adult fractures

7/28/2019 Adult Fractures

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Adult

Fracture management


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Youngs modulus

Stress / Strain curve:

Yield point

Ultimate strengthBreak point


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BONE PROPERTIES

Lamellar bone:

cortical or cancellous.

Woven bone.

Cortical bone high Young'smodulus.

Cancellous bone undergoesmore remodelling.


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Bone tissue

Wet 70% mineralised matrix, 25% organic

matrix and cells and 5% water.90% of organic matrix is collagen


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Mechanical properties

Tensile property

Compressile strength

Yield strain is approximately 7000 microstrain.

Ultimate strain approximately 15000 micro

strains in normal bone.


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FRACTURE DISCRIPTION

Anatomical location - ? Joint

Direct / Indirect

Fracture configuration

Simple or comminuted

Open or Closed

Pathological

Stress fracture

Greenstick Fracture


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Fracture management

Resuscitation

Emergency procedures - openDiagnosis

Stabilization

Delayed operative procedures andRehabilitation.


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Diagnosis

Look, Feel, MoveX-rays: Rule of Three


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Treatment

ATLS

Reduce

Hold

Move


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Direct Trauma


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Indirect Trauma

Rotation

Compression

Combination

Tension

Angulation


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Classification of fractures

Evidence based medicine

Communication

Treatment plan


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Fracture Immobilization

Plaster

Traction

Internal FixationExternal Fixation

Intra-articular fractures

Alignment

LengthRotation

Rule of three


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Principles of Internal

Fixation Interfragmentary compression


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Interfragmentary compression


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Fixation

Intramedullary fixation


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Fixation

Hybrid Fixation


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External fixation

Process of manipulating, aligning, andstabilizing bony structures with pins,

wires, screws, or other bone fastenersthat affix the bone to an external scaffoldor frame.


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External fixation


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CID / CIND

VISI / DISI

ACUTE / CHRONIC

1. PERILUNATE

2. RADIOCARPAL

3. MIDCARPAL


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Two Types of Recurrent Instability

TraumaticUnidirectional

Bankart lesion (avulsion of glenohumeral ligaments fromglenoid)

Surgery is often necessary

Atraumatic

Multidirectional

Bilateral

Rehabilitation enhances stability

Inferior capsular shift should be a part of repair if surgery is

necessary


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LATERAL COMPRESSION

ANTEROPOSTERIOR COMPRESSION

VERTICAL COMPRESSION

COMBINATION

PELVIC FRACTURES

PELVIC FRACTURES


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Young System

Category Distinguishing Characteristics

LC Transverse fracture of pubic rami + posterior injury

ISacral compression on side of impact

IICrescent (iliac wing) fracture on side of impact

IIILC-I or LC-II injury on side of impact; contralateral APC injury

APC Symphyseal diastasis or longitudinal rami fractures

ISlight widening of pubic symphysis or anterior SI joint; stretched

but intact anterior SI, sacrotuberous, and sacrospinous ligaments;intact posterior SI ligaments

IIWidened anterior SI joint; disrupted anterior SI, sacrotuberous,

and sacrospinous ligaments; intact posterior SI ligaments

IIIComplete SI joint disruption with lateral displacement; disrupted

anterior SI, sacrotuberous, and sacrospinous ligaments; disrupted

posterior SI ligamentsVS Symphyseal diastasis or vertical displacement anteriorly and

posteriorly, usually through the SI joint, occasionally through the iliac

wing or sacrum

CM Combination of other injury patterns, LC/VS being the most common

PELVIC FRACTURES


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LC APC VC

LC/VC


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Acetabular Fracture

PARTIAL ARTICULAR ONE COLUMN FRACTURE

PARTIAL ARTICULAR TRANSVERSE FRACTURECOMPLETE ARTICULAR, BOTH COLUMN


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TYPE A PARTIAL ARTICULAR ONE COLUMN FRACTURE

A1Posterior wall

A2Posterior column

A3Anterior wall and/or anterior column

TYPE B PARTIAL ARTICULAR TRANSVERSE FRACTURE

Portion of the roof attached to intact illium

B1Transverse + posterior wall

B2T types

B3Anterior with posterior hemitransverse

TYPE C COMPLETE ARTICULAR, BOTH COLUMNAll articular segments, including the roof, are detached from the

remaining segment of the intact ilium,

the floating acetabulum.

C1Both columnanterior column fracture extends to the

iliac crest (high variety)C2Both columnanterior column fracture extends to the

anterior border of the ilium (low variety)

C3Both columnanterior fracture enters the sacroiliac

joint


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Hip fracture dislocations


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Thompson and Epstein

Anterior or Posterior Hip Dislocations

Type I : No significant associated fractures

Type II: Irreducible dislocation without significantfemoral head or acetabular fractures

Type III: Unstable hip after reduction or incarcerated

fragments of cartilage, labrum, or bone

Type IV: Associated acetabular fracture requiring

reconstruction

Type V: Associated femoral head or neck injury

P t i


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Posterior


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Type I: Fracture femoral head caudad to the fovea

centralis

Type II: Fracture of the femoral head cephalad to thefovea centralis

Type III: Type I and type II with fracture of the femoral

neck

Type IV: Type I, II, or III with associated fracture of

the acetabulum

Pipkin


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adult fractures

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