Few important things in fractures and dislocations

1. FLT LT (DR) YKKS BANDARA
SCHOOL MEDICAL OFFICER
SLAF CTS - DIYATALAWA

2. What is a Fracture?
• BREAK IN THE STRUCTURAL CONTINUITY OF A BONE
• If the overlying skin remains intact – closed (simple fracture)
• If skin or one of the body cavities is breached - open (compound
fracture)

3. Types
• Complete
• Incomplete

4. Complete fracture
• Bone is split into two or more fragments
• Transverse
• Oblique
• Impacted
• Comminute

6. Incomplete fracture
• The bone is incompletely divided and the periosteum remains in
continuity
• Greenstick
• Compressed

8. How fractures are displaced
• Force of the injury
• Effects of gravity
• Pull of muscles attached to the site
• Age of the Patient

9. Mechanism of injury
• Injury
• Repetitive stress
• Pathological fractures

10. Injury
• Direct force - With a direct force, the bone breaks at the point of
impact; the soft tissues also are damaged
• Indirect force - the bone breaks at a distance from where the force is
applied

11. Some fracture patterns suggest the causal mechanism:
(a) spiral pattern (twisting);
(b) Short oblique pattern (compression);
(c) triangular ‘butterfly’ fragment (bending)
(d) transverse pattern (tension).

13. Stress fractures / Fatigue
• Occur in normal bone, subject to repeated heavy loading, typically in
athletes, dancers or military personnel
• Drugs like steroids and methotrexate

14. Pathological fractures
• Occurs in a bone that is made weak by some disease

15. Symptoms
• A history of injury, followed by inability to use the injured limb
• Pain
• Bruising
• Swelling
• Deformity
• Numbness or Loss of movement
• Difficulty with breathing

16. Bone Healing
• Primary - Surgical
• Secondary – Non Surgical

17. FACTORS AFFECTING BONE HEALING
• Age: Fractures unite faster in children
• Type of bone: Faster union in flat and cancellous bone
• Pattern of fracture: Spiral # > oblique # > transverse # > comminute #
• Disturbed pathoanatomic: soft tissue interposition and ischaemic #
prevent faster healing
• Type of reduction: good apposition of fracture results in faster healing
• Immobilisation: depends on the fracture site eg. Fracture ribs and
scapula do not require immobilisation
• Open fractures: often go into delayed union and non-union

18. Complications
• Organ Injuries
• Blood vessel Injuries
• Blood clots
• Nerve Injuries
• Tendon / Muscle injuries
• Infections
• Deformity
• Shortening of limbs
• Movements limitation

19. Treatment
• Assess
• Call for help
• Immobilize
• Splint
• POP Cast
• Traction
• Surgery if necessary

20. What is a Dislocation
• When the bones at a joint are no longer in proper contact
• Can be caused by severe twisting or indirect force, or even a muscular
contraction
• Most frequently dislocated joints
• Shoulder
• Elbow
• Thumb
• Finger
• Jaw
• Knee

21. Signs and Symptoms
• Deformity or abnormal appearance
• Pain and tenderness aggravated by movement
• Loss of normal function
• Joint may be locked in one position
• Swelling of the joint
• Redness

23. Treatment
• Stop the activity.
• Survey the injured area.
• First Aid if qualified.
• Get help if not.
• Determine if additional medical attention is necessary

24. •R - Rest
•I - Ice
•C - Compression
•E - Elevate

25. Further Treatment
• Splint
• Cast
• Traction
• Surgery if necessary