Fractures, Syed Alam Zeb

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Fractures, Syed Alam Zeb

  1. 1. FRACTURES Dr.Syed Alam Zeb, ortho B ,hmc
  2. 2. DEFNITION <ul><li>Fractures (breaks) are failure of the skeletal system to cope with the load put upon it. </li></ul><ul><li>There may be associated neurovascular injuries. </li></ul><ul><li>History: Ask about the nature of injury. </li></ul>
  3. 3. Assessment of patient with fracture <ul><li>First perform ABCDE, then a quick general survey. </li></ul><ul><li>Check distal neurovascular status on any injured limb. </li></ul><ul><li>If you find one fracture, look for another. </li></ul>
  4. 4. CLASSIFICATION <ul><li>Classification by quality of bone in relation to load. </li></ul><ul><li>Classification by direction of force. </li></ul><ul><li>Classification by anatomical site. </li></ul>
  5. 5. Classification by quality of bone in relation to load. <ul><li>Traumatic fracture. </li></ul><ul><li>Pathological fracture. </li></ul><ul><li>Stress fracture. </li></ul><ul><li>Partial or green stick fracture. </li></ul>
  6. 6. Classification by direction of force <ul><li>Compression facture. </li></ul><ul><li>Avulsion or distraction fracture. </li></ul><ul><li>Spiral fracture. </li></ul><ul><li>Transverse fracture. </li></ul><ul><li>Butterfly fracture. </li></ul><ul><li>Communited fracture. </li></ul>
  7. 7. Classification by anatomical site. <ul><li>Diaphysial fractures. </li></ul><ul><li>Metaphysial fractures. </li></ul><ul><li>Epiphysial fractures. </li></ul>
  8. 8. PRINCIPLES OF MANAGEMENT <ul><li>Deal with life saving procedures,ABC. </li></ul><ul><li>Then deal with limb saving procedure, neurovascular problems. </li></ul><ul><li>Then deal with the fracture. </li></ul>
  9. 9. Planning fracture management <ul><li>Reduction : may be closed or open. </li></ul><ul><li>Holding a fracture: using plaster casts, plates and nails. </li></ul><ul><li>Rehabilitation ; exercise program, physiotherapy. </li></ul>
  10. 10. Complications of fractures <ul><li>EARLY: </li></ul><ul><li>hypovolaemic shock. </li></ul><ul><li>neurovascular loss. </li></ul><ul><li>compartment syndrome. </li></ul><ul><li>degloving of skin. </li></ul><ul><li>severe pain. </li></ul><ul><li>fracture blisters. </li></ul>
  11. 11. Complications of fractures <ul><li>LATE COMPLICATIONS: </li></ul><ul><li>non-union. </li></ul><ul><li>malunion. </li></ul><ul><li>stiffness. </li></ul><ul><li>infection and arthritis. </li></ul><ul><li>myoglobinuria. </li></ul><ul><li>multi-organ failure. </li></ul><ul><li>depression. </li></ul>
  12. 12. FRACTURES OF THE FACIAL SKELETON
  13. 13. <ul><li>Divided in to: </li></ul><ul><li>Upper 1/3. Above the eye brows.Zygomatricmaxillary. </li></ul><ul><li>Middle third. Above the mouth.Lefort fractures. </li></ul><ul><li>Lower third. The mandible. </li></ul>
  14. 14. Radiographic signs of facial fractures <ul><li>Direct Signs </li></ul><ul><li>nonanatomic linear lucencies </li></ul><ul><li>cortical defect or diastatic suture </li></ul><ul><li>bone fragments overlapping causing a &quot;double-density&quot; </li></ul><ul><li>asymmetry of face </li></ul><ul><li>Indirect Signs </li></ul><ul><li>soft tissue swelling </li></ul><ul><li>periorbital or intracranial air </li></ul><ul><li>fluid in a paranasal sinus </li></ul>
  15. 15. Zygomaticmaxillary complex fracture <ul><li>Probably the most common facial fracture is the tripod or zygomaticomaxillary complex fracture, so called because it involves separation of all three major attachments of the zygoma to the rest of the face. </li></ul>
  16. 16. Blow out fractures <ul><li>&quot;blowout fracture&quot; -- the arrows point to the fracture fragments and periorbital tissue which have herniated into the maxillary sinus </li></ul>
  17. 17. LeFort Complex fractures <ul><li>LeFort studied fracture patterns produced in cadavers. He found three main planes of &quot;weakness&quot; in the face, which correspond to where fractures often occur: </li></ul><ul><li>Transmaxillary plane. </li></ul><ul><li>Subzygomatic or pyramidal plane (this is really two planes with an apex up at the bridge of the nose). </li></ul><ul><li>Craniofacial plane. </li></ul>
  18. 18. LeFort fractures frontal view
  19. 19. LeForts fractures Side view
  20. 20. Diagnosing facial fractures <ul><li>Look at the orbits carefully, since 60 - 70 % of all facial fractures involve the orbit in some way. </li></ul><ul><li>Bilateral symmetry can be very helpful. </li></ul><ul><li>Carefully trace along the lines of Dolan. </li></ul><ul><li>Use CT liberally in working up facial fractures. </li></ul>
  21. 21. Mandibular Fractures <ul><li>Body 30 - 40 % </li></ul><ul><li>Angle 25 - 31 % </li></ul><ul><li>Condyle 15 - 17 % </li></ul><ul><li>Symphysis 7 - 15 % </li></ul><ul><li>Ramus 3 - 9 % </li></ul><ul><li>Alveolar 2 - 4 % </li></ul><ul><li>Coronoid process </li></ul><ul><li>1 - 2 % </li></ul>

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