6 fracture[1]
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FRACTUREFRACTURE
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D EFINITIOND EFINITION
A fracture is a complete orA fracture is a complete orincomplete break in theincomplete break in thecontinuity of bone. This willcontinuity of bone. This willbe accompanied by varyingbe accompanied by varyingdegrees of injury todegrees of injury tosurrounding soft tissues.surrounding soft tissues.
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WHATWHAT CAUSES FRACTURE?CAUSES FRACTURE?
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D IRECT TRAUMAD IRECT TRAUMA
HARD HIT
FALL
ACCIDENTS
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INDIRECT TRAUMAINDIRECT TRAUMA
osteoporosis
osteomyelitis
Pathologic glands
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TWISTING FORCETWISTING FORCE
SEVERE TWISTING OVER STRETCHING
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FATIGUE AND STRESSFATIGUE AND STRESS
J OGGING
P ROLONGED MARCHING
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P OWERFUL MUSCLEP OWERFUL MUSCLE
CONTRACTIONCONTRACTION
GRAND MAL SIZURE
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GENERAL SIGNS ANDGENERAL SIGNS ANDSYM P TOMSSYM P TOMS
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A. Break in the continuity of the bonecause:
1.B LEEDING
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2 . AB NORMAL
MOB
ILITY
3 . CRE P ITUS
- abnormal sound created due to f riction o f f ractured area as the bones are moved
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B. DIS P LACEMENT OF FRAGMENTCAUSES:
1. DEFORMITY
2 . LOSS OF FUNCTION
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C. DAMAGE TO THE SOFT P ARTCAUSES:
1. SKIN WOUND
2 . HEMATOMA
3 . P AIN
4 . P ARALYSIS
3 . SWELLING
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B ROA D CLASSIFICATIONB ROA D CLASSIFICATION
A . CLOSED/SIM P LE FRACTURE
when the breakin the bone has no
communication inthe outside
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B. OPEN/COMPOUND FRACTUREB. OPEN/COMPOUND FRACTURE
when the breakin the bone comesout through theskin or there is
communication ofthe bone to theoutside
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CLASSIFICATION AS TOCLASSIFICATION AS TO
EXTENTEXTENT
COM P LETE INCOM P LETE
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CLASSIFICATION AS TOP ATTERN
TRANSVERSE O B LIQUE S P IRAL
break that runs across the bonebreak runs in slanting direction on
bone
break coils around the bone
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CLASSIFICATION AS TOCLASSIFICATION AS TO
APPEARANCEAPPEARANCE
GREENSTICK FISSURED COMMINUTED
is in incomplete, and the breaks occurs at the convex sur f ace o f the bend in the bone
involves an incomplete longitudinal break
bone splintered into f ragments
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COM P RESSION
DE P RESSION
is one in w hich bone, typically a vertebra, collapses on itsel f
AVULSION
usually occurs in the skull, w ith the broken bone driven in w ard
A f ragment o f bone, w hich is the site o f insertion o f a muscle, tendon or ligament, is detached as the result o f excessive tension
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CLASSIFICATION AS TOCLASSIFICATION AS TOLOCATIONLOCATION
P ROXIMAL
MEDIAL
DISTAL
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CLASSIFICATION INCLASSIFICATION IN
RELATION TO THE JOINTRELATION TO THE JOINT
S ynovial f luid Articular cartilage
J oint capsule
H ead
Femur J oint capsule
INTRA-CA P SULAR
EXTRA-CA P SULAR
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V ARIOUS FRACTURESV ARIOUS FRACTURES ::ITS CLINICALITS CLINICAL
MANIFESTATION ANDMANIFESTATION AND
MANAGEMENTMANAGEMENT
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MANDIBULAR FRACTURESMANDIBULAR FRACTURES
FACIALDISTORTION
MALOCCLUSIONOF THE TEETH
FACIALDISTORTION
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TREATMENTTREATMENT
IMMOBILIZATION
B ARTONSB ANDAGE
INTERDENTAL
WIRING
2 - P C LORENZSCREW
O P EN REDUCTION
INTERNAL FIXATION
