Fractures & Dislocations
ALMAS KHAN
Radiology Technologist
KHORFAKKHAN HOSPITAL
TALK PLAN
 Signs or Symptoms of a Fracture
 Types of fracture and dislocations
 Emergency care for fracture patient
 D...
FRACTURE
i. Bones form the skeletal frame work of the body and
supports the body against gravity.
ii. It helps in movement...
Description of Location of #
• Which bone?
• Thirds (long bones)
• Proximal, middle, distal third
• Anatomic orientation
•...
Signs or Symptoms of a Fracture
• Pain and tenderness
• Loss of function
• A wound (with bone sticking out)
• Deformity
• ...
Emergency Care For Fractures
& Dislocations
• Administer O2
• Control any bleeding & dress open wounds
• Check distal puls...
Diagnosing Bone Fractures
• X-rays of injured area
• Some fractures are
difficult to see in an x-
ray, so a CT scan, MRI,
...
COMPLETE
• bone is completely
broken into 2 or more
fragments.
• -eg:
• transverse fracture
• oblique fracture
• spiral fr...
COMPLETE FRACTURES
INCOMPLETE FRACTURE
Open Fractures
An open fracture is a broken bone
that penetrates the skin. This is an
important distinction because
when a...
Comminuted fracture
• Comminuted fracture -
a fracture in which the
bone breaks into more
than two fragments;
usually caus...
Spiral Fracture
• Fracture where at least one part of the bone has been twisted
Spiral fracture of femur
Oblique Fracture
• When the bone is broken on a steep angle
fibula
Transverse Fracture
• A fracture that occurs at
a right angle to the
bone’s axis
Impacted Fracture
• A fracture in which the
ends of bones are
driven into one another
(common in children)
• Also known as...
Greenstick
• An incomplete
fracture in a long bone
of a child (bones are
not yet fully calcified
and they break like a
gre...
Compression Fractures
• Compression Fracture usually
occurs in the vertebrae.
• When the front portion of
vertebrae in the...
Hairline Fracture
• A very thin crack or break in the bone
Hairline fracture of the foot
Stress Fracture
• Stress fracture - fracture without being
visibly broken; microscopic fissures in
bone that forms without...
Skull Fracture and Sutures
Depression Fracture
A depressed skull fracture is a break in a cranial
bone (or "crushed" portion of skull) with
depressio...
Pathologic Fracture
• A type of fracture that is a
secondary result of another
illness or chronic condition
that weakens t...
Pediatric Supra-condylar
fracture
Supracondylar fractures of the elbow are one
of the most common fractures in children
Ra...
Scaphoid Fracture
 History
 FOOSH
 Dull, deep, ache in radial side
of wrist
 occur most commonly from a
fall on the ou...
Colle`s and smith`s fracture
• Fig : -
Describe by : - Abraham colle`s - 1814.
It is not just fracture lower end of radius...
Colle’s fracture Smith’s fracture
• Fig : -
BENNETT’S FRACTURE
• Intra-articular
fracture/dislocation of base of
1st metacarpal
• Small palmar fragment
continues to a...
Salter – Harris
I – S = Slipped . Slipped growth plate
II – A = Above . The fracture lies above the growth plate (metaphys...
Associated Complications:
Visceral injury
• Fractures around the trunk are
often complicated by visceral
injury.
– E.g. Ri...
HOW FRACTURES HEAL?-Physiology
When bone breaks, so do the blood vessels
that supply the bone
1) a clot forms in the damag...
Treatment of Fractures
• There are two main types of
treatments:
– External fixation - casts
– Internal fixation - surgery...
Treatment - Traction of the forearm
Internal fixation
Cast Splintage
External fixation
• Methods:
– Plaster of Paris
– Fibreglass
• Especially for distal limb # and for most ch...
Complications
Infection
Non-union
Implant
failure
Refracture
CAUSES OF DELAYED UNION OR NON-
UNION OF THE FRACTURES
Distraction &
separation of the
fragments
Interposition of soft
tis...
Missed fractures
• Missed fractures occurs in
different reason . It could be that
the doctor is inexperienced with
bone fr...
Exercise
• Prevention of edema
– active exercise and elevation
– Active exercise also stimulates the circulation.
Prevents...
What is a dislocation?
• When the bones at a joint are no longer in proper contact.
• Can be caused by severe twisting or ...
Signs and Symptoms of a Dislocation
• Deformity or abnormal appearance
• Pain and tenderness aggravated by movement
• Loss...
