ueflnlLlons

lracLure
A break ln Lhe sLrucLural conLlnulLy of bone
(buL we have Lo remember LhaL Lhere ls
always some degree of sofL Llssue ln[ury wlLh a
fracLure)
oals of fracLure LreaLmenL
W revenL fracLure and sofL Llssue compllcaLlons
W eL fracLure Lo heal and ln saLlsfacLory poslLlon
for opLlmal funcLlonal recovery
W lnLraarLlcular fracLure needs accuraLe reducLlon
rlgld flxaLlon buL non arLlcular fracLure of bone
requlre anaLomlcal reducLlon sLable flxaLlon
W 8ehablllLaLe as early as posslble by acLlve
passlve exerclses
W 8esLore paLlenL Lo opLlmal funcLlonal sLaLe
ow fracLure happen
1 A slngle LraumaLlc lncldenL
2 8epeLlLlve sLress
3 Abnormal weakenlng of Lhe bone
(paLhologlcal fracLure)
ow fracLure happen
1 1wlsLlng causes a splral fracLure
2 Compresslon causes a shorL obllque fracLure
3 8endlng resulLs ln fracLure wlLh a Lrlangular
buLLerfly' fragmenL
4 1enslon Lends Lo break Lhe bone Lransversely
1ypes Cf lracLure (AnaLomlcal over vlew)
1ypes of lracLureconL
W Cpen fracLure
When Lhe bony fragmenLs are exposed
Lo exLernal envlronmenL by means of
wound
W Closed fracLure
1he fracLure fragmenLs are noL
exposed Lo ouLslde
1ypes Cf ln[ury
lgh energy
Low energy
Cpen (compound) fracLures
W usLllo classlflcaLlon
1ype 1 Low energy wound 1cm (usually peneLraLlng
ln[ury by bony fragmenLs from lnslde )
1ype 2 Wound 1cm wlLh moderaLe sofL Llssue damage
1ype 3 lgh energy wound 1cm wlLh exLenslve sofL
Llssue damage
1ype 3A AdequaLe sofL Llssue cover
1ype 38 exLenslve sofL Llssue ln[ury wlLh exLernal or
lnLernal deglovlng ln[ury whlch needs flap coverage
1ype 3C any open fracLure assoclaLed wlLh neuro
vascular ln[ury
CompllcaLlons of fracLures
W eneral compllcaLlons
Shock
A8uS
laL embollsm
ead chesL abdomen and pelvlc ln[urles
Crush syndrome
1eLanus
as gangrene
lnfecLlons D1l ChesL
uv1/L
8ed sores
uepresslon/1Su
CompllcaLlons of fracLures
W Lar|y
vlsceral ln[ury
vascular ln[ury
ComparLmenL
syndrome (laLer
volkmann concLracLure)
nerve ln[ury
aemarLhrosls
lnfecLlon
Late
uelayed unlon
nonunlon
Malunlon
1endon rupLure
MyoslLls osslflcans
CsLeonecrosls
AlgodysLrophy
CsLeoarLhrlLls and
[olnL sLlffness
ManagemenL of Lhe ln[ured paLlenL
W uon'L LreaL Lhe xrays of Lhe fracLure buL LreaL Lhe
paLlenL
W Llfe savlng measures
ulagnose and LreaL llfe LhreaLenlng ln[urles (head ln[urles
ChesL abdomlnal ln[urles)
Lmergency orLhopaedlc lnvolvemenL
W Llfe savlng
W CompllcaLlon savlng
W Lmergency orLhopaedlc managemenL (day 1)
W MonlLorlng of fracLure (days Lo weeks)
W 8ehablllLaLlon and LreaLmenL of compllcaLlons
(weeks Lo monLhs)
Llfe savlng measures
W A A|rway and cervlcal
splne lmmoblllsaLlon
W reath|ng
W C C|rcu|at|on
(LreaLmenL and
dlagnosls of cause)
W |sab|||ty (head
ln[ury)
W L Lxposure (musculo
skeleLal ln[ury)
1reaLmenL prlnclple of fracLure
1) 8educLlon
2) MalnLaln reducLlon (+ hold unLll
unlon)
3) 8ehablllLaLe resLore funcLlon by
movemenL of Lhe [olnL paLlenL
lLself
4) revenL or LreaL compllcaLlons
Cpen (compound) fracLures
W lgh rlsk of lnfecLlon
W Can be assoclaLed wlLh gross sofL Llssue
damage severe haemorrhage or vascular
ln[ury
Cpen (compound) fracLures managemenL
W Whlle conLacLlng orLhopaedlc Leam for deflnlLlve
surglcal LreaLmenL
lrrlgaLe wound wlLh nsallne lf noL avallable wlLh Lap
waLer Cover wound wlLh sLerlle molsL dresslng
lmmoblllse llmb preferable wlLh exLernal flxaLor lf noL
posslble by pos casL(lncludlng [olnL above below)
8emove obvlous conLamlnanLs wlLh meLlculous efforL
1ake phoLos
lv anLlbloLlcs (eg cefuroxlme +/ meLronldazole or
genLamlcln)
1eLanus prophylaxls
Check dlsLal neurovascular sLaLus
8eassess
8educLlon
W lf necessary whaL reducLlon
Lechnlque?
