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OBJECTIVES
To define fractures and understand various types of classification. To study the salient features of open and pathological fractures.
DEFINITION
Break in the continuity of bone
Basics of Fractures
Deformation of bone is directly proportional to the nature, magnitude and direction of force. Treatment protocols are based on these deformation patterns. Deforming forces can be direct or indirect.
CLASSIFICATION
Etiology
Traumatic
Pathological
Displacement
Undisplaced
Displaced
Open
Closed
Transverse
Oblique
Spiral
Comminuted
Segmented
OPEN FRACTURES
Communicates with the external environment Break in overlying skin and soft tissue Can be an Open fracture from Within or Without Greater risk of infection
Type II
Wound > 1 cm Moderate contamination Fracture pattern may be complex or simple
Type III
Extensive soft tissue crushing Extensive contamination Subdivided into:
IIIa : Soft tissue coverage by closure
PATHOLOGICAL FRACTURE
Occurs in a bone with weakened structure due to a disease Break occurs due to trivial trauma or even spontaneously Causes can be localized or generalized Commonest Cause ? Most often affected bone ?
Localized Causes
Inflammatory
Osteomyelitis (pyogenic/tubercular)
Neoplastic
Benign : GCT Malignant : Osteosarcoma; Ewings; Secondaries from Lung, Kidney, Prostate
Miscellaneous
Cysts; Dysplasia; Granulomas
Generalized Causes
Hereditary
Osteogenesis imperfecta Osteopetrosis
Acquired
Osteoporosis Rickets/Osteomalacia Scurvy Pagets Disease
DISLOCATION
Injury to a joint Articular surfaces are wholly separated Can be traumatic and pathological Traumatic dislocations - FORA Features include Pain, Swelling, Deformity, Loss of movement, Limb shortening Treatment is based on conservative management and operative reduction
SUBLUXATION
Articular surfaces are partly displaced and retain some contact
SUMMARY
Fracture is break in normal continuity of bone It can be classified in many ways which alters the treatment protocols. Most important are Open fractures and Pathological fractures Dislocation is COMPLETE separation of 2 articular surfaces Subluxation is INCOMPLETE separation of 2 articular surfaces
SOURCES
Google Image Search Essential Orthopaedics by J. Maheshwari Essentials of Orthopaedics by RM Shenoy
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