Fracture General

8/9/2019 Fracture General

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FRACTURE AND DISLOCATION

- CLASSIFICATION

-COMPLICATION


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WHAT IS FRACTURE ?WHAT IS FRACTURE ?

Complete or incomplete break inComplete or incomplete break inthe continuity of a bonethe continuity of a bone


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WHAT IS DISLOCATION &WHAT IS DISLOCATION &SUBLUXATION?SUBLUXATION?

DislocationDislocation

A total loss of contact between the two ends ofA total loss of contact between the two ends ofbonesbones

SubluxationSubluxation

Partial loss of contact between the two ends ofPartial loss of contact between the two ends ofbonesbones


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Types of dislocationTypes of dislocation

CongenitalCongenital

e.g: CDHe.g: CDH

AcquiredAcquired

-- TraumaticTraumatic-- PathologyPathology

-- ParalysisParalysis


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Clinical FeaturesClinical Features

-- Shock (severe injury)Shock (severe injury)

-- PainPain

-- EdemaEdema-- BruisingBruising

-- Local tendernessLocal tenderness

-- Muscle spasmMuscle spasm

-- Loss of functionLoss of function


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CLASSIFICATION OF FRACTURECLASSIFICATION OF FRACTURE

Can be classified in 3 ways:Can be classified in 3 ways:

1) The cause of fracture1) The cause of fracture2) Relation to surrounding tissues2) Relation to surrounding tissues

3) The pattern of the fracture3) The pattern of the fracture


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The Causes of fractureThe Causes of fracture

1) Traumatic1) Traumatic-- caused bycaused by

-- direct violencedirect violence

-- indirect violenceindirect violence

2) Stress2) Stress

3) Pathological3) Pathological

4) Avulsion4) Avulsion


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Relation to surrounding tissuesRelation to surrounding tissues

a) Closed fracture / Simple fracturea) Closed fracture / Simple fractureNo communication between the fracture bone and theNo communication between the fracture bone and thebody surfacebody surface

b) Open fracture / Compound fractureb) Open fracture / Compound fracture

Direct communication exists between the body surfaceDirect communication exists between the body surfaceand the fractured bone endsand the fractured bone ends

c) Complicated fracturec) Complicated fracture

In association with the fracture other importantIn association with the fracture other importantstructures have been damaged. E.g: nerves, vessels,structures have been damaged. E.g: nerves, vessels,viscera organ etc.viscera organ etc.--


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Pattern of fracturePattern of fracture

a)a) CompleteComplete

-- The bone is completely divided into 2 separateThe bone is completely divided into 2 separatefragments.fragments.

-- The fracture line itself maybe transverse,The fracture line itself maybe transverse,oblique and spiral.oblique and spiral.

b) Incompleteb) Incomplete

-- It involves only one surface of the boneIt involves only one surface of the bone-- In childrenIn children greenstick fracturegreenstick fracture


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c)c) ComminutedComminuted-- More than two fragments.More than two fragments.

d)d) Compression or crushCompression or crush-- Usually occur in cancellous boneUsually occur in cancellous bone

e)e) SegmentalSegmental-- proximal, middle and distal thirdproximal, middle and distal third

f)f) DisplacementDisplacement-- undisplacedundisplaced-- displaceddisplaced-- ImpactedImpacted

-- StableStable


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Healing of fractureHealing of fracture

Stage of haematomaStage of haematoma

Stage of subperiosteal & endosteal cellularStage of subperiosteal & endosteal cellular

Stage of callus formationStage of callus formation Stage of consolidationStage of consolidation

Stage of remodellingStage of remodelling


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Healing time of fractureHealing time of fracture

2 most stages of fracture healing2 most stages of fracture healing

1. Union1. Union

2. Consolidation2. Consolidation


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Factors affecting the rate of fracture healingFactors affecting the rate of fracture healing

-- Type of boneType of bone

-- Pattern of fracturePattern of fracture

-- Blood supplyBlood supply-- FixationFixation

-- AgeAge


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UnionUnion-- Usually take 3Usually take 3--10 weeks after fracture occurred10 weeks after fracture occurred

partial repair of the bonepartial repair of the bone

-- Initial callus formation (not reach full bone maturity)Initial callus formation (not reach full bone maturity)

-- Minimal movement of the fracture siteMinimal movement of the fracture site

-- Painful with pressure or weight bearingPainful with pressure or weight bearing