General Treatment Principles
• Stop the activity.
• Survey the injured area.
• First Aid if qualified.
• Get help if not.
...
RICE
• R - Rest
• I - Immobilize
• C - Cold
• E - Elevate
Shoulder Dislocation
• Take a past medical history (i.e. has
this happened before?)
• Clinical exam (check for circumflex
...
Anterior Dislocation, Right Shoulder
Glenohumeral Reductions
• Hippocratic Method
1. Practitioner’s stockinged
foot is place in between the
patient’s chest wal...
Posterior Elbow Dislocation
• Typical mechanism of an
elbow dislocation
1. A fall backward on the arm
with the elbow in a ...
Patella Dislocation
• Mechanism of Acute
Dislocation
1. Typically, the patient bears
weight on the slightly flexed
knee
2....
Role of Radiographer
 Explain the procedure polarity and assist the pt’s to get
required position.
 Maintain immobilizat...
Continue…
 Follow universal patient transfer protocol while patient in
transferred to avoid severity of the injury.
 The...
Tips to Remember
1) Updated in current radiographic imaging
standards the technologist is armed with the
understanding of ...
fracture and dislocation ppt . Almas khan. khorfakkhan hospital dubai
fracture and dislocation ppt . Almas khan. khorfakkhan hospital dubai
fracture and dislocation ppt . Almas khan. khorfakkhan hospital dubai
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fracture and dislocation ppt . Almas khan. khorfakkhan hospital dubai

  1. 1. Fractures & Dislocations ALMAS KHAN Radiology Technologist KHORFAKKHAN HOSPITAL
  2. 2. TALK PLAN  Signs or Symptoms of a Fracture  Types of fracture and dislocations  Emergency care for fracture patient  Diagnosis of fracture  Treatment of fracture  Physiology of fracture healing  Role of Radiographer
  3. 3. FRACTURE i. Bones form the skeletal frame work of the body and supports the body against gravity. ii. It helps in movement and activities. iii. Bones protect some body parts. iv. Bone marrow produces blood products. v. When outside forces are applied to bone it has the potential to fail. Fractures occur when bone cannot withstand those outside forces vi. A bone fracture (sometimes abbreviated FRX or Fx or Fx or #
  4. 4. Description of Location of # • Which bone? • Thirds (long bones) • Proximal, middle, distal third • Anatomic orientation • E.g. proximal, distal, medial, lateral, anterior, posterior • Anatomic landmarks • E.g. head, neck, body / shaft, base, condyle • Segment (long bones) • Epiphysis, physis, metaphysis, diaphysis Epiphysis Metaphysis Diaphysis (Shaft) Physis Articular Surface
  5. 5. Signs or Symptoms of a Fracture • Pain and tenderness • Loss of function • A wound (with bone sticking out) • Deformity • Unnatural movement • Shock • Swelling and bruising
  6. 6. Emergency Care For Fractures & Dislocations • Administer O2 • Control any bleeding & dress open wounds • Check distal pulse • Apply slight traction—if splinting long bones in arms and legs If injury to a joint • DO NOT apply traction • Splint in the position found • Apply splint above & below the fracture • Re-check distal pulses after splinting • Control swelling with ice pack & elevation if distal pulse is present and strong • Maintain body temperature
  7. 7. Diagnosing Bone Fractures • X-rays of injured area • Some fractures are difficult to see in an x- ray, so a CT scan, MRI, or other bone scans are used
  8. 8. COMPLETE • bone is completely broken into 2 or more fragments. • -eg: • transverse fracture • oblique fracture • spiral fracture • impacted fracture • comminuted fracture • segmental fracture INCOMPLETE • bone is incompletely divided and the periosteum remains in continuity. • -eg: • greenstick fracture • torus fracture • stress fracture • compression fracture. Types of Fractures
  9. 9. COMPLETE FRACTURES
  10. 10. INCOMPLETE FRACTURE
  11. 11. Open Fractures An open fracture is a broken bone that penetrates the skin. This is an important distinction because when a broken bone penetrates the skin there is a need for immediate treatment, and an operation is often required to clean the area of the fracture. The risk of infection, there are more often problems associated with healing when a fracture is open to the skin.
