HOW TO DEAL HOW TO DEAL WITH A FRACTUREWITH A FRACTURE

FRACTURESFRACTURES

SYMPTOMS:SYMPTOMS: History of trauma,History of trauma,

Pain,Pain,

Swelling,Swelling,

Limited movements.Limited movements.

SIGNSSIGNS

SYSTEMIC: SHOCKHYPOVOLAEMIC

NEUROGENIC SPINAL

DISTAL:NEURO-VASCULAR

LOCALLOCAL:: SwellingSwelling,,

EcchymosisEcchymosis , , TendernessTenderness,,

Limited movementsLimited movements DeformityDeformity,,

Length discrepancyLength discrepancy,, Abnormal Abnormal

movementsmovements,, CrepitusCrepitus

TRAUMA TRAUMA Direct Direct

IndirectIndirect Vehicular accidentsVehicular accidents Fall from heightFall from height Crushing accidentsCrushing accidents Avulsion fracturesAvulsion fractures

Fall on out-stretched Fall on out-stretched armarm

FRACTURE FRACTURE DISLOCATION DISLOCATION FRACTURE-DISLOCATIONFRACTURE-DISLOCATION

FRACTURESFRACTURESPROBABLE(SUSPICIOUS) PROBABLE(SUSPICIOUS) SIGNS OF FRACTURESIGNS OF FRACTURE

SwellingSwelling

Local painLocal pain

Tenderness Tenderness Ecchymosis, abrasionsEcchymosis, abrasions

Limited joint Limited joint movementmovement

Sure SignsSure Signs:: Deformity,Deformity, Length discrepancy,Length discrepancy, Abnormal Abnormal movements,movements, CrepitusCrepitus

DINNER FORK

VARUSS-SHAPE

CrepitusCrepitus

Abnormal MAbnormal M

Length discrepancyLength discrepancy,,

OPEN AND CLOSED OPEN AND CLOSED FRACTURESFRACTURES

- Definition- Precautions

FRACTURE PLETHORA (BULLAE)

MULTIPLE INJURIES RISK

InvestigationsInvestigations

Plain X-rayPlain X-ray

Transverse ObliqueSpiral

GREENSTICK

X-RAYSX-RAYS

-Comminuted - Segmental

Special Types

COLLES FR.

SMITH FRSMITH FR

SUPRACONDYLAR FRACTURESUPRACONDYLAR FRACTURETwo typesTwo types::

Flexion typeFlexion typeₒExtension typeₒExtension type

Caused by fall onCaused by fall on caused by fall on caused by fall on

tip of elbow(tip of elbow(15%15%))outstretched hand(outstretched hand(85%85%))

EXT

FLEX

MONTEGGIA FRACTURE-DISLOCATION

GALEAZZI FRACTURE-DISLOCATION

Hip FracturesHip FracturesFemoral neck 45%Femoral neck 45% intracapsular, intracapsular, disruption of blood supply to disruption of blood supply to

femoral head, femoral head, high incidence of healing high incidence of healing

complications (nonunion, complications (nonunion, osteonecrosisosteonecrosis))

Intertrochanteric 45%Intertrochanteric 45% extracapsular, extracapsular, no interference with the no interference with the

blood supply of the femoral blood supply of the femoral head, head,

less complicationsless complications MalunionMalunion

SubtrochantericSubtrochanteric extracapsularextracapsular MalunionMalunion Blood lossBlood loss

DISLOCATIONSDISLOCATIONS

SHOULDER ANTERIOR

RECURRENCE

ELBOW POSTERIOR

HIP POSTERIORSCIATIC N. INJMYOSITIS OSSIFICANS

PATHOLOGICAL FR.

