Principles of fracture treatment


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Principles of fracture treatment

  1. 1. Principles ofPrinciples ofFracture TreatmentFracture Treatment
  2. 2. Definition of FractureDefinition of Fracture• It is disruption of bone continuity.It is disruption of bone continuity.Although most of #s occur as a resultAlthough most of #s occur as a resultof a single episode by a force powerfulof a single episode by a force powerfulenough to fracture a normal bone, thereenough to fracture a normal bone, thereare 2 types of # in which this is not so :are 2 types of # in which this is not so :1.1. Pathological fract.Pathological fract.2.2. Stress fract.Stress fract.
  3. 3. Pathological fracturePathological fracture::It is one in which a bone isIt is one in which a bone isbroken through an areabroken through an areaweakened by pre-existingweakened by pre-existingdisease , & by a degree of forcedisease , & by a degree of forcethat would have left normalthat would have left normalbone intact e.g osteoporosis ,bone intact e.g osteoporosis ,O.M. , bone tumours.O.M. , bone tumours.
  4. 4. Stress fractureStress fracture::Bone , like other materials ,Bone , like other materials ,reacts to repeated loading . Onreacts to repeated loading . Onoccasion , it becomes fatiguedoccasion , it becomes fatigued& a crack develops e.g military& a crack develops e.g militaryinstallations , ballet dancers &installations , ballet dancers &athletes.athletes.
  5. 5. DiagnosisDiagnosis• Clinical pictureClinical picture• RadiographyRadiography
  6. 6. Clinical Features ofClinical Features ofFractureFracture• History of traumaHistory of trauma• Symptoms & signs:Symptoms & signs:1. Pain & tenderness 2. Swelling1. Pain & tenderness 2. Swelling3. Deformity 4. Crepitus3. Deformity 4. Crepitus5. Loss of function 6. Abnormal move.5. Loss of function 6. Abnormal move.7. N.V. injuries7. N.V. injuries
  7. 7. Radiographic FindingsRadiographic Findings• Plain x-ray: should show joint abovePlain x-ray: should show joint above& joint below , in at least 2 views ,& joint below , in at least 2 views ,special views on request.special views on request.• C.T.C.T.• MRI : It is not helpful in fract.MRI : It is not helpful in fract.diagnosis other than delineatingdiagnosis other than delineatingassociated injuries to the CNS , S.T.associated injuries to the CNS , S.T.disruption or occasionally fatiguedisruption or occasionally fatiguefract.fract.
  8. 8. FractureFractureClassificationClassification• Anat. LocationAnat. Location• Direction of fract.Direction of fract.LineLine• Wherther the fract.Wherther the fract.Is linear orIs linear orcomminutedcomminuted• Condition ofCondition ofoverlying S.T.overlying S.T.• Mechnism of injuryMechnism of injury• AO classificationAO classification
  9. 9. AO ClassificationAO Classification• A :A : Simple fract.Simple fract.• B :B : Wedge fract.Wedge fract.• C :C : Complex fract.Complex fract.
  10. 10. AO ClassificationAO ClassificationA= simple fract.A1 simple fract.SpiralA2 simple fract.Oblique(≥30)A3 simple fract.Transverse(<30)
  11. 11. AO ClassificationAO ClassificationB1 wedge fractSpiral wedgeB2 wedge fractBending wedgeB= wedge fract.B3 wedge fractfragmented wedgeB= Wedge fract.B1 wedge fractSpiral wedgeB2 wedge fractBending wedgeB3 wedge fractfragmented wedge
  12. 12. AO ClassificationAO ClassificationC= complex fract.C1 complex fract.spiralC2 complex fract.segmentalC3 complex fract.irregular
  14. 14. Mechanism of InjuryMechanism of InjuryClassificationClassification• Direct traumaDirect trauma• Indirect TraumaIndirect Trauma
  15. 15. Direct traumaDirect trauma::• Tapping fracturesTapping fractures• Crushing fracturesCrushing fractures• Penetrating fracturesPenetrating fractures- High velocity missiles > 2500 f/s- High velocity missiles > 2500 f/s- Low velocity missiles < 2500 f/s- Low velocity missiles < 2500 f/s
  16. 16. Indirect TraumaIndirect Trauma::• Traction or tension fract.Traction or tension fract.• angulation fract.angulation fract.• Rotational fract.Rotational fract.• Compression fract.Compression fract.