1) Closed reducLlon
need anaesLhesla/sedaLlon analgesla xray
faclllLles equlpmenL knowledge
Dsed for mlnlmally dlsplaced fracLures and mosL
fracLures of chlldren
W ulsLal parL of llmb pulled ln llne of bone
W AllgnmenL ad[usLed ln each plane
2) Cpen reducLlon
Above + LheaLre sLaff + addlLlonal equlpmenL
8lsks
MalnLaln reducLlon
W necessary?
1) 8elleve paln
2) revenL malunlon naLure heals
Lhe fracLure we keep lL ln a good
poslLlon
3) Mlnlmlse nonunlon
malnLenance of reducLlon should
be conLlnuous
MalnLaln reducLlon
W ow?
1) LxLernal meLhod
W C (+ equlvalenLs) LracLlon exLernal
flxaLor
2) lnLernal meLhod
W Wlres plns plaLes nalls screws
MalnLaln reducLlon exLernal meLhod
W 1) C
W Mould wlLh palms
Adv cheapeasy Lo use
convenlenL can be
moulded
ulsadv suscepLlblllLy Lo
damage (dlslnLegraLes
when weL) up Lo 48hrs
Lo dry dlfflculLy Lo care
of open wound
MalnLaln reducLlon exLernal meLhod
2) 8esln casL
W Adv llghLer and sLronger
more reslsLanL Lo damage
seLs ln 310mlns max
sLrengLh ln 30mlns
W ulsadvanLage cosL more
dlfflculL Lo apply/remove
more rlgld wlLh greaLer rlsk
of compllcaLlons eg
swelllng and pressure
necrosls
MalnLaln reducLlon exLernal meLhod
W 3) Surface LracLlon
1emporary measure
when operaLlve
flxaLlon noL avallable
for awhlle
Skln can be ln[ured lf
applled for long
perlods of Llme
neurovascular sLaLus
should be checked
durlng surface LracLlon
perlod
MalnLaln reducLlon exLernal meLhod
W 4) SkeleLal LracLlon
8equlres lnvaslve
procedure for longer
Lerm LracLlon
requlrlng heavler
welghLs
CompllcaLlons
assoclaLed wlLh pln
lnserLlon eg
lnfecLlon
MalnLaln reducLlon exLernal meLhod
W 3) LxLernal flxaLor
W lndlcaLlons
lracLures assoclaLed wlLh sofL
Llssue ln[ury
lracLure assoclaLed wlLh n/v
damage
Severely commlnuLed and
unsLable fracLure
DnsLable pelvlc fracLure
lnfecLed fracLure
lor skln grafL flap coverage
W CompllcaLlons
ln Lrack lnfecLlon
uelayed unlon
MalnLaln reducLlon lnLernal meLhod
W AdvanLages
8esLoraLlon of absoluLe anaLomlcal sLaLe
ShorLer hosplLal sLay
Lnables lndlvlduals Lo reLurn Lo funcLlon earller
W lndlcaLlons
lracLures LhaL need operaLlve flxaLlon
lnherenLly unsLable fracLures prone Lo re
dlsplacemenL afLer reducLlon (eg mldshafL femoral
fracLures)
aLhologlcal fracLure
olyLrauma (mlnlmlse A8uS)
aLlenLs wlLh nurslng dlfflculLles (parapleglcs v
elderly mulLlple Lrauma)
MalnLaln reducLlon lnLernal meLhod
W 8y nall plaLe screws ware
W CompllcaLlons
lnfecLlon
nonunlon
lmplanL fallure
8efracLure
MalnLaln reducLlon lnLernal meLhod
W Wlres plns
Can be used ln
con[uncLlon wlLh
oLher forms of