Osteogenesis Osteogenesis imperfectaimperfecta

OTHER INVESTIGATIONSOTHER INVESTIGATIONS

CT

CT & 3D-CT

MRI

BONE SCAN

US examinationUS examination

LAB INVESTIGATIONSLAB INVESTIGATIONS

METHODS OF METHODS OF TREATMENTTREATMENT

TREATMENT OF CLOCED FRACTURES

UNDISPLACEDREDUCIBLE CONSERVATIVE TREATMENT

GALLOW,s TRACTION

BALANCED SKIN TRACTIONSKELETAL TRACTION

1-TRACTION

22..CAST (POP) CAST (POP) FOR SIMPLE NONDISPLACED FRACTURES WITH NO FOR SIMPLE NONDISPLACED FRACTURES WITH NO

SKIN NOR NEUROVASCULAR COMPROMISESKIN NOR NEUROVASCULAR COMPROMISE

OPEN FRACTURESDEBRIDEMENTEXTERNAL FIXATOR

EXTERNAL FIXATOR

percutaneous pinning.percutaneous pinning.

K-WIRES

ORIFORIF

METHODS OF INTERNAL FIXATION

INTER TROCHANTERIC FRACTUREDHS

Displaced Femoral neck Displaced Femoral neck Fracture esp. in elderly pt.Fracture esp. in elderly pt.

Prosthetic replacementProsthetic replacement

HEMIARTHROPLASTY

TOTAL ARTHROPLASTY

COMPLICATIONSCOMPLICATIONS

MalunionMalunion Cross unionCross union

NonunionNonunion

ULNAR N PALSY

Axillary nerve injuryAxillary nerve injury

Deltoid wasting

VOLKMANN,s ISCHAEMIC CONTRACTURE

MYOSITIS OSSIFICANSMYOSITIS OSSIFICANS

Recurrence of dislocationRecurrence of dislocationof the shoulderof the shoulder

This is the most common complication.This is the most common complication. Causes of recurrence:Causes of recurrence:

1- Patient age: High incidence below the age of 1- Patient age: High incidence below the age of 40 years.40 years.

2- 2- Inadequate immobilizationInadequate immobilization: less than 3 : less than 3 weeks.weeks.

3- associated head fractures: (3- associated head fractures: (Hill-Sachs lesionHill-Sachs lesion))

increase the incidence of recurrence.increase the incidence of recurrence.

4- Glenoid labral injury (4- Glenoid labral injury (Bankart lesionBankart lesion))

INFECTIONSINFECTIONS

Pathology:Pathology:Affected bone is Affected bone is

destroyed or devitalized with destroyed or devitalized with cavities cavities

containing pus and pieces of dead containing pus and pieces of dead bone (bone (sequestrumsequestrum), ),

surrounded by vascular tissue, surrounded by vascular tissue, and beyond that by areas of and beyond that by areas of

sclerosis.sclerosis.Sequestra act as Sequestra act as

substrates for bacterial substrates for bacterial adhesion causing persistence adhesion causing persistence of the infection until removed of the infection until removed or discharged through draining or discharged through draining sinuses.sinuses.

SinusesSinuses may close may close spontaneously then reopen spontaneously then reopen when tissue tension rises. when tissue tension rises.

Pathological Pathological fracturefracture may develop.may develop.

•New bone formation

Involucrum•Bone necrosis Sequestrum•Cavity,discharging sinus Cloaca

CHRONIC OSTEOMYELITIS

Imaging :Imaging :X-ray X-ray shows bone shows bone

resorption with resorption with thickening and thickening and sclerosis of the sclerosis of the surrounding bone.surrounding bone.

SequestraSequestra seen seen as unnaturally dense as unnaturally dense fragments in contrast fragments in contrast with the surrounding with the surrounding vascularized bone.vascularized bone.

Sometimes the Sometimes the bone is crudely bone is crudely thickened and thickened and misshapen resembling misshapen resembling a bone a bone tumour,tumour,involucruminvolucrum..

DeformitieDeformitiess

Genu varum & valgumGenu varum & valgum

Cubitus varus “Carrying angle”

Cubitus varus “Carrying angle”

Cubitus valgum “Carrying angle”

Coxa vara Neck shaft angle