  12. 12. Comminuted fracture • Comminuted fracture - a fracture in which the bone breaks into more than two fragments; usually caused by severe forces
  13. 13. Spiral Fracture • Fracture where at least one part of the bone has been twisted Spiral fracture of femur
  14. 14. Oblique Fracture • When the bone is broken on a steep angle fibula
  15. 15. Transverse Fracture • A fracture that occurs at a right angle to the bone’s axis
  16. 16. Impacted Fracture • A fracture in which the ends of bones are driven into one another (common in children) • Also known as a “buckle fracture”
  17. 17. Greenstick • An incomplete fracture in a long bone of a child (bones are not yet fully calcified and they break like a green stick)
  18. 18. Compression Fractures • Compression Fracture usually occurs in the vertebrae. • When the front portion of vertebrae in the spine collapses due to Osteoporosis which causes bones to become brittle and susceptible to fracture , with or without trauma. • An x-ray of the spine can reveal the bone injury , however sometimes a CT scan or MRI will be used to insure that no damage is done to the spinal cord.
  19. 19. Hairline Fracture • A very thin crack or break in the bone Hairline fracture of the foot
  20. 20. Stress Fracture • Stress fracture - fracture without being visibly broken; microscopic fissures in bone that forms without any evidence of injury to other tissues; caused by repeated strenuous activity (ex: running)
  21. 21. Skull Fracture and Sutures
  22. 22. Depression Fracture A depressed skull fracture is a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain. The brain can be affected directly by damage to the nervous system tissue and bleeding. The brain can also be affected indirectly by blood clots that form under the skull and then compress the underlying brain tissue (subdural or epidural hematoma).
  23. 23. Pathologic Fracture • A type of fracture that is a secondary result of another illness or chronic condition that weakens the bones of the skeletal system • The x-ray to the right shows thinning of the femurs, resulting in a fracture of the proximal end of the right bone • x-ray showing pathological fracture right humorous due to bone cyst
  24. 24. Pediatric Supra-condylar fracture Supracondylar fractures of the elbow are one of the most common fractures in children Radiographer with a significant challenge. In addition to the normal difficulties associated with imaging children, the radiographer must consider that the patient may be in severe pain
  25. 25. Scaphoid Fracture  History  FOOSH  Dull, deep, ache in radial side of wrist  occur most commonly from a fall on the outstretched hand  early (first week) may appear negative  An X-ray a couple of weeks later may then more clearly reveal the fracture. In questionable cases, MRI scan, CT scan, or bone scan
  26. 26. Colle`s and smith`s fracture • Fig : - Describe by : - Abraham colle`s - 1814. It is not just fracture lower end of radius but a fracture dislocation of the inferior radioulnar joint . Occurs about 2.5 cm above the carpal extremity of the radius . A Smith's fracture, also sometimes known as a reverse Colles' fracture is a fracture of the distal radius. It is caused by a direct blow to the dorsal forearmor falling onto flexed wrists, as opposed to a Colles' fracture which occurs as a result of falling onto wrists in extension.
  27. 27. Colle’s fracture Smith’s fracture • Fig : -
  28. 28. BENNETT’S FRACTURE • Intra-articular fracture/dislocation of base of 1st metacarpal • Small palmar fragment continues to articulate with trapezium • Mechanism: forced abduction of thumb • Treatment: open reduction and internal fixation
  29. 29. Salter – Harris I – S = Slipped . Slipped growth plate II – A = Above . The fracture lies above the growth plate (metaphyseal) III – L = Lower . The fracture is lower than (below) the growth plate ( epiphyseal) IV – T = Through. The fracture through the growth plate including the ( metaphysis and epiphysis ) V – R = Rammed . The growth plate has been rammed or ruined ( the physis suffers a compression injury )
  30. 30. Associated Complications: Visceral injury • Fractures around the trunk are often complicated by visceral injury. – E.g. Rib fractures  pneumothorax / spleen trauma / liver injuries. – E.g. Pelvic injuries  bladder or urethral rupture / severe hematoma in the retro- peritoneum . • Rx: Surgery of visceral injuries
  31. 31. HOW FRACTURES HEAL?-Physiology When bone breaks, so do the blood vessels that supply the bone 1) a clot forms in the damaged area 2) blood vessels and cells invade the clot and produce a fibrous network and cartilage between broken bones (callus) 3) osteoblasts enter callus and begin forming cancellous bone 4) Cancellous bone is remodeled to form compact and cancellous bone; repair is complete • Healing by callus • Healing without callus
  32. 32. Treatment of Fractures • There are two main types of treatments: – External fixation - casts – Internal fixation - surgery • Wires - used on small fractures • Plates - hold two lengths of bone together with screws • Nails or rods - placed in centers of long bones and held in place with screws • Screws - most common method; used by self or with other items
  33. 33. Treatment - Traction of the forearm Internal fixation
  34. 34. Cast Splintage External fixation • Methods: – Plaster of Paris – Fibreglass • Especially for distal limb # and for most children # • Disadvantage: joint encased in plaster cannot move and liable to stiffen • Can be minimized: – Delayed splintage (traction initially) – Replace cast by functional brace after few weeks
  35. 35. Complications Infection Non-union Implant failure Refracture
  36. 36. CAUSES OF DELAYED UNION OR NON- UNION OF THE FRACTURES Distraction & separation of the fragments Interposition of soft tissues between the fragments. Excessive movement at the fracture site Poor local blood supply Severe damage to soft tissues which makes them nearly/non-viable. Infection Abnormal bone.
