Dr.Metwally Shaheen ( FRCSI) Ortho. Consultant

( Head 0f Orthopedic Department SGH-J )

FracturesTreatment and Complications

How ???

1. Single traumatic incident.2. Repetitive stress.3. Abnormal weakening of the bone

( pathological fracture ).

Clinical features

History SymptomsGeneral signsLocal signs :- Look- Feel- Move

Radiological examination

X. ray :- Two views.- Two joints.- Two limbs.

Special imaging.- C.T scan.- MRI.- Isotopic scaning.

REDUCEHOLD

EXERCISE

Closed Fractures

The Fracture Quartet

Speed/Safety

Hold/Move

Reduction

Aims at adequate apposition and normal alignmentMore healing is expected with greater surface area

in contact at the fracture surfaceA gap is a cause of nonunionOverlap is permissible except in articular fracturesCan be achieved by:

ManipulationTractionOpen reduction

Manipulation

Pulling

Disengagement

Alignment

Mechanical Traction

Used when manipulation

is not effective as in cases of powerful muscle pull as in femoral fractures

Hold is not perfectMove is applicableSafeSpeed is a problem

(long bed rest)

Classified as:1. Skin traction2. Skeletal traction

Classified as:1. Traction by gravity2. Balanced traction3. Fixed traction

Mechanical Traction

Forms of Splintage

Cast SplintageMove is a problem

Functional BracingMove is allowed

Open Reduction

Indicated in:1.Failure of closed reduction2.Soft tissue interposition3.Large articular fragment4.Avulsion fracture where fragments are held

apart due to muscle pull5.When operation is needed for associated

injury6.When the fracture will need anyhow internal

fixation to hold it

Internal Fixation

Screws

Wires

Plate and screws

Intramedullary nailing

Internal Fixation

Open Fractures

Gustilo Classification:Type I: Low energy, small clean wound, little soft

tissue damageType II: Moderate eneregy, wound > 1 cm, not

much soft tissue damageType III: High energy, extensive soft tissue

damage, wound contaminationType IIIA: No periosteal stripping ( skin coverage

not needed)Type IIIB: Periosteal stripping ( need skin

coverage )Type IIIC: Vascular or nerve injury

Open Fractures

Principles of treatment:

1. Aggressive wound debridement

2. Antibiotic Prophylaxis

3. Stabilization of fracture

4. Early and definitive wound coverage

Complications of fractures

General complications: Shock Adult respiratory distress syndrome. DVT & Pulmonary embolism. Fat embolism Disseminated intravascular coagulopathy Crush syndrome Tetanus Gas Gangrene.

Complications of Fractures

Local complications: Early Late

Local Complications of Fractures

Early complications - bone Infection …..esp in open fractures.

Local Complications of Fractures

Early complications – soft tissues Fracture plisters. Plaster sores. Torn muscle fiberes. Haemoarthrosis. Vascular injury. Compartment syndrome. Nerve injury. Visceral injuries.

Local Complications of Fractures

Early complications - joints Haemoathrosis and infection. Ligament injury. Regional pain syndrome(Sudek’s atrophy)

Local Complications of Fractures

Late complications - bones Avascular necrosis. Delayed union. Non union. Malunion.

Local Complications of Fractures

Late complications – sost tissues Bed sores. Myositis ossificance. Tendenitis and tendon rupture. Nerve compression and entrapment. Volkmmanns contracture.

Local Complications of Fractures

Late complications – joints Instability. Stiffness. Stiffness. Regional pain syndrome(Sudek’s atrophy) Osteoarthritis.

Thank you