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TREATMENTTREATMENT
CHEST STRAPPING ISCHEST STRAPPING IS CONTRAINDICATEDCONTRAINDICATED It reduces respiratory expansionIt reduces respiratory expansion
PULMONARY TOILETPULMONARY TOILET
STOVESTOVE--IN CHEST TRACTIONIN CHEST TRACTION Skeletal traction for multiple ribs fractureSkeletal traction for multiple ribs fracture
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FRACTURES OF THEFRACTURES OF THE UPPERUPPER
EXTREMETIES AND SHOULDEREXTREMETIES AND SHOULDERGIRDLEGIRDLE
CLAVICLE
HEAD OF THEHUMERUS
SCAPULAE
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CLAVICLE FRACTURE
FALL WITHSTRETCHED ARMS
CLAVICLE FRACTURE
TRIANGULAR B ANDAGE
SHOULDER S P ICA
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FRACTURE OF THE HUMERUSFRACTURE OF THE HUMERUS
Lateral aspect
Anatomical neck
G reater tubercle
S urgical neck
sha f t
Deltoid tuberosity
G roove f or R adial nerve
Posterior vie w
H ead
Medial aspectO lecranon f ossa
Lateral epicondyle
trochlea
Medial epicondyle
G roove f or ulnar nerve
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HUMERUSHUMERUS
O P EN FRACTUREOF THE
P ROXIMALHUMERUS
FRACTURE OFTHE HUMERUS
SHAFT
SU P RACONDYLAR FRACTURE OF THE
HUMERUS
MELCH TY P E
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TREATMENTTREATMENT
CASTING
Closed F racture in the humerus
sha f t
HANGINGCAST
FUNCTIONAL CAST with callusformation
O P EN F racture in the humerus
sha f t
SUGAR TONG
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TRACTION
OVERHEAD TRACTION
-S keletal kind o f traction used f or supracondylar f racture o f the humerus
ZERO-DEGREE TRACTION
- S kin kind o f traction used f or f racture o f the neck o f the humerus
DUNLO P S TRACTION
- skin traction used f or supracondylar f racture o f
the humerus
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FRACTURES OF THEFRACTURES OF THE RADIUSRADIUS
AND ULNA AND ULNA
GALLEAZI FRACTURE COLLES FRACTURE SMITH FRACTURE
B ARTONS FRACTURE FRACTURES OF THE SHAFT
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TREATMENTTREATMENT
CASTINGCASTING
LONG ARM CIRCULAR CASTLONG ARM CIRCULAR CAST
SHORT ARM CIRCULAR CASTSHORT ARM CIRCULAR CAST
LONG ARM POSTERIOR MOLDLONG ARM POSTERIOR MOLD
SHORT ARM POSTERIOR MOLDSHORT ARM POSTERIOR MOLD
MUNSTER CASTMUNSTER CAST
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P ELVIC FRACTURESP ELVIC FRACTURES
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MALGAIGNE FRACTURE
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TREATMENTTREATMENT
CASTINGCASTING HIP SPICAHIP SPICA
DOUBLE HIP SPICADOUBLE HIP SPICA11 -- 1/2 HIP SPICA1/2 HIP SPICASINGLE HIP SPICASINGLE HIP SPICADOUBLE HIP SPICA POSTERIOR MOLDDOUBLE HIP SPICA POSTERIOR MOLD11 -- 1/2 HIP SPICA POSTERIOR MOLD1/2 HIP SPICA POSTERIOR MOLDSINGLE HIP SPICA POSTERIOR MOLDSINGLE HIP SPICA POSTERIOR MOLDFROG KCASTFROG KCAST
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TRACTIONTRACTION
SKIN TRACTIONSKIN TRACTION
B UCKS TRACTIONB UCKS TRACTION
HAMMOCK SUS P ENSIONHAMMOCK SUS P ENSIONB RYANTS TRACTIONB RYANTS TRACTION
SKELETAL TRACTIONSKELETAL TRACTIONB ALANCED SKELETALB ALANCED SKELETALTRACTIONTRACTION
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HOFFMANS EXTERNALFIXATOR
SCREWING
P LATING
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FRACTURES OF THE FEMURFRACTURES OF THE FEMUR
GREATER TROCHANTER
I ntertrochanteric Crest
G luteal Tuberosity
I ntercondylar Fossa
G luteal Tuberosity
Lateral Condyle
H ead
Lesser Trochanter
Medial condyle
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FEMORAL NECK FRACTURE
GARDENS CLASSIFICATION
incomplete
and nondisplaced
complete and nondisplaced
complete
and partially displaced
complete and totally displaced
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INTERTROCHANTERICFRACTURES
EVANS CLASSIFICATION
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SU B TROCHANTERICFRACTURES
RUSSEL-TAYLORSCLASSIFICATION
TYP E 1
FRACTURESDO NOTEXTEND INTOTHEP INFORMISFOSSA
FRACTURESEXTEND INTOTHE GREATER TROCHANTER
AND INVOLVESTHEP INFORMISFOSSA
TYP E2
