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Classification and mangement of fractures

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  • 1. Classification of Fractures
    Dr SrinivasBodla
    Ortho PG(PIMS)
  • 2. Definition
    What is a fracture?
    Break in structural continuity of bone
  • 3. Based on etiology
    Traumatic fracture- sustained due to trauma
    Pathological fracture- fracture through a bone which has been made weak by some underlying disease
  • 4. Based on displacements
    Undisplaced fracture-absence of displacement
    Displaced fracture- displacement can be in the form of shift, angulation or rotation
  • 5. Undisplaced
    Impacted
    Stable
    Fracture with complications
  • 6. Based on relationship with external environment
    Simple or closed- not communicating with external environment
    Compound or open-communicating with environment
    A)Internal compounding –fracture end pierces the skin within.
    B)External compounding- the object causing the fracture lacerates the skin and soft tissue.
  • 7. closed open
  • 8. Based on pattern
    Transverse-fracture line perpendicular to long axis of bone
    Oblique- fracture line is oblique
    Spiral – fracture line runs spirally in more than one plane
    Comminuted- fracture with multiple fragments
    Segmental- two fractures in one bone,but at different levels
  • 9.
  • 10. DIAGNOSING THE SOFT TISSUE INJURY
    Skin
    Open fractures, degloving injuries and ischaemic necrosis
    Muscles
    Crush and compartment syndromes
    Blood vessels
    Vasospasm and arterial laceration
    Nerves
    Neurapraxias, axonotmesis, neurotmesis
    Ligaments
    Joint instability and dislocation
  • 11. TREATING THE SOFT TISSUE INJURY
    All severe soft tissue injuries require urgent treatment
    Open fractures , Vascular injuries, Nerve injuries, Compartment syndromes, Fracture/dislocations
    After the treatment of the soft tissue injury the fracture requires rigid fixation
    A severe soft-tissue injury will delay fracture healing
  • 12. GOALS OF FRACTURE TREATMENT
    Restore the patient to optimal functional state
    Prevent fracture and soft-tissue complications
    Get the fracture to heal, and in a position which will produce optimal functional recovery
    Rehabilitate the patient as early as possible
  • 13. HOW FRACTURES HEAL
    In nature
    Regeneration vs repair
    Three phases of healing by callus
    Rapid process, rehabilitation slow, low risk
    With operative intervention (reduction + compression)
    Primary bone healing
    Slow process, rehabilitation rapid, high risk
    With operative intervention (nailing or external fixation)
    Healing by callus
    Rapid process, rehabilitation rapid, lesser risk
  • 14. STAGES OF BONE HEALING
    INDUCTION
    tissue destruction and fracture hematoma
    STAGE OF INFLAMATION
    acute inflammatory reaction with cell proliferation
    CALLUS FORMATION
    proliferating cells, "woven” bone
    CONSOLIDATION
    osteoclastic and osteoblastic activity in “woven” bone
    transformed into lamellar bone
    REMODELLING
    over a period of months or years reshaping by bone
    resorbtion and formation
  • 15.
  • 16. FACTORS AFFECTING FRACTURE HEALING
    The energy transfer of the injury
    The tissue response
    Two bone ends in opposition or compressed
    Micro-movement or no movement
    No infection
    The patient
    The method of treatment
  • 17. DESCRIBING THE FRACTURE
    Mechanism of injury (traumatic, pathological, stress)
    Anatomical site (bone and location in bone)
    Configuration Displacement
    three planes of angulation
    translation
    shortening
    Articular involvement/epiphyseal injuries
    fracture involving joint
    dislocation
    ligamentous avulsion
    Soft tissue injury
  • 18. Treatment of fracture
    Emergency care
    Definitive care
    Rehabilitation
  • 19. Emergency care
    Begins at the site of accident
    ABC(airway, breathing, circulation)
    Splinting at the site of accident
  • 20. Definitive care
    Reduction
    Immobilization
    Preservation of function
  • 21. Reduction
    Closed manipulation
    Continuous traction
    Open reduction
  • 22. Immobilization- conservative
    Strapping
    Sling
    Cast immobilization-using POP
    Functional bracing
    Splints and traction
  • 23. Immobilization- operative
    Internal fixation
    Implants used: steel wire, kirschner wire, intramedullary nail, screws, plate and screws
    External fixation
    It is a device by which the fracture is held in a frame outside the limb
  • 24.
  • 25. Rehabilitation
    Physiotherapy
    It essentially consists of muscle re-education exercises and instructions regarding mobilization of the limb and gait training
  • 26. WHEN IS THE FRACTURE HEALED?
    Clinical
    Upper limb Lower limb
    Adult 6-8 weeks 12-16 weeks
    Child 3-4 weeks 6-8 weeks
    Radiological
    Bridging callus formation
    Remodelling
  • 27. THANK YOU