PPT on Fractures of Bones and Dislocation of Joints

1. FRACTURES OF
BONES AND
DISLOCATION OF
JOINTS
RIYA MAHAJAN

2. FRACTURES
Fracture is a break or interruption in the continuity of a
bone, which is caused by mechanical exposure (trauma) or
pathology (tumour or inflammation)
Classification of fractures:
• on the basis of etiology
• the relationship of the fracture with the external
environment
• the displacement of the fracture, and the pattern of
the fracture.

3. ON THE BASIS OF ORIGIN:
1. Congenital fractures: mostly multiple, are due to changes
in the foetal bones or maternal abdominal trauma during
pregnancy.
2. Acquired fractures : arc subdivided further into traumatic
and pathological ones. The latter are caused by bone
tumours, osteomyelitis, tuberculosis, echinococcosis and
syphilis.
Obstetric fractures that occur during delivery (passage
through the birth canal) are also identified.

4. ON THE BASIS OF ETIOLOGY
1. Traumatic fracture:
• A fracture sustained due to trauma is called a traumatic fracture.
• Normal bone can withstand considerable force, and breaks only when
subjected to excessive force.
• Most fractures seen in day