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TREATMENTTREATMENT
CASTINGCASTINGHIP SPICAHIP SPICAQUADRILATERAL/QUADRILATERAL/ISCHIAL WEIGHTISCHIAL WEIGHTBEARINGBEARINGBASKET CASTBASKET CAST
CAST BRACECAST BRACE
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FRACTURES OF THEFRACTURES OF THE
LOWER LEGLOWER LEG
P OTTS FRACTURE SHATZNERSFRACTURE
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TREATMENTTREATMENT
CASTINGCASTINGLONG LEG CIRCULAR CASTLONG LEG CIRCULAR CASTSHORT LEG CIRCULARSHORT LEG CIRCULARCASTCAST
LONG LEGP
OSTERIORLONG LEGP
OSTERIORMOLDMOLDSHORT LEG P OSTERIORSHORT LEG P OSTERIORMOLDMOLDP ATELLARP ATELLAR- -TENDONTENDONBEARINGBEARING
WALKING CASTWALKING CASTDELVIT CASTDELVIT CASTCYLINDRICAL CASTCYLINDRICAL CAST
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CELLULAR P ROLIFERATION
takes place a f ter several days .
The combination o f periosteal elevation and the
granulation tissue containing blood vessel, f ibroblast and
osteoblasts produce a substance called osteoids
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CALLUS FORMATION
Af ter the f ollo w ing w eeks, minerals are being deposited in the osteoid f orming a large mass o f di ff erentiated tissue bridging the f ractured called
callus
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OSSIFICATION
F inal laying do w n o f bone,
is the stage in w hich f racture ends knit together
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CONSOLIDATION
W hen the consolidation is
completed the excess cells are absorbed
The primary cancellous bone is remodelled, compact
bone being f ormed according to stress patterns
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COMPLICATIONS
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Interruptions in the sequenceInterruptions in the sequence
of healing are caused by:of healing are caused by:D EB RI D EMENTD EB RI D EMENTLACK OF VITAMIN DLACK OF VITAMIN D
INFECTIONINFECTIONLOSS OF CIRCULATIONLOSS OF CIRCULATIONIMPROPER IMMO B ILIZATIONIMPROPER IMMO B ILIZATION
INA D EQUATE FIXATIONINA D EQUATE FIXATIONNECROSIS D UE TO FIXATION D EVICESNECROSIS D UE TO FIXATION D EVICESMETA B OLIC D ISTUR B ANCEMETA B OLIC D ISTUR B ANCE
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AVASCULAR NECROSIS AVASCULAR NECROSIS
W hen a j oint is W hen a j oint is in j ured, as in a in j ured, as in a f racture or f racture or dislocation, the dislocation, the blood vessels may blood vessels may be damaged . This be damaged . This can inter f ere w ith can inter f ere w ith the blood the blood circulation to the circulation to the bone and lead to bone and lead to traumatrauma -- related related avascular necrosis . avascular necrosis .
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SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS
P AIN
P AIN ON B EARINGWEIGHT
CRE P ITUS ONROTATION
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TREATMENTTREATMENT
CONSERVATIVE TREATMENTCONSERVATIVE TREATMENTMedicines to reduced fatty acidsMedicines to reduced fatty acidsReduced weight bearingReduced weight bearingRange of motion exerciseRange of motion exerciseElectrical stimulation to induced bone growthElectrical stimulation to induced bone growth
SURGICAL TREATMENTSURGICAL TREATMENTCORE DECOMPRESSIONCORE DECOMPRESSION
This surgical procedure removes the inner layer of bone,This surgical procedure removes the inner layer of bone,which reduces pressure within the bone, increases bloodwhich reduces pressure within the bone, increases blood
flow to the bone, and allows more blood vessels to formflow to the bone, and allows more blood vessels to form
OSTEOTOMY OSTEOTOMY This surgical procedure reshapes the bone to reduceThis surgical procedure reshapes the bone to reducestress on the affected areastress on the affected area
BONE GRAFTBONE GRAFT
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OTHER COMPLICATIONSOTHER COMPLICATIONS
PNEUMONIAPNEUMONIABED SORESBED SORESINFECTIONINFECTIONCONTRACTURESCONTRACTURESCOMPRESSION SYNDROMECOMPRESSION SYNDROME
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