  37. 37. Missed fractures • Missed fractures occurs in different reason . It could be that the doctor is inexperienced with bone fractures or the misread radiograph or the failure to obtain a radiograph. • Poorly positioned or poorly taken radiograph may also result in diagnostic errors. • Doctors use today diagnosing fractures are CT, MRI, Bone scan . Even a hairline fractures , stress fractures can detected those equipments
  38. 38. Exercise • Prevention of edema – active exercise and elevation – Active exercise also stimulates the circulation. Prevents soft-tissue adhesion and promotes fracture healing. • Preserve the joint movement • Restore muscle power • Functional activity
  39. 39. 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
  40. 40. Signs and Symptoms of a Dislocation • 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
  41. 41. General Treatment Principles • Stop the activity. • Survey the injured area. • First Aid if qualified. • Get help if not. • Determine if additional medical attention is necessary.
  42. 42. RICE • R - Rest • I - Immobilize • C - Cold • E - Elevate
  43. 43. Shoulder Dislocation • Take a past medical history (i.e. has this happened before?) • Clinical exam (check for circumflex nerve function) • X-ray to rule out possible fracture (i.e. head of the humorous) • Several methods for reduction - Scapular rotation - Traction/counter traction
  44. 44. Anterior Dislocation, Right Shoulder
  45. 45. Glenohumeral Reductions • Hippocratic Method 1. Practitioner’s stockinged foot is place in between the patient’s chest wall and axilla folds but not in the axilla. 2. Steady traction is maintained while the patient gradually relaxes. 3. Shoulder is slowly rotated externally and abducted. 4. Gentle internal rotation reduces the humeral head.
  46. 46. Posterior Elbow Dislocation • Typical mechanism of an elbow dislocation 1. A fall backward on the arm with the elbow in a flexed position and 2. The forearm supinated is the most common mechanism. 3. The injury causes radius and ulna to dislocate posterior to the humerus. 4. There may also freq. Be an associated fracture of the radial head or 5. The coracoid process of the ulna.
  47. 47. Patella Dislocation • Mechanism of Acute Dislocation 1. Typically, the patient bears weight on the slightly flexed knee 2. A sudden external rotation or twisting load to the femur causes the patella to slide superiorly over the lateral femoral condyle. 3. As the knee flexes, the patella jumps over the lateral condyle and the knee collapses.
  48. 48. Role of Radiographer  Explain the procedure polarity and assist the pt’s to get required position.  Maintain immobilization of the injured area while AP and use horizontal beam for lateral radiograph.  Wise application of all radiographic skills while include appropriate positioning , exposure factors ( as much as possible high kv technique) , breathing technique.  Effective communication with referring physician to achieve the best result.  Best Practices in Trauma Radiography Speed Efficiency in producing quality images in the shortest possible time Accuracy Optimum image quality
  49. 49. Continue…  Follow universal patient transfer protocol while patient in transferred to avoid severity of the injury.  The rule for protecting the spine from further injury is to immobilize it. These precautions are the standard of care for handling a trauma patient suspected of spine injury.  Patient Preparation Use good communication skills with appropriate touch and eye contact Trauma often causes anxiety Check patient for potential artifacts Explain what you are removing and why Secure all personal effects using proper procedure for your facility
  50. 50. Tips to Remember 1) Updated in current radiographic imaging standards the technologist is armed with the understanding of what it is to have a high suspicion for injury that translates into safe quality patient care. 2) Radiology Technologist can make minimal diagnosis 3) Update your skills…. More in Anatomy

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