4-conservative treatment fx , casting
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CONSERVATIVE
TREATMENT OFFRACTURES
Dr. Muhammad ASIF
Orthopedic Surgeon
Department of Orthopaedics
College of Medicine
King Khalid University Hospital
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Fracture management
The ideal goal of fracture management is
anatomical reduction and function restoration
compatible with the severity of injury, age,
occupation and activity of daily living of injuredpatient.
Either
Operative Non operative (Conservative)
Traction
Splint (Cast / Slab)
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Traction
Tractionis the application of a pulling
force to a part of the body
Purpose:
to reduce, align, and immobilize fractures;
Unstable and unfixable
When reduction and/or proper length cannot
be maintained by static immobilization
to minimize muscle spasm
to prevent or reduce skeletal deformities or
muscle contractures.
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Classification of Traction
Skin Traction : is maintained by direct
application of a pulling force on the patients skin
. Generally temporary measure.
To reduce muscle spasms To maintain immobilization before surgery
In children
Skeletal Traction : applied to bone by means ofa pin or wire surgically inserted into the bone,
providing a strong steady, continuous pull, and
can be used for prolonged periods .
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Complications of traction
Neurovascular compromise.
Inadequate fracture alignment..
Skin breakdown .
Soft tissue injury
Pin tract infection .
Osteomyelitis can occur with skeletal traction.
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Complications of traction
complications from immobility especially with
long term traction and in elder pt.
Pressure ulcer
Pneumonia Constipation
Anorexia
Urinary stasis and infection
Venous stasis with DVT
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General Indications for CAST
1. Most fractures in children:
a. Tremendous capacity of remodeling.
b. Non union and stiffness is unlikely.
2. Undisplaced fracture
3. Poor bone Quality: Osteoporosis.
4. Unfixable fracture e.g. severe comminuted.
5. Systemic contraindication.
6. Local contraindication.
7. Psychosocial problem.
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Splint / Cast
Principle:
To stabilize joint above and joint below the
site of injury whenever and wherever is
possible
Objectives:
To hold broken bone anatomically to prevent
malunion. To reduce excessive movements to prevent
non union.
To get early function
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How to Preserve Function?
Immobilize only joint necessary,
Range of motion of uninvolved joints.
Isometric exercise. Physiotherapy after cast removal.
Weight bearing whenever possible in case
of lower limb fracture.
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What are casts made of ?
The outside, or hard part of the cast,two different kinds of casting materials.
Plaster (POP)- white in color.
hemihydrated calcium sulphate.On adding water it solidifies by an exothermic
reaction into hydrated calcium sulphate
fiberglass- variety of colors, patterns, and designs.
inside of the castCotton and other synthetic materials are used to
line theinside of the cast to make it soft and to
provide padding around bony areas.
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Plaster is usually used in the early stagesof treatment,
Displaced Fracture that need manipulation
can be molded more precisely. heavy
must remain dry, water will distort the cast
Fiberglass
Can be used in Undisplaced Fx if swelling not
expected
healing process has already started.
lighter weight, durable, require less maintenance.
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Different types of casts
Type of Cast/Slab Location Uses
Short arm Applied below the elbow
to the hand.
Distal Forearm or wrist
Fx. Also used to hold the
forearm or wrist muscles
and tendons in place aftersurgery.
Long arm Applied from the upper
arm to the hand.
Distal humerus, elbow, or
proximal forearm
fractures. Also used to
hold the arm or elbowmuscles and tendons in
place after surgery.
Scaphoid cast/ thumb
spica
Below elbow to hand
including thumb
Scaphoid Fx, thumb FX
U slab From shoulder to elbow
and then to armpit
Humerus shaft fx
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Type of Cast / Slab Location Uses
Short leg cast: Applied to the area below
the knee to the foot.
Distal T/F Fx,
ankle Fx,
severe anklesprains/strains.
Long leg cast From above knee to foot Proximal T/F Fx,
trauma around knee
Hip spica From lower chest to oneor both feet
Femur fracture in children
PTB cast From knee to foot For weight bearing in
healing Fx T/F
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Closed Reduction Method
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After Closed Reduction and
Casting
must have circulation check
Plaster takes 48 hours to become fully dryand harden so take care.
Weekly radiographs for 3 weeks to confirmacceptable reduction.
Can re-manipulate within 3 weeks after
injury if displaced.
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Excellent Reduction with Well
Molded Cast
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Colles Fracture
Displaced
dorsolaterrally
Treatment:
Cast +/- surgery,depending on
shortening and
displacement
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Scaphoid Bone FX
Retrograde blood
supply
Total healing time of
10-12 weeks or more
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Boxers Fracture
Classically neck of
the fifth metacarpal
bump over the back
of palm just below thesmall finger knuckle
Treatment: casting or
surgery (pins)
http://en.wikipedia.org/wiki/Fifth_metacarpal_bonehttp://en.wikipedia.org/wiki/Fifth_metacarpal_bone -
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Patellar Fracture
Fall onto kneecap or
when quadriceps is
contracting
Attempt straight legraise
If Extensor mechanism
intact / undisplaced Fx
Cast / Slab
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Fracture of 5thMetatarsal
Avulsion Fracture
base of 5th metatarsal from pull of attached
tendon;
heal well in cast
Jones Fracture
Transverse fracture through base of 5th
metatarsal, about 1-2 cm from tip;
cast for 6-8 wks if undisplaced
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Fracture of 5thMetatarsal
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Avulsion Fx
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Jones fracture
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30 year old patient
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Torus Fracture
Buckle
fracture
mostly in
children;metaphysis
cast for 2-4
weeks
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Type 1 S/C Fx humerus:
non-displaced
conservative
Note the non-displaced fracture(Red Arrow)
Note the posterior fatpad (Yellow Arrows)
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Type 2: Angulated/displaced fracture with intact
posterior cortex;
close reduction and K-wires fixation
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Post Cast instructions
Keep your limb elevated to prevent swelling.
Apply an ice bag to injured area.
Keep the cast clean and dry.
Check for cracks or breaks in the cast. Rough edges should be padded to protect the skin
from scratches.
Do not scratch the skin under the cast by inserting
sticks.
Encourage patient to move his/her fingers or toes to
promote circulation
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Contd
Prevent small toys or objects from being put inside
the cast.
Do not put powders or lotion inside the cast.
Cover the cast while your child is eating to preventfood spills and crumbs from entering the cast.
Do not use the abduction bar on the cast to lift or
carry the child.
Use a diaper or sanitary napkin around the genitalarea to prevent leakage or splashing of urine.
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How To Know if Something Is
Wrong With Your Cast Pain that is not adequately controlled with
medication prescribed by your doctor.
Increasingswelling
Numbness or tingling in the extremity (hand or foot). Inability to move your fingers or toes beyond the
cast.
Circulation problems in your hand or foot.
Loosening, splitting or breaking of the cast.
Unusual odors, sensations, or woundsbeneath the
cast.
If you develop a feveror generalized illness
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Complications of cast
Compartment syndrome, tight cast that restricts
swelling.
Impaired distal neurovascular.
most serious is deep venous thrombosis leadingto pulmonary embolism----calf pain.
Re displacement of fracture.
stiff joints, muscle wasting. Plaster Sores.
Malunion, Nonunion, Delayed union
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Cast Burns- can
occur during cast
removal if blade dull
or improper techniqueused.
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Fracture distal Radius & ulna
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Fracture Healed
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Fx distal Radius ulna in a Child
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After Close reduction and casting
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One week follow up; Angulated
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Surgery; close reduction and fixation
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Healed
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21 year old patient
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THANKS