FRACTURES AND DISLOCATIONS

Dr VARUN SHARMARESIDENT IN ORTHOPAEDICS AND TRAUMATOLOGY

OSMANIA GENERAL HOSPITAL

Definition of trauma:

Injuries which are caused by external force or violence. They may range from minor to major, obvious to not apparent, single injury to multiple.

When a bone fractures, there is usually damage to the surrounding area which may include:

• Damage to muscles• Tearing of blood & lymph

vessels• Severing of nerves• Damage to nearby organs• Laceration of the skin

Signs of fracture:

• limited or no movement of a limb• swelling at the site of injury• pain at, or distal to, the injury• bruising at injury site• deformity of a limb• no pulse distal to the injury• loss of feeling at, and distal to, the

injury

Clinical indication of dislocation

Deformity of a limb

Fracture Healing

Healing begins when swelling occurs.

Blood, lymph, & tissue fluids form a fibrin clot around the fracture.

Soon fibroblasts appear & begin granulation.

Granulation process helps stabilize the fracture…….. (continued)

Healing (continued)

Calcium is deposited around the fracture forming a callus.

*The callus is the first phase of healing which can be demonstrated radiographically.

Calcified area may be large at first, but will reduce with use.

Fracture site may be stronger than before!

Factors affecting healing:

•Patient age•general health•nutrition•circulation at site of injury

Terminology

A/A or MVAabrasionamputationconcussioncrepitusdislocation

Fracturehematomasprainluxationsubluxation

Examples of dislocation

Example of subluxation

General types of fractures

•Complete vs. Incomplete

Entire cross section of the bone fractures vs. not broken into separate pieces.

General fracture types (cont.)

•Closed (simple) vs. compound

Bone does not pierce through the skin

vs. bone is through the skin

Closed vs compound fractures

General types of fractures (cont.)

•Direct vs Indirect

fracture occurs at the site of trauma vs away from the impact point

Fracture Alignment

Displacement or apposition = misalignment of a fracture

Other terms denoting misalignment:

•Varus•Valgus•Bayonet

(see note)

OUCH!

Varus or Valgus?

ANOTHER OUCH !

Overlapping fx.

Specific types of fractures

LINEAR - straight lines

Transverse fx

Transverse fx.

Longitudinal (cleft)

Oblique fx

(also an oblique fx because of the direction of the fracture line)

Spiral fx

Fracture line rotates around the bone, usually from a twisting force

Spiral fx.

Comminuted fx

2 or more fracture lines = 3 or more fragments

Crush fx

Severe communited !

Impacted fx

Typical of a front seatpassenger in a car

crash !

Fractured ends get pushed into one another

Impacted fx.

Splinter fx

Fracture ends are thin shards or splinters like wood.

(gunshot wounds)

Stellate fx

Specific to the patella-

fracture lines radiate out from a center point in a star-like pattern.

Compression fx

Specific to the vertebrae - vertebral body collapses, anterior aspect is reduced in height.

From trauma or demineralization of bone (old age).

Burst fx

C - 1 (atlas)C1 ring is broken, fragments move outward.

Football injuries, heavy object dropped on head.

Blowout fx

Orbital floor collapses from direct blow to eyeball

(fist, baseball)

Depressed fx

Section of bone pushed into center of an area

(skull, sternum)

Complicated fx

Fractured bone causes damage to an internal organ. Ex. - rib pierces lung

Avulsion fx (chip fx)

Caused by stress to a joint, ligament, or tendon. Small piece of bone is torn away. Often seen with dislocations.(see note)

NON-TRAUMA FRACTURES

1. Pathologic - bone is weakened by disease, spontaneous fx’s

(cancer, osteomalacia, osteomyelitis, Pagets)

2. Stress - caused by prolonged running or marching - metatarsals fracture. Difficult to visualize.

Pediatric fractures

1. Greenstick (torus) - incomplete fx, bones more flexible, bends & fractures only outer edge.

2. Epiphyseal - fractures located at the site of an epiphysis. Sometimes with associated dislocation (slipped epiphysis)

THE END !!