  17. 17. FractureFractureManagementManagement
  18. 18. Fracture ManagementFracture Management• Emergency careEmergency care –– (splinting)(splinting)• Definitive fracture treatmentDefinitive fracture treatment• RehabilitationRehabilitation
  19. 19. Emergency careEmergency care –– (splinting(splinting((• Splint them where they lie.Splint them where they lie.• Adequate splinting is desirable , why ?Adequate splinting is desirable , why ?• Types of splints :Types of splints :- improvised- improvised- conventional- conventional
  20. 20. Definitive fractureDefinitive fracturetreatmenttreatmentThe goal of fracture treatment is to obtain unionof the fracture in the most anatomical positioncompatible with maximal functional return of theextremity.• ConservativeConservative• OperativeOperative
  21. 21. ConservativeConservative• Reduction : if displacedReduction : if displaced under G.A. theunder G.A. thesooner the better.sooner the better.steps :- traction , align (which fragment),steps :- traction , align (which fragment),reverse mechanism of injury.reverse mechanism of injury.• Immobilization : POP cast , slab ,Immobilization : POP cast , slab ,traction (fixed or balanced).traction (fixed or balanced).• Rehab.Rehab.
  23. 23. POPPOP (Plaster Of Paris(Plaster Of Paris((
  24. 24. POPPOP Slab or SplintSlab or Splint
  25. 25. TractionTraction
  26. 26. OperativeOperative• ORIF (open reduction internalORIF (open reduction internalfixat.)fixat.)• Percutineous pinningPercutineous pinning• External fixationExternal fixation
  27. 27. Indications of ORIFIndications of ORIF- absolute- absolute- relative- relative
  28. 28. Types of Internal FixationTypes of Internal Fixation- Pin & wire fixat.- Pin & wire fixat.- Screw fixat.- Screw fixat.- Plate & screws fixat.- Plate & screws fixat.- Intra-medullary fixat.- Intra-medullary fixat.
  29. 29. Plate & screws fixatPlate & screws fixat..Functional types:Functional types:• Compression platesCompression plates• Neutralization platesNeutralization plates• Buttress platesButtress plates• Bridge platesBridge plates• LC- DCPLC- DCP• Liss platesLiss plates• Locking plates & screwsLocking plates & screws
  30. 30. Intra-medullary fixatIntra-medullary fixat..• Centro-medullaryCentro-medullary- Unlocked- Unlocked-Interlocking(static-Interlocking(static –– dynamicdynamic –– doubledoublelocked)locked)• CondylocephalicCondylocephalic• CephalomedullaryCephalomedullary
  31. 31. CONTRAINDICATIONS TOSURGICAL REDUCTION ANDSTABILIZATIONSituations in which there is a high probability forfailure with operative treatment are as follows:1. Osteoporotic bone that is too fragile to allowstabilization by internal or external fixation.2. Soft tissues overlying the fracture or plannedsurgical approach of such poor quality because ofscarring, burns,active infection, or dermatitis .3. Active infection or osteomyelitis.4. Fracture comminution to a degree that does notallow successful reconstruction. This is mostcommonly seen in severe intraarticular fractures.5. General medical conditions that are contraindicationsto anesthesia are generally contraindications to thesurgical treatment of fractures.6. Undisplaced or stable impacted fractures inacceptable position do not require surgical exposureor reduction.7. Inadequate equipment, manpower, training, and
  32. 32. RehabilitationRehabilitation• When ?When ?• How ?How ?
  33. 33. External fixatExternal fixat..• Advantages.Advantages.• Disadvantges.Disadvantges.• Complications.Complications.• Indications.Indications.
  34. 34. FrameFrame
  35. 35. Thank youThank you