PRINCIPLES OF FRACTURE MANAGEMENT Dr Saseendar S, MS Ortho, DNB Ortho, MNAMS, Dip SICOT(Belgium), FISOC(US), FASM (Sing), Shoulder, Elbow and Knee Arthroscopy Surgeon, Chettinad Super Speciality Hospital, Chettinad Health City, Chennai
Jul 12, 2015
PRINCIPLES OF FRACTURE
MANAGEMENT
Dr Saseendar S, MS Ortho, DNB Ortho, MNAMS,
Dip SICOT(Belgium), FISOC(US), FASM (Sing),
Shoulder, Elbow and Knee Arthroscopy Surgeon,
Chettinad Super Speciality Hospital,
Chettinad Health City, Chennai
TOPICS COVERED
Definition
Mechanism of fractures
Fracture types
Complete
Incomplete
Types of displacements
Fracture healing
Stages
Treatment of fractures
Closed fractures
Open fractures
DEFINITION
An interruption in the continuity of
the bone which may be a
complete break or an incomplete
break.
MECHANISMS
Single traumatic event
Repitive stress – Stress fractures
Pathological – Insufficiency fractures
HIGH-ENERGY
INJURY
High-energy injury
LOW ENERGY INJURY
Low-energy injury
PATHOLOGIC FRACTURES
Often need surgery
diagnostic workup
important
prognosis dependent
on biology of lesion
Polyostotic Fibrous Dysplasia
MECHANISMS OF FRACTURES
Direct – Bending / Crushing
Indirect
MECHANISMS OF FRACTURES - INDIRECT
Twisting causes a spiral fracture;
Compression causes a short oblique fracture;
Bending results in fracture with a triangular
'butter-fly‘ fragment;
Tension tends to break the bone transversely
CLASSIFICATION OF FRACTURES
Complete/ Incomplete
Fracture pattern
Soft-tissue cover
Displacement
Comminution
COMPLETE/ INCOMPLETE
GREENSTICK FRACTURES
Bending mechanism
Failure on tension side
Incomplete fracture,
plastic deformation on
compression side
May need to complete
fracture to realign
BUCKLE OR TORUS FRACTURE
Compression failure
Stable
Usually at
metaphyseal /
diaphyseal junction
CLASSIFICATION OF FRACTURES
Closed fractures
There is no communication between the external
surface of the body and the fracture
Open fractures
There is a communication between the fracture and the
skin.
From inside-out
From outside-in
High risk of infection/
neurovascular injury
OPEN FRACTURES
OPEN FRACTURES
DISPLACEMENT
Angulation
Translation
Rotation
DISPLACEMENT
UNDISPLACED DISTAL RADIUS FRACTURE
MINIMALLY DISPLACED DISTAL RADIUS FRACTURE
DISPLACED FEMUR FRACTURE
HEALING OF FEATURES
Stage of haematoma
Stage of cellular proliferation
Stage of callus formation
Stage of consolidation
State of remodelling
PRINCIPLES OF MANAGEMENT
General condition
Temporary stabilisation
Definitive treatment
Reduce
Hold
Exercise
TEMPORARY STABILISATION
DEFINITIVE TREATMENT
Closed reduction
Open reduction
Immobilisation
Internal/ External fixation
CLOSED REDUCTION
HOLD/ MAINTAIN REDUCTION
Traction
Slab/ Cast
Brace
MAINTAIN
Fixation
Internal Fixation
Screws
K wires
Plates and screws
Nails
External Fixation
TENSION BAND WIRING
PLATES AND SCREWS
Extramedullary internal
fixation
INTERLOCKING NAIL
Intramedullary internal
fixation
EXTERNAL FIXATION
SKELETAL TRACTION – SKULL TONGS
SKELETAL TRACTION
– UPPER TIBIAL PIN TRACTION
SKELETAL TRACTION
– UPPER TIBIAL PIN TRACTION
SKIN TRACTION
– GALLOWS TRACTION
EXTERNAL FIXATOR
PLASTER OF PARIS
- ABOVE ELBOW CAST
EXTERNAL STABILISATION
– BUDDY STRAPPING
BOHLER BRAUN FRAME
OPEN FRACTURES
PRINCIPLES
IV antibiotics,
tetanus prophylaxis
emergent irrigation &
debridement
skeletal stabilization
soft tissue coverage
LAWNMOWER INJURIESprobably most common
cause of open fractures in children
most children are a rider or bystander (70%)
high complication rate -infection, growth arrest,amputation
> 50% unsatisfactory results (Loder)
LAWNMOWER INJURIES – OFTEN
RESULT IN AMPUTATIONS
PHYSIOTHERAPY DURING
IMMOBILIZATION
Reduce oedema – to prevent the adhesion formation
Assist the maintenance of the circulation – active exercise either by static or isotonic muscle activity
Maintain muscle function by active or static contraction
Maintain joint range where possible
Maintain as much function as allowed by the particular injury and the fixation
Teach the patient how to use special appliances such as crutches, sticks, frames, and how to care for these or any other apparatus
PHYSIOTHERAPY AFTER THE
REMOVAL OF FIXATION
To reduce any swelling
To regain full range of joint movement
To regain full muscle power
To re-educate full function
THANK YOU
Information contained in this presentation are intended for
academic purpose only for the students of orthopaedic
surgery.
The guidelines mentioned cannot be used absolutely for
management of patients.
I am not responsible for any controversies that arise out of
this presentation.
For clarifications/ suggestions please contact
[email protected] or call at 91-9500366970.