of a person's relevant service:
- (1)having significant physical force applied to or through the affected bone at the time of clinical onset;
- (2)for stress fracture only, having significant repetitive loading stress to the affected bone prior to clinical onset;
Note: Examples of situations involving significant repetitive loading stress includes military training, weight training, athletics or running.
- (3)for stress fracture only, having significant chronic repetitive loading stress to the affected bone due to abnormal force intensity or direction of application, at the time of clinical onset;
Note: An example of chronic repetitive stress due to changed force intensity or force direction would be an uncorrected substantial leg length inequality, or a substantial valgus or varus joint malalignment.
- (4)smoking at least 5 cigarettes per day, or the equivalent thereof in other tobacco products, during treatment for fracture prior to fracture non- union;
Note: One gram of tobacco is considered to be equivalent to one cigarette.
Note: Fracture non-union is considered to be a clinical worsening of the fracture.
- (5)having diabetes mellitus at the time of the fracture non-union;
Note: Fracture non-union is considered to be a clinical worsening of the fracture.
- (6)inability to obtain appropriate clinical management for fracture before clinical worsening;
