FRACTURES AND DISLOCATIONS Dr VARUN SHARMA RESIDENT IN ORTHOPAEDICS AND TRAUMATOLOGY OSMANIA GENERAL HOSPITAL
Definition of trauma: Injuries which are caused by external force or violence. They may range from minor to major, obvious to not apparent, single injury to multiple.
When a bone fractures, there is usuallydamage to the surrounding area whichmay include: • Damage to muscles • Tearing of blood & lymph vessels • Severing of nerves • Damage to nearby organs • Laceration of the skin
Signs of fracture: • limited or no movement of a limb • swelling at the site of injury • pain at, or distal to, the injury • bruising at injury site • deformity of a limb • no pulse distal to the injury • loss of feeling at, and distal to, the injury
Deformity of a limb Clinical indication of dislocation
Fracture Healing Healing begins when swelling occurs. Blood, lymph, & tissue fluids form a fibrin clot around the fracture. Soon fibroblasts appear & begin granulation. Granulation process helps stabilize the fracture…….. (continued)
Healing (continued) Calcium is deposited around the fracture forming a callus. *The callus is the first phase of healing which can be demonstrated radiographically. Calcified area may be large at first, but will reduce with use. Fracture site may be stronger than before!
Factors affecting healing: • Patient age • general health • nutrition • circulation at site of injury
General types of fractures • Complete vs. Incomplete Entire cross section of the bone fractures vs. not broken into separate pieces.
General fracture types (cont.) • Closed (simple) vs. compound Bone does not pierce through the skin vs. bone is through the skin
Closed vs compound fractures
General types of fractures(cont.) • Direct vs Indirect fracture occurs at the site of trauma vs away from the impact point
Fracture Alignment Displacement or apposition = misalignment of a fracture(seenote) Other terms denoting misalignment: • Varus • Valgus • Bayonet
Varus or Valgus?
ANOTHER OUCH !
Specific types of fractures LINEAR - straight lines
Oblique fx (also an oblique fx because of the direction of the fracture line)
Spiral fx Fracture line rotates around the bone, usually from a twisting force
Comminuted fx 2 or more fracture lines = 3 or more fragments
Crush fx Severe communited !
Impacted fxFracturedends getpushed Typical of a front seatinto one passenger in a caranother crash !
Splinter fx Fracture ends are thin shards or splinters like wood. (gunshot wounds)
Stellate fx Specific to the patella- fracture lines radiate out from a center point in a star-like pattern.
Compression fx Specific to the vertebrae - vertebral body collapses, anterior aspect is reduced in height. From trauma or demineralization of bone (old age).
Burst fx C1 ring is C - 1 (atlas) broken, fragments move outward. Football injuries, heavy object dropped on head.
Blowout fx Orbital floor collapses from direct blow to eyeball (fist, baseball)
Depressed fx Section of bone pushed into center of an area (skull, sternum)
Complicated fx Fractured bone causes damage to an internal organ. Ex. - rib pierces lung
Avulsion fx (chip fx) Caused by stress to a joint, ligament, or tendon. Small piece of bone is torn away. Often seen with dislocations.(see note)
NON-TRAUMA FRACTURES 1. Pathologic - bone is weakened by disease, spontaneous fx’s (cancer, osteomalacia, osteomyelitis, Pagets) 2. Stress - caused by prolonged running or marching - metatarsals fracture. Difficult to visualize.
Pediatric fractures 1. Greenstick (torus) - incomplete fx, bones more flexible, bends & fractures only outer edge. 2. Epiphyseal - fractures located at the site of an epiphysis. Sometimes with associated dislocation (slipped epiphysis)