ortho 03 principle of closed reduction in fracture and dislocation

Principle of closed reduction in fracture and dislocation Department of Orthopaedic Surgery Faculty of Medicine Siriraj Hospital Mahidol University

Principle of closed reduction
Recognition the pathologies
Associated injury
Deforming forces
Adequate anesthesia
Good team
Good technique
Acceptable reduction
Retention

Recognizing the pathology
Type of fracture/dislocation
Deformities (including the deforming forces)

Signs and symptoms of fracture/dislocation
Pain
Swelling
Tenderness
Deformities
Limit ROM
Stepping
Crepitus

Typical fractures

Stress-strain curve

Mode of failure
Tension

Mode of failure
Compression

Mode of failure
Shear

Mode of failure
Bending
Tension
Compression

Mode of failure
Torsion
Tension
Compression
Shear

Mode of failure
Crush
Tension
Compression
Shear

Know the classification

Anesthesia
Local
Hematoma block
Regional block
General
General anesthesia
Sedation using morphine, benzodiazepine

Regional/sedation

Reduction technique with or without assistances

Principle of reduction
Traction based technique
Increase deformities
Reverse mechanisms
Forces using:
Constance
Shaking for muscle relaxation

Sequences of fracture reduction
Traction
Increase deformity
Reverse deformity
3 point bending

Ligamentotaxis
Tension applied across a fracture site
Realign the fracture fragments by the surrounding intact soft tissue
Soft tissue hinge eg. Periostium
Perform early after injury

Shoulder dislocation
Siriraj reduction technique
Usually no need the anesthesia
Supine position
Gentle longitudinal traction and external rotation
Gradual abduction
Usually reduce around 120 deg of abduction

Traction based

Hip dislocation (Allis method)

Acceptable reduction?
Mainly focus on fracture not dislocation
Joint must be congruent and concentric

Functional concern
Mechanics
Shortening
Apposition
Sagital, coronal plane malalignment
Axial malalignment is not accepted (rotation)

More acceptable in:
Young age eg. Bayonette
# Far from the joint
Compensation
Less acceptable in:
# Near the joint
Intraarticular involvement

Immobilization alone (no reduction needed)
Non displaced fracture
Isolated fibular fracture
Acceptable alignment
Pediatric # shaft of femur
Bayonett apposition

High failure rate of reduction in:
Avulsion fracture
Unstable fracture
Displaced fracture both bone of forearm
But realign the fracture
Except # BB in children
Fracture that won’t heal
Fracture neck of femur in elderly

Common fracture in upper extremities
Distal end of radius
Boxer’s (neck of 5 th MCB)
Humerus
Neck of humerus
Shaft
Supracondyle
Clavicle

Common fractures in lower extremities
Common Fracture in Adult
Femoral shaft
Tibia and fibular
Ankle

Common fractures in lower extremities
Common Fracture in Elderly
Femoral neck
Intertrochanteric

Fracture of the spine
C-spine
Odontoid
Compression
Burst
Fracture dislocation
Thoracolumbar
Compression
Burst

Commonly missed conditions
Scaphoid fracture
Perilunate dislocation
Forearm fracture with radioulnar joint dislocation
Pediatric fracture around the elbow
Supracondyle
Lateral condyle
Medial condyle
Nerve injury eg. Axillary nerve
Occult fracture
Obese patients
Uncommon injuries eg. Posterior shoulder dislocation
Impact fracture neck of femur

Occult fracture
Not visible in an x-ray within 1-2 day of injury
Become visible
Within 3-4weeks
At the time that healing

Posterior shoulder dislocation

Management problems?
Complex dislocation eg. MCP joint
Fracture of necessity eg. Monteggia’s, Galeazzi’s

Complex dislocation

Monteggia fracture

Fracture healing
Clinical union
Timing
No false movement
No local tenderness of #site
Axial loading
Bending
Rotation
Radiographic union
Crossing trabeculae
Absent fracture line

ortho 03 principle of closed reduction in fracture and dislocation

by vora kun on Jul 03, 2010

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ortho 03 principle of closed reduction in fracture and dislocation — Presentation Transcript