General Principles of Fracture Managment

8/17/2019 General Principles of Fracture Managment

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General principles of

fracture management


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Etiology and types of fractures,

Diagnosis and imaging,

Indications for dierent types of treatment,

Complications of fractures,

Examples of common bone injuries.

Intended Learning Objectives(ILO)


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Denition of a fracture?

Interruption of bone continuity

Aetiology

!raumatic high or low velocity injury

"at#ologic already diseased bone


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!raumatic fractures


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"at#ological fractures


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$#ape !ransverse, short obli"ue, spiral

comminuted, #egemental.

Level $etaphysis, Diaphysis , Intra%articular.

$tability !endency to re%displace after

reduction & Instability

!ype #imple ' open

"at#ological Anatomy


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$pecic types

(vulsion )racture (t sites of muscle'ligament pull.

!orus )r. * +ucle fracture - bucling of thecortex.

reen stic )r. )r. of one cortex and bending

of the other.

)ragility )r. /steoporotic bones.

"at#ological Anatomy


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"at#ological anatomy


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$#apes of fractures


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"roper #istory ta%ing

General evaluation including t#e vital signs

General s%eletal evaluation

!#oroug# local e&amination

#igns of the )racture

0eurovascular testing , thigh, leg, foot )orearm ??? 'ompartment $yndrome

&amination


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"lain & ray +asic and informative with proper

. views (1, lateral and obli"ue

$pecic vies for certain )r. e.g

acetabulum,

shoulder

pelvis, and Calcaneus

'! Comminuted intra%articular )r

*+I /ccult )r. e.g nec of femur, scaphoid

Imaging


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Imaging


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Aim is to eep the )r. reduced in good

position till complete union

,on operative "O" cast or slab !raction $%in -$%eletal

Indications Children 2 #table 2eneral or

local contraindication for surgery

!reatment


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Operative (dults 2 3nstable 2 /pen 2

Intra%articular 2 1oly trauma%

0eurovascular injury 2 4ead injury

0on compliance with conservative

treatment

/pen 2 minimal invasive 2 percutaneous

Internal .i&ation 1lates , #crews , I$0, 5%wires

#taples

&ternal .i&ation 6ods, 6ings, 4ybrid.

'ombinations

!reatment


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'onservative treatment


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'onservative treatment!raction


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Operative !reatmentInternal &ation


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&ternal &ation


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General complications of trauma +leeding, shoc, (6D#, D7!, etc..

Local complications of the fracture

8$al union 80on union

8 #tiness of joints

89asting of muscles

8(trophy of bones

8Edema of the limbs

80erve injury

8Infection

'omplications of .ractures


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*alunion


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,on union


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,on union


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.r/ nec% of femur (lways treatment issurgical

+iologic factors , $echanical factors

0ealing $tability

1nion

!reatment internal &/ 2 art#roplasty

'omplications ,on union 2 avascular

necrosis

"ro&imal .emoral.ractures


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3lood $upply to,ec% of .emur


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'linical "icture


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!roc#anteric .r/ preferred treatment issurgical

9hy:

General problems of prolongedrecumbancy

*alunion

!reatment $%eletal traction2 Internal.i&ation

"ro&imal .emoral.ractures


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,

1referred to be treated $urgically

'lassied according to severity of injury ofbones and soft tissues in ascending scale ( ,+ , C,

Complications $alunion and anleart#ritis/

An%le .ractures


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'olles4 .racture Distal end of radius

4ow : 9hen :

Deformity Dinner )or

!reatment Closed reduction under ( &cept?

'omplications malunion, median n. compression #ude;s atrophy :::

Distal +adius .ractures


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!ypes Extension %%% )lexion c5p )r. * pain, swelling, loss of function,

deformity- <

'ompartment $yndrome

!reatment 'losed reduction 6 casting

'losed reduction 6

percutaneous 7 ires

Open reduction 6 7 ires

$upracondylar .racturesIn '#ildren


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$upracondylar fracture


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7 ire &ation


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'omplications =% 7ascular injuries arterial spasm 2 tear of

brachial artery

>% neural injury $edian nerve ,,,,,,, 6adial ? 3lnar

@% #tiness of elbow joint

A% $alunion Cubitus varus

$upracondylar .racture


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3nderstanding anatomy and pat#ology of any fractureis

essential before treatment,

!reatment of fractures should be individuali8ed,

eneral patient4s assessment is a part of fracturetreatment,

!he aim of treatment is restoration of function and ,

avoidance of complications

"roper #andling of tissues , by conservative oroperative,

methods of treatment < close follow up is crucial.

!a%e 0ome *essage


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General Principles of Fracture Managment

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