lnLernal flxaLlon
Dsed Lo LreaL
fracLures of small
bones
MalnLaln reducLlon lnLernal meLhod
W laLes screw
LxLend along Lhe
bone and screwed ln
place
May be lefL ln place
or removed (ln
selecLed cases) afLer
heallng ls compleLe
MalnLaln reducLlon lnLernal meLhod
W nall or rods
eld ln place by
screws unLll Lhe
fracLure ls healed
May be lefL ln Lhe
bone afLer heallng ls
compleLed
SLages of lracLure eallng
W lnflammaLlon
emaLoma
W Callus lormaLlon
W Woven 8one
W 8emodellng
1ypes of fracLure heallng
W rlmary heallng of Lhe bone occur by
lnLersLlLlal growLh of bone ln rlgld flxaLlon
by plaLe or nall
W Secondary heallng occurs wlLh adequaLe
callus formaLlon boLh lnLersLlLlal
surroundlng when mlcro movemenL occur
ln sLable flxaLlon by C casL locklng plaLe
exLernal flxaLor
Modern concepL ls secondary heallng ls
preferable excepL lnLraarLlcular fracLure
lacLors lnfluenclng eallng
ystem|c Iactors
W Age
W ormones
W luncLlonal acLlvlLy
W nerve funcLlon
W nuLrlLlon
W urugs (nSAlu)
lacLors lnfluenclng eallngconL
Loca| Iactors
W Lnergy of Lrauma
W uegree of bone loss
W vascular ln[ury
W lnfecLlon
W 1ype of bone fracLured
W uegree of lmmoblllzaLlon
W aLhologlcal condlLlon
lracLure heallng operaLlve
1) 8educLlon and compresslon
rlmary bone heallng
Slow process rehablllLaLlon rapld hlgh rlsk
2) nalllng or exLernal flxaLlon
eallng by callus
8apld process rehablllLaLlon rapld lesser rlsk
eallng CompllcaLlons
W uelayed unlon
W nonunlon
W Malunlon
W osL LraumaLlc arLhrlLls
W rowLh abnormallLles
W lracLure dlseases [olnL sLlffness
nonuses aLrophy Sudeck osLeo
dysLrophy
lollow up of LreaLmenL by C
W !udge each case on lLs own merlLs
W SLlcky ueformable buL noL dlsplaceable
W Dnlon (weeks)
lncompleLe repalr arL moves as one Local Lenderness
Local paln on sLress See fracLure llne onxray
W ConsolldaLlon (monLhs)
CompleLe repalr no exLernal proLecLlon needed Dpper
llmb 6/32 Lower llmb 12/32 alf for chlld uouble for
Lransverse fracLures
W 8emodelllng (years) successfully occur ln growlng
skeleLon
lndlcaLlons for operaLlve LreaLmenL
CurrenL absoluLe lndlcaLlons
W olyLrauma ulsplaced lnLraarLlcular
fracLures
W Cpen fracLures wlLh vascular ln[ury or
comparLmenL syndrome
W aLhologlcal fracLures and nonunlon
CurrenL relaLlve lndlcaLlons
W Loss of poslLlon wlLh closed meLhod oor
funcLlonal resulL wlLh nonanaLomlcal
reducLlon ulsplaced fracLures wlLh poor
blood supply
8ehablllLaLlon
W 8esLore Lhe paLlenL as close Lo pre
ln[ury funcLlonal level as posslble
W 8esL LlevaLlon MoblllsaLlon
(acLlve/passlve)
W hysloLherapy
W Work assessmenL and reemploymenL