Classification of Fractures<br />                                              Dr SrinivasBodla<br />                     ...
Definition<br />What is a fracture?<br />Break in structural continuity of bone<br />
Based on etiology<br />Traumatic fracture- sustained due to trauma<br />Pathological fracture- fracture through a bone whi...
Based on displacements<br />Undisplaced fracture-absence of displacement<br />Displaced fracture- displacement can be in t...
Undisplaced<br />Impacted<br />Stable<br />Fracture with complications<br />
Based on relationship with external environment<br />Simple or closed- not communicating with external environment<br />Co...
closed                  open<br />
Based on pattern<br />Transverse-fracture line perpendicular to long axis of bone<br />Oblique- fracture line is oblique<b...
DIAGNOSING THE SOFT TISSUE INJURY<br />Skin	<br />Open fractures, degloving injuries and ischaemic necrosis<br />Muscles<b...
TREATING THE SOFT TISSUE INJURY<br />All severe soft tissue injuries require urgent treatment<br />Open fractures , Vascul...
GOALS OF FRACTURE TREATMENT<br />Restore the patient to optimal functional state<br />Prevent fracture and soft-tissue com...
HOW FRACTURES HEAL<br />In nature<br />Regeneration vs repair<br />Three phases of healing by callus<br />Rapid process, r...
STAGES OF BONE HEALING<br />INDUCTION<br />	tissue destruction and fracture hematoma<br />STAGE OF INFLAMATION<br />	acute...
FACTORS AFFECTING FRACTURE HEALING<br />The energy transfer of the injury<br />The tissue response<br />Two bone ends in o...
DESCRIBING THE FRACTURE<br />Mechanism of injury (traumatic, pathological, stress)<br />Anatomical site (bone and location...
Treatment of fracture<br />Emergency care <br />Definitive care<br />Rehabilitation<br />
Emergency care<br />Begins at the site of accident<br />ABC(airway, breathing, circulation)<br />Splinting at the site of ...
Definitive care<br />Reduction<br />Immobilization<br />Preservation of function<br />
Reduction <br />Closed manipulation<br />Continuous traction<br />Open reduction<br />
Immobilization- conservative<br />Strapping <br />Sling<br />Cast immobilization-using POP<br />Functional bracing <br />S...
Immobilization- operative<br />Internal fixation<br />    Implants used: steel wire, kirschner wire, intramedullary  nail,...
Rehabilitation <br />Physiotherapy <br />It essentially consists of muscle re-education exercises and instructions regardi...
WHEN IS THE FRACTURE HEALED?<br />Clinical<br />				Upper limb	Lower limb<br />Adult			6-8 weeks	12-16 weeks<br />Child			...
     THANK YOU<br />
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Classification and mangement of fractures

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Classification and mangement of fractures

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

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