Fractures

Dr Ayman Soliman Isamail
Common Outdoor Injury
Management
Objectives







Review mechanisms and patterns of
traumatic injury
Illustrate the ty...
Mechanism of Injury
Mechanism of Injury
Types of Trauma
Mechanism of Injury
Types of Trauma

 Penetrating

Trauma
 Compression (Blunt)
Trauma
 Bending Trauma
Hyperflexion
Hype...
Nail in Index Finger
Mechanism of Injury
Types of Trauma

 Penetrating

Trauma
 Compression (Blunt)
Trauma
 Bending Trauma
Hyperflexion
Hype...
Severe Contusion of Foot
Mechanism of Injury
Types of Trauma

 Penetrating

Trauma
 Compression (Blunt)
Trauma
 Bending Trauma
Hyperflexion
Hype...
Cervical
(C5-C6)
Fracture
Dislocation
Mechanism of Injury
Types of Trauma

 Penetrating

Trauma
 Compression (Blunt)
Trauma
 Bending Trauma
Hyperflexion
Hype...
Dorsal
Dislocation,
Long Finger
Middle Joint
(PIP Joint)
Mechanism of Injury
Types of Trauma

 Rotational

Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acce...
Normal
Tibia
Left

Spiral
Fracture
Tibia
Right
Mechanism of Injury
Types of Trauma

 Rotational

Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acce...
Dislocation of Right
Shoulder
Mechanism of Injury
Types of Trauma

 Rotational

Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acce...
Train Crush Injury, Leg
Mechanism of Injury
Types of Trauma

 Rotational

Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acce...
Deceleration Trauma
Mechanism of Injury
Types of Trauma

 Rotational

Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acce...
Car struck from behind
“accelerates” passengers,
producing an extension injury
to the neck!
Trauma

Acceleration
Mechanism of Injury
Types of Force
Mechanism of Injury
Types of Force

 Direct

Force
 Indirect Force
 Twisting Force
 High Energy Force
Direct
Mid-Shaft Fracture, Femur
Mechanism of Injury
Types of Force

 Direct

Force
 Indirect Force
 Twisting Force
 High Energy Force
Indirect
Posterior Dislocation,
Elbow
Mechanism of Injury
Types of Force

 Direct

Force
 Indirect Force
 Twisting Force
 High Energy Force
Twisting
Subtalar Dislocation, Ankle
Mechanism of Injury
Types of Force

 Direct

Force
 Indirect Force
 Twisting Force
 High Energy Force
High Energy
Fractured Pelvis
Types of Injury
Types of Injury
Fracture

•

Any break in the continuity
of a bone
•

May vary from a simple
crack to a completely
shatter...
Fracture Classification
Closed/Open
Incomplete/Complete
Non-Displaced/Displaced
Closed Fracture,
Base of Thumb

Closed
Dorsally
Angulated
Forearm Fracture
Open Fracture, Tibia

Open Fracture, Forearm
Open Fractures Are
More Serious!
 Blood
 Potential

loss

contamination
with risk of infection
Fracture Classification
Closed/Open
Incomplete/Complete
Displaced/Displaced
Incomplete Fracture,
Distal Radius
Complete Fracture, Femur
Fracture Classification
Closed/Open
Incomplete/Complete
Non-Displaced/Displaced
Non-Displaced Fracture,
Distal Tibia and Fibula
Displaced Forearm Fractures
Other Types of Fracture
Comminuted – fractured into
more than two segments
Pathologic – fracture through
diseased bone
Epi...
Comminuted Femur
Fracture
Other Types of Fracture
Comminuted – fractured into
more than two segments
Pathologic – fracture through
diseased bone
Epi...
Pathologic

Lytic lesion (darker = tumor)
in proximal phalanx of finger,
with associated transverse
fracture
Other Types of Fracture
Comminuted – fractured into
many pieces
Pathologic – fracture through
diseased bone
Epiphyseal – f...
Epiphyseal (growth-line)
Fracture,
Signs of a Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 In...
Seven Signs of Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
...
Fractured Patella
Seven Signs of Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
...
Angulated Fracture,
Radius and Ulna
Seven Signs of Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
...
Crepitus
In a complete fracture, the
sounds of bone ends clicking or
rubbing against each other;
denotes an unstable fract...
Seven Signs of Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
...
Open Ankle Fracture
Seven Signs of Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
...
False Motion
The unusual visual sensation
of observing motion at a long
bone fracture site where
“ there is no joint!”
Seven Signs of Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
...
Fracture, Right Clavicle
Right Arm Protected
Seven Signs of Fracture
The presence of
any one
of the
seven fracture signs just listed
is sufficient to assess this injur...
Types of Injury
Dislocation





