principles of fracture management saseendar

PRINCIPLES OF FRACTURE

MANAGEMENT

Dr Saseendar S, MS Ortho, DNB Ortho, MNAMS,

Dip SICOT(Belgium), FISOC(US), FASM (Sing),

Shoulder, Elbow and Knee Arthroscopy Surgeon,

Chettinad Super Speciality Hospital,

Chettinad Health City, Chennai

TOPICS COVERED

Definition

Mechanism of fractures

Fracture types

Complete

Incomplete

Types of displacements

Fracture healing

Stages

Treatment of fractures

Closed fractures

Open fractures

DEFINITION

An interruption in the continuity of

the bone which may be a

complete break or an incomplete

break.

MECHANISMS

Single traumatic event

Repitive stress – Stress fractures

Pathological – Insufficiency fractures

HIGH-ENERGY

INJURY

High-energy injury

LOW ENERGY INJURY

Low-energy injury

PATHOLOGIC FRACTURES

Often need surgery

diagnostic workup

important

prognosis dependent

on biology of lesion

Polyostotic Fibrous Dysplasia

MECHANISMS OF FRACTURES

Direct – Bending / Crushing

Indirect

MECHANISMS OF FRACTURES - INDIRECT

Twisting causes a spiral fracture;

Compression causes a short oblique fracture;

Bending results in fracture with a triangular

'butter-fly‘ fragment;

Tension tends to break the bone transversely

CLASSIFICATION OF FRACTURES

Complete/ Incomplete

Fracture pattern

Soft-tissue cover

Displacement

Comminution

COMPLETE/ INCOMPLETE

GREENSTICK FRACTURES

Bending mechanism

Failure on tension side

Incomplete fracture,

plastic deformation on

compression side

May need to complete

fracture to realign

BUCKLE OR TORUS FRACTURE

Compression failure

Stable

Usually at

metaphyseal /

diaphyseal junction

CLASSIFICATION OF FRACTURES

Closed fractures

There is no communication between the external

surface of the body and the fracture

Open fractures

There is a communication between the fracture and the

skin.

From inside-out

From outside-in

High risk of infection/

neurovascular injury

OPEN FRACTURES

OPEN FRACTURES

DISPLACEMENT

Angulation

Translation

Rotation

DISPLACEMENT

UNDISPLACED DISTAL RADIUS FRACTURE

MINIMALLY DISPLACED DISTAL RADIUS FRACTURE

DISPLACED FEMUR FRACTURE

HEALING OF FEATURES

Stage of haematoma

Stage of cellular proliferation

Stage of callus formation

Stage of consolidation

State of remodelling

PRINCIPLES OF MANAGEMENT

General condition

Temporary stabilisation

Definitive treatment

Reduce

Hold

Exercise

TEMPORARY STABILISATION

DEFINITIVE TREATMENT

Closed reduction

Open reduction

Immobilisation

Internal/ External fixation

CLOSED REDUCTION

HOLD/ MAINTAIN REDUCTION

Traction

Slab/ Cast

Brace

MAINTAIN

Fixation

Internal Fixation

Screws

K wires

Plates and screws

Nails

External Fixation

TENSION BAND WIRING

PLATES AND SCREWS

Extramedullary internal

fixation

INTERLOCKING NAIL

Intramedullary internal

fixation

EXTERNAL FIXATION

SKELETAL TRACTION – SKULL TONGS

SKELETAL TRACTION

– UPPER TIBIAL PIN TRACTION

SKELETAL TRACTION

– UPPER TIBIAL PIN TRACTION

SKIN TRACTION

– GALLOWS TRACTION

EXTERNAL FIXATOR

PLASTER OF PARIS

- ABOVE ELBOW CAST

EXTERNAL STABILISATION

– BUDDY STRAPPING

BOHLER BRAUN FRAME

OPEN FRACTURES

PRINCIPLES

IV antibiotics,

tetanus prophylaxis

emergent irrigation &

debridement

skeletal stabilization

soft tissue coverage

LAWNMOWER INJURIESprobably most common

cause of open fractures in children

most children are a rider or bystander (70%)

high complication rate -infection, growth arrest,amputation

> 50% unsatisfactory results (Loder)

LAWNMOWER INJURIES – OFTEN

RESULT IN AMPUTATIONS

PHYSIOTHERAPY DURING

IMMOBILIZATION

Reduce oedema – to prevent the adhesion formation

Assist the maintenance of the circulation – active exercise either by static or isotonic muscle activity

Maintain muscle function by active or static contraction

Maintain joint range where possible

Maintain as much function as allowed by the particular injury and the fixation

Teach the patient how to use special appliances such as crutches, sticks, frames, and how to care for these or any other apparatus

PHYSIOTHERAPY AFTER THE

REMOVAL OF FIXATION

To reduce any swelling

To regain full range of joint movement

To regain full muscle power

To re-educate full function

THANK YOU

Information contained in this presentation are intended for

academic purpose only for the students of orthopaedic

surgery.

The guidelines mentioned cannot be used absolutely for

management of patients.

I am not responsible for any controversies that arise out of

this presentation.

For clarifications/ suggestions please contact

ssaseendar@yahoo.co.in or call at 91-9500366970.