A very informative article

1. Fractures
DR ANEELA ZIA
DPT
MS-OMPT (FRAHS)

2. Description
 A disruption or break in the
continuity of the structure of bone
 Traumatic injuries account for the
majority of fractures

3. Description
 Described and classified according
to:
Type
Communication or
noncommunication with external
environment
Anatomic location

4. Types of Fractures
Fig. 61-4

5. Classification by Communication with
External Environment
Fig. 61-5

6. Classification by Fracture Location
Fig. 61-6

7. Description
 Described and classified according
to:
Appearance, position, and
alignment of the fragments
Classic names
Stable or unstable

8. Description
 Closed (also called simple)
 Open (also called compound)

9. Description
 Stable fractures
Occur when a piece of the
periosteum is intact across the
fracture
External or internal fixation has
rendered the fragments stationary

10. Description
 Unstable fractures
Grossly displaced
Poor fixation

11. Clinical Manifestations
Immediate localized pain
 Function
Inability to bear weight or use
affected part
Guarding
May or may not see obvious bone
deformity

12. Fracture Healing
1. Fracture hematoma (d/t bleeding,
edema)
2. Granulation tissue → osteoid (3 –
14 days post injury)
3. Callus formation (minerals deposited in
osteoid)

13. Fracture Healing
4. Ossification (3 wks – 6 mos)
5. Consolidation (distance between
fragments decreases → closes).
6. Remodeling (union completed;
remodels to original shape, strength)

17. goals of treatment:
Anatomic realignment of bone
fragments (reduction)
Immobilization to maintain
alignment (fixation)
Restoration of normal function

18. Fracture Reduction
 Closed reduction
Nonsurgical, manual realignment
 Open reduction
Correction of bone alignment
through a surgical incision

19. open reduction

20. Fracture Reduction
 Traction Application of pulling force
to attain realignment

21. Fracture Immobilization
 Casts
 Temporary circumferential immobilization device
Common following closed reduction

22. Casts
Fig. 61-9

23. Fracture Immobilization
 External fixation
Metallic device composed of pins that
are inserted into the bone and attached
to external rods

24. Collaborative Care
Fracture Immobilization
 Internal fixation
Pins, plates, intramedullary rods, and
screws
Surgically inserted at the time of
realignment

26. Collaborative Care
Fracture Immobilization
 Traction
Application of a pulling force to an
injured part of the body while
countertraction pulls in the opposite
direction

27. Collaborative Care
Fracture Immobilization
 Purpose of traction:
Prevent or reduce muscle spasm
Immobilization
Reduction
Treat a pathologic condition

28. Complications of Fractures
Infection
 Open fractures and soft tissue injuries
have  incidence
 Osteomyelitis can become chronic
 Collaborative Care
Open fractures require aggressive
surgical debridement
Post-op IV antibiotics for 3 to 7 days
(prophylactic)

29. Complications of Fractures
Compartment Syndrome
 Condition in which elevated
intracompartmental pressure within a
confined myofascial compartment
compromises the neurovascular function
of tissues within that space
 Causes capillary perfusion to be reduced
below a level necessary for tissue
viability

30. Complications of Fractures
Compartment Syndrome
 Two basic etiologies create compartment
syndrome:
Decreased compartment size
(dressings, splints, casts)
Increased compartment content
(bleeding, edema)

31. Complications of Fractures
Compartment Syndrome
 Clinical Manifestations
Six Ps:
1. Paresthesia (unrelieved by
narcotics)
2. Pain (unrelieved by narcotics)
3. Pressure

32. Complications of Fractures
Compartment Syndrome
 Clinical Manifestations
 Six Ps:
4. Pallor (loss of normal color,
coolness)
5. Paralysis
6. Pulselessness (decreased/absent
pulses)

33. Complications of Fractures
Compartment Syndrome
 Clinical Manifestations
Six Ps:
Patient may present with one or all of
the six Ps
Compare extremities

34. Complications of Fractures
Compartment Syndrome
 Clinical Manifestations
Absence of peripheral pulse
Myoglobinuria
(Dark reddish-brown urine)

35. Complications of Fractures
Compartment Syndrome
 Collaborative Care
Prompt, accurate diagnosis is critical
Early recognition is the key
Do not apply ice or elevate above heart
level

36. Complications of Fractures
Compartment Syndrome
 Collaborative Care
Remove/loosen the bandage and
bivalve the cast
Reduce traction weight
Surgical decompression (fasciotomy)

37. Complications of Fractures
Venous Thrombosis
 Veins of the lower extremities and pelvis are highly susceptible to
thrombus formation after fracture, especially hip fracture
 Precipitating factors:
 Venous stasis caused by incorrectly applied casts or traction
 Local pressure on a vein
 Immobility
 Prevent with anticoagulant medications

38. Complications of Fractures
Fat Embolism Syndrome (FES)
 Characterized by the
presence of fat globules in
tissues and organs after a
traumatic skeletal injury
 Fractures that most often
cause FES:
 Long bones
 Ribs
 Tibia
 Pelvis
•Tissues most often affected:
Lungs
Brain
Heart
Kidneys
Skin
•Usually occur 24-48 hours
after injury

39. Complications of Fractures
Fat Embolism Syndrome (FES)
 Clinical Manifestations
 Symptoms of ARDS:
 Chest pain
 Tachypnea
 Cyanosis
  PaO2
 Dyspnea
 Apprehension
 Tachycardia

40. Complications of Fractures
Fat Embolism Syndrome (FES)
 Clinical Manifestations
Rapid and acute course
Feeling of impending disaster
Patient may become comatose in a
short time

41. Complications of Fractures
Fat Embolism Syndrome (FES)
 Collaborative Care
Treatment directed at prevention
Careful immobilization of a long bone
fracture
Most important preventative factor

42. Complications of Fractures
Fat Embolism Syndrome (FES)
 Collaborative Care (treatment)
Symptom management
Fluid resuscitation
Oxygen
Reposition as little as possible

43.  JAZAKAALLAH KHAIR