Disruption of a joint such that
the bone ends are no longer in
normal contact
Must have...
Signs of Dislocation
 Tenderness
 Deformity

(usually marked)
 Swelling and Ecchymosis
 Loss of normal joint motion
Common Dislocations
 Shoulder
 Finger
 Hip
 Elbow
Anterior Dislocation, Right
Shoulder
Common Dislocations
 Shoulder
 Finger
 Hip
 Elbow
Dislocation, Middle Joint
(PIP Joint), Ring Finger
Common Dislocations
 Shoulder
 Finger
 Hip
 Elbow
Posterior Hip Dislocation
Common Dislocations
 Shoulder
 Finger
 Hip
 Elbow
Posterior Elbow Dislocation
Types of Injury

Fracture-Dislocation
A combined injury with
joint dislocation and an
adjacent bone fracture
Fracture–Dislocation, Ankle
Types of Injury
Sprain

 Partial

or complete
temporary joint dislocation
 Ligaments are torn
partially or completely
 ...
Sprain, Left Ankle
Assessing
Musculoskeletal Injuries
ABC’s
 Injury History (“What happened?”)
 Palpation of injury site -

“ Take one fin...
DCAP-BTLS
 D eformities
 C ontusions
 A brasions
 P uncture
 B urns

Wounds

 T enderness
 L acerations
 S welling
Evaluation of Distal
Neurovascular Function
(CMS)

 Pulse

(circulation)
 Motor Function
 Sensation
Radial Pulse
Tibial
Pulse

Posterior
Evaluation of Distal
Neurovascular Function
(CMS)

 Pulse

(circulation)
 Motor Function
 Sensation
Extension
Flexion

Ankle Dorsiflexion

Ankle Plantar
Evaluation of Distal
Neurovascular Function
(CMS)

 Pulse

(circulation)
 Motor Function
 Sensation
Medial and
Foot
Lateral Hand

Medial Foot

Lateral
Principles of
Musculoskeletal Injury
Management

 ABC’s

 Evaluate

distal
neurovascular
function
 Dress all wounds
 S...
Injury Management
All
open wounds
should be covered with a
dry sterile compression
dressing
Injury Management

Splinting Immobilizes the
Injury and:
 Reduces

Pain
 Facilitates Transport
 Prevents further damage...
Principles of Splinting
Check and record CMS
 Dress all wounds
 Immobilize the joints above and
below a suspected fractu...
Principles of Splinting
Use gentle in-line manual traction
to realign displaced long bone
fractures
 Expect to encounter ...
Total Body
Immobilization
When in doubt:
SPLINT!
Soft Splints
Air Splint
Splint

Sling and Swathe

Vacuum

Blanket Roll
Traction Splint
When standard splints
are unavailable,
improvisation
is better than doing
nothing!
UPPER
EXTREMITY
All fractures can
be immobilized
by securing the
extremity to the
chest!
LOWER EXTREMITY
All fractures can be immobilized by
securing the injured extremity to the
opposite lower extremity!
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Gp lecture