-- FWB is contraindicatedFWB is contraindicated

-- Encourage PWBEncourage PWB

-- X RayX Ray fracture line still visiblefracture line still visible


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ConsolidationConsolidation

-- Usually take approximately double the union time & fullUsually take approximately double the union time & fullremodelling double the consolidation timeremodelling double the consolidation time

full repair and maturity of the bonefull repair and maturity of the bone

-- No movement at the fracture siteNo movement at the fracture site

-- X RayX Ray no fracture linesno fracture lines-- Start full functionStart full function


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Approximate healing timeApproximate healing time

FractureFracture Union (wks)Union (wks) Consolidation (wks)Consolidation (wks)

Prox 3 rd humerusProx 3 rd humerus 77--10 days10 days 33--44

Distal 3 rd radius ulna

Distal 3 rd radius ulna 44--66 88--1010

ScaphoidScaphoid 33--44 66--88

Prox 3 rd FemurProx 3 rd Femur 44--66 88--1212

Distal 3 rd Femur

Distal 3 rd Femur 66 1212

Prox 3 rd tibiaProx 3 rd tibia 66--88 1212--1616

Distal 3 rd tibiaDistal 3 rd tibia 88--1010 1616--2020


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COMPLICATIONS OF FRACTURECOMPLICATIONS OF FRACTURE

1) Complications related to the fracture itself1) Complications related to the fracture itself

a) Non union d) Infectiona) Non union d) Infection

b) Delayed unionb) Delayed union e) Shorteninge) Shortening

C) Mal union f) Avascular necrosisC) Mal union f) Avascular necrosis

2) Complication caused by associated injury2) Complication caused by associated injury

Injury to : major blood vessels, nerves, viscera, tendon,Injury to : major blood vessels, nerves, viscera, tendon,

Fat embolism and injuries and post traumatic affectionFat embolism and injuries and post traumatic affectionof jointsof joints


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Non unionNon union

-- Fracture failed to unite.Fracture failed to unite.-- The gap between the bones is filled with fibrous tissue &The gap between the bones is filled with fibrous tissue &

form pseudoarthrosisform pseudoarthrosis-- X ray : sclerotic or dense and roundedX ray : sclerotic or dense and rounded-- Causes:Causes:

-- InfectionInfection-- Poor blood supplyPoor blood supply

-- Poor fixationPoor fixation-- Treatment:Treatment:

-- Bone grafting with internal fixationBone grafting with internal fixation


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Delayed unionDelayed unionFracture take longer time to heal than expected timeFracture take longer time to heal than expected time

Causes & treatment: same as non unionCauses & treatment: same as non union

Mal unionMal union

-- Union of the fracture fragment in an imperfect positionUnion of the fracture fragment in an imperfect position-- Can be prevented by competent initial treatmentCan be prevented by competent initial treatment

Causes:Causes:-- Poor initial treatmentPoor initial treatment

Treatment:Treatment:-- Osteotomy with internal fixationOsteotomy with internal fixation


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InfectionInfection

-- Occur in open fractureOccur in open fracture-- contaminated wound leads osteomyelitiscontaminated wound leads osteomyelitis

Treatment:Treatment:

Dressing & antibioticDressing & antibiotic

ShorteningShorteningCaused by mal union or crush fractureCaused by mal union or crush fracture

Avascular necrosisAvascular necrosisNecrosis of the bone as a result of lack of blood supplyNecrosis of the bone as a result of lack of blood supply


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ReferencesReferences

Adams(1986). Outline of fractureAdams(1986). Outline of fracture

Ann Thompson, Alison Skinner, Joan Piercy (1991) TidysAnn Thompson, Alison Skinner, Joan Piercy (1991) TidysPhysiotherapist, 12 editPhysiotherapist, 12 edit

David F. Paton (1992) Fractures and OrthopaedicsDavid F. Paton (1992) Fractures and Orthopaedics

Marian Tidswell(1998) Orthopaedic PhysiotherapyMarian Tidswell(1998) Orthopaedic Physiotherapy

Ronald Mc Rae (2001) Pocket Book Of Orthopaedics andRonald Mc Rae (2001) Pocket Book Of Orthopaedics andFracturesFractures

John Ebnezar (2003) Essentials Orthopaedics forJohn Ebnezar (2003) Essentials Orthopaedics for

Physiotherapist. 1 st editPhysiotherapist. 1 st edit Karen Atkinson (2005) Physiotherapy In Orthopaedic : AKaren Atkinson (2005) Physiotherapy In Orthopaedic : A

Problem Solving Approach. 2 editProblem Solving Approach. 2 edit

Fracture General

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