LECTURE

FRACTURE and DISLOCATION

Presented by:
Dr. ADRIAN KHU,SpOT

Orthopaedic and Traumatology

Department
UNPRI UNIVERSITY
 DEFINITION

Fracture  a break in the

structural continuity of bone

Closed Open
fractured fractured
HOW FRACTURES HAPPEN?
Single traumatic
incident

Repetitive stress

Pathological fracture
 How fractures happen
• Traumatic incident  direct force , ex : traffic
accident
• Stress fractures  repetitive stress , ex : in
athlete or soldier
• Pathological fractures  normal force in
weakened bone , ex : osteoporosis
 Mechanism of Trauma

Spiral pattern Short oblique Triangle ‘butterfly’ Transverse pattern

(twisting) pattern pattern (tension)
(compression) (bending)
Types of
Fracture

Complete
Fracture

Incomplete
Fracture
 Type of fractures
• Complete fractures  the bone is completely
broken into two or more fragments. Ex :
transverse, oblique, spiral, comminutive,
impacted
• Incomplete fractures  the bone
incompletely divided and the periosteum
remains in continuity, ex : greenstick fractures
 HOW FRACTURE DISPLACED
Force of the injury

Gravity
Causes
The pull of muscles
attached to them

HOW FRACTURE
DISPLACED Translation (shift)

Alignment (angulation)
Terms of
displacement
Rotation (twist)

Altered length
Fractures Displacement
HEALING PROCESS OF FRACTURE
Tissue destruction and
haematoma formation

Inflammation and
cellular proliferation

Callus formation

Consolidation

Remodelling
Healing Process of Fracture
 Union, Consolidation & Non union
Union Consolidation
Incomplete repair Complete repair
Ensheathing callus is calcified Calcified callus is ossified
X- Ray: X- Ray:
Fracture line still clearly visible, Fracture line to be almost
fluffy callus around it obliterated, crossed by bone
trabeculae, well defined callus
around it
Not safe to subject the Future protection is
unprotected bone to stress unnecessary
 Non Union
Distraction and separation of the fragments

Excessive movement at the fracture line

A severe injury which renders the local tissues

non viable and nearly so

Poor blood supply

Hypertrophy Atrophy
 Clinical Features
• History of injury
History • Inability to use injured arm

General • Priority must be given to dealing

with general effects of trauma 
Signs Primary survey

• Look: swelling, bruising,

deformity, the important point is
whether the skin is intact
Local Signs • Feel: the injured part is gently
palpated  tenderness, NVD
• Move:crepitus, ROM
X- Ray Examination (Rules of Two)

2 views 2 joints 2 injuries

2
2 limbs
occasions
 TREATMENT OF CLOSED
FRACTURES
• Treatment of fractures consists of :
Manipulation to improve the position of the
fragment, followed by
Splintage to hold them together untill they unite.
• Joint movement and function must be
preserved.
• Fractures healing is promoted by physiological
loading of bone, so muscle activity and early
weight bearing are encouraged
3 simple injunctions to achieve the
objectives :

1
Reduce

3 2
Exercise Hold
The most important factor in healing of bone
1- state of surrounding soft tissue
2- local blood supply

Low-energy (or low- velocity)

fractures cause only
moderate soft tissue damage

High energy (velocity)

fractures cause severe soft
tissue damage
Tscherne Classification of Closed Injuries
Grades Explanation
Grade 0 • Simple fracture +
• Little/no soft-tissue injury
Grade 1 • Fracture +
• Superficial abrasion/bruising of skin and
subcutaneous tissue
Grade 2 • More severe fracture +
• Deep soft tissue contusion and swelling
Grade 3 • Severe injury +
• Marked soft-tissue damage +
• Threatened compartment syndrome
 REDUCE
Adequate apposition
Aims
Normal alignment of bone
fragment

The greater the

contact surface area
between fragment, the more likely is
healing to occur
Condition where reduction is
unnecessary :

displacement
does not
little or no
matter
displacement
(fracture of
clavicle )

reduction is unlikely
to succeed
(compression
fractures of
vertebrae)
 REDUCTION

Closed Open
reduction reduction
 CLOSED REDUCTION
• Under anaesthesia and muscle relaxation.
• Fracture is reduced by THREEHOLD
MANUOVER :

The distal part of

As the fragment Alignment is
the limb is pulled
disengage, they adjust in each
in the line of the
are repositioned plane
bone
 The distal part of
the limb is pulled in
the line of the bone

As the fragment
disengage, they are
repositioned

Alignment is adjust
in each plane
 OPEN REDUCTION
• Is an operative reduction of the fracture under
direct vision

Indication of Open Reduction :

• Closed reduction fails
• When large articular fragment need accurate
positioning
• For traction fractures which fragments are held apart
 HOLD REDUCTION
1- Continuous
Traction

5- External
Fixation 2- Cast Splintage
5
methods

4- Internal 3- Functional
Fixation Bracing
1- Continuous Traction

Hold Speed

Safety Move
 1- Continuous Traction
• Traction by gravity
• Skin traction
• Skeletal traction
Complication of Traction :
• Circulatory embarrasement
• Nerve injury
• Pin- site infection
2- Cast Splintage

Hold Move

Speed Safety
 2- Cast Splintage
• Plaster of Paris is still widely used as a splint,
especially for distal limb fracture and for most
children’s fracture
• Speed of union is neither greater nor less than
with traction
• However, joints encased in plasters cannot
move and are liable to stiffness.
Complication Cast Splintage :
• Tight cast  vascular compression
• Pressure sore  Localized pain
• Skin abrasion or laceration  due to removing
plasters
• Losse cast  no longer hold the fracture due
to subsided of swelling
 3- Functional Bracing
• One way of preventing joint stiffness while still
permitting fracture splintage and loading
• The splints are functional in that joint
movements are much less restricted than with
conventional cast
4- Internal fixation

Hold Safety

Speed Move
Indication for internal fixation:

Fractures that Fractures that

Fractures that
cannot be reduced unstable &
Unite poorly and
except by prone to
slowly
operation redisplacement

Fractures in
Pathological
Multiple fracture Patient with
fractures
nursing difficulty
Types of internal
fixation
Interfragmentary
screws

Wires

Plates and screws

Intermedullary nails
Types of internal
fixation
Interfragmentary
screws

Wires

Plates and screws

Intermedullary nails
Types of internal
fixation
Interfragmentary
screws

Wires

Plates and screws

Intermedullary nails
Types of internal
fixation
Interfragmentary
screws

Wires

Plates and screws

Intermedullary nails
Complication of Internal fixation
Infection

Non-union

Implant failure

Refracture
Useful 5- External fixation
for :

• Severe soft tissue damage

• Nerve or vessel damage

• Severe comminuted and unstable fractures

• Ununited fractures

• Fractures of the pelvis

• Infected fractures
• Severe multiple injuries
complication

overdistraction
 Exercise
1- Reduce
oedema

4- Guide
the patient 2- Preserve
back to objectives joint
normal movement
activity

3- Restore
muscle
power