  1. 1. Fractures Dr Ayman Soliman Isamail
  2. 2. Common Outdoor Injury Management Objectives    Review mechanisms and patterns of traumatic injury Illustrate the types of injury that occur to the skeleton, soft tissue, and skeletal support structures Explain the general principles of wound care and the emergency care for musculoskeletal injuries
  3. 3. Mechanism of Injury
  4. 4. Mechanism of Injury Types of Trauma
  5. 5. Mechanism of Injury Types of Trauma  Penetrating Trauma  Compression (Blunt) Trauma  Bending Trauma Hyperflexion Hyperextension
  6. 6. Nail in Index Finger
  7. 7. Mechanism of Injury Types of Trauma  Penetrating Trauma  Compression (Blunt) Trauma  Bending Trauma Hyperflexion Hyperextension
  8. 8. Severe Contusion of Foot
  9. 9. Mechanism of Injury Types of Trauma  Penetrating Trauma  Compression (Blunt) Trauma  Bending Trauma Hyperflexion Hyperextension
  10. 10. Cervical (C5-C6) Fracture Dislocation
  11. 11. Mechanism of Injury Types of Trauma  Penetrating Trauma  Compression (Blunt) Trauma  Bending Trauma Hyperflexion Hyperextension
  12. 12. Dorsal Dislocation, Long Finger Middle Joint (PIP Joint)
  13. 13. Mechanism of Injury Types of Trauma  Rotational Trauma  Distraction Trauma  Crush Trauma  Deceleration Trauma  Acceleration Trauma
  14. 14. Normal Tibia Left Spiral Fracture Tibia Right
  15. 15. Mechanism of Injury Types of Trauma  Rotational Trauma  Distraction Trauma  Crush Trauma  Deceleration Trauma  Acceleration Trauma
  16. 16. Dislocation of Right Shoulder
  17. 17. Mechanism of Injury Types of Trauma  Rotational Trauma  Distraction Trauma  Crush Trauma  Deceleration Trauma  Acceleration Trauma
  18. 18. Train Crush Injury, Leg
  19. 19. Mechanism of Injury Types of Trauma  Rotational Trauma  Distraction Trauma  Crush Trauma  Deceleration Trauma  Acceleration Trauma
  20. 20. Deceleration Trauma
  21. 21. Mechanism of Injury Types of Trauma  Rotational Trauma  Distraction Trauma  Crush Trauma  Deceleration Trauma  Acceleration Trauma
  22. 22. Car struck from behind “accelerates” passengers, producing an extension injury to the neck! Trauma Acceleration
  23. 23. Mechanism of Injury Types of Force
  24. 24. Mechanism of Injury Types of Force  Direct Force  Indirect Force  Twisting Force  High Energy Force
  25. 25. Direct Mid-Shaft Fracture, Femur
  26. 26. Mechanism of Injury Types of Force  Direct Force  Indirect Force  Twisting Force  High Energy Force
  27. 27. Indirect Posterior Dislocation, Elbow
  28. 28. Mechanism of Injury Types of Force  Direct Force  Indirect Force  Twisting Force  High Energy Force
  29. 29. Twisting Subtalar Dislocation, Ankle
  30. 30. Mechanism of Injury Types of Force  Direct Force  Indirect Force  Twisting Force  High Energy Force
  31. 31. High Energy Fractured Pelvis
  32. 32. Types of Injury
  33. 33. Types of Injury Fracture • Any break in the continuity of a bone • May vary from a simple crack to a completely shattered bone
  34. 34. Fracture Classification Closed/Open Incomplete/Complete Non-Displaced/Displaced
  35. 35. Closed Fracture, Base of Thumb Closed Dorsally Angulated Forearm Fracture
  36. 36. Open Fracture, Tibia Open Fracture, Forearm
  37. 37. Open Fractures Are More Serious!  Blood  Potential loss contamination with risk of infection
  38. 38. Fracture Classification Closed/Open Incomplete/Complete Displaced/Displaced
  39. 39. Incomplete Fracture, Distal Radius
  40. 40. Complete Fracture, Femur
  41. 41. Fracture Classification Closed/Open Incomplete/Complete Non-Displaced/Displaced
  42. 42. Non-Displaced Fracture, Distal Tibia and Fibula
  43. 43. Displaced Forearm Fractures
  44. 44. Other Types of Fracture Comminuted – fractured into more than two segments Pathologic – fracture through diseased bone Epiphyseal – fracture passes through the growth plate
  45. 45. Comminuted Femur Fracture
  46. 46. Other Types of Fracture Comminuted – fractured into more than two segments Pathologic – fracture through diseased bone Epiphyseal – fracture passes through the growth plate
  47. 47. Pathologic Lytic lesion (darker = tumor) in proximal phalanx of finger, with associated transverse fracture
  48. 48. Other Types of Fracture Comminuted – fractured into many pieces Pathologic – fracture through diseased bone Epiphyseal – fracture through the growth plate
  49. 49. Epiphyseal (growth-line) Fracture,
  50. 50. Signs of a Fracture  Tenderness  Swelling and Ecchymosis  Deformity  Crepitus  Exposed Fragments  False Motion  Inability to Use the Limb
  51. 51. Seven Signs of Fracture  Tenderness  Swelling and Ecchymosis  Deformity  Crepitus  Exposed Fragments  False Motion  Inability to Use the Limb
  52. 52. Fractured Patella
  53. 53. Seven Signs of Fracture  Tenderness  Swelling and Ecchymosis  Deformity  Crepitus  Exposed Fragments  False Motion  Inability to Use the Limb
  54. 54. Angulated Fracture, Radius and Ulna
  55. 55. Seven Signs of Fracture  Tenderness  Swelling and Ecchymosis  Deformity  Crepitus  Exposed Fragments  False Motion  Inability to Use the Limb
  56. 56. Crepitus In a complete fracture, the sounds of bone ends clicking or rubbing against each other; denotes an unstable fracture!
  57. 57. Seven Signs of Fracture  Tenderness  Swelling and Ecchymosis  Deformity  Crepitus  Exposed Fragments  False Motion  Inability to Use the Limb
  58. 58. Open Ankle Fracture
  59. 59. Seven Signs of Fracture  Tenderness  Swelling and Ecchymosis  Deformity  Crepitus  Exposed Fragments  False Motion  Inability to Use the Limb
  60. 60. False Motion The unusual visual sensation of observing motion at a long bone fracture site where “ there is no joint!”
  61. 61. Seven Signs of Fracture  Tenderness  Swelling and Ecchymosis  Deformity  Crepitus  Exposed Fragments  False Motion  Inability to Use the Limb
  62. 62. Fracture, Right Clavicle Right Arm Protected
  63. 63. Seven Signs of Fracture The presence of any one of the seven fracture signs just listed is sufficient to assess this injury!
  64. 64. Types of Injury Dislocation   Disruption of a joint such that the bone ends are no longer in normal contact Must have torn ligaments and joint capsule
  65. 65. Signs of Dislocation  Tenderness  Deformity (usually marked)  Swelling and Ecchymosis  Loss of normal joint motion
  66. 66. Common Dislocations  Shoulder  Finger  Hip  Elbow
  67. 67. Anterior Dislocation, Right Shoulder
  68. 68. Common Dislocations  Shoulder  Finger  Hip  Elbow
  69. 69. Dislocation, Middle Joint (PIP Joint), Ring Finger
  70. 70. Common Dislocations  Shoulder  Finger  Hip  Elbow
  71. 71. Posterior Hip Dislocation
  72. 72. Common Dislocations  Shoulder  Finger  Hip  Elbow
  73. 73. Posterior Elbow Dislocation
  74. 74. Types of Injury Fracture-Dislocation A combined injury with joint dislocation and an adjacent bone fracture
  75. 75. Fracture–Dislocation, Ankle
  76. 76. Types of Injury Sprain  Partial or complete temporary joint dislocation  Ligaments are torn partially or completely  May produce as much structural damage as a dislocation
  77. 77. Sprain, Left Ankle
  78. 78. Assessing Musculoskeletal Injuries ABC’s  Injury History (“What happened?”)  Palpation of injury site - “ Take one finger and show me where it hurts!”
  79. 79. DCAP-BTLS  D eformities  C ontusions  A brasions  P uncture  B urns Wounds  T enderness  L acerations  S welling
  80. 80. Evaluation of Distal Neurovascular Function (CMS)  Pulse (circulation)  Motor Function  Sensation
  81. 81. Radial Pulse Tibial Pulse Posterior
  82. 82. Evaluation of Distal Neurovascular Function (CMS)  Pulse (circulation)  Motor Function  Sensation
  83. 83. Extension Flexion Ankle Dorsiflexion Ankle Plantar
  84. 84. Evaluation of Distal Neurovascular Function (CMS)  Pulse (circulation)  Motor Function  Sensation
  85. 85. Medial and Foot Lateral Hand Medial Foot Lateral
  86. 86. Principles of Musculoskeletal Injury Management  ABC’s  Evaluate distal neurovascular function  Dress all wounds  Splint all suspected injuries  Prepare patient for transport
  87. 87. Injury Management All open wounds should be covered with a dry sterile compression dressing
  88. 88. Injury Management Splinting Immobilizes the Injury and:  Reduces Pain  Facilitates Transport  Prevents further damage to blood vessels, nerves and skin adjacent to the injury  Decreases Bleeding
  89. 89. Principles of Splinting Check and record CMS  Dress all wounds  Immobilize the joints above and below a suspected fracture  With injuries at or near joints, immobilize the bones above and below the injury  Stabilize the injury site during splint application 
  90. 90. Principles of Splinting Use gentle in-line manual traction to realign displaced long bone fractures  Expect to encounter increased pain and some resistance when attempting to realign a deformed limb  Immobilize all suspected spinal injuries in a neutral in-line position on a spineboard 
  91. 91. Total Body Immobilization
  92. 92. When in doubt: SPLINT!
  93. 93. Soft Splints Air Splint Splint Sling and Swathe Vacuum Blanket Roll
  94. 94. Traction Splint
  95. 95. When standard splints are unavailable, improvisation is better than doing nothing!
  96. 96. UPPER EXTREMITY All fractures can be immobilized by securing the extremity to the chest!
  97. 97. LOWER EXTREMITY All fractures can be immobilized by securing the injured extremity to the opposite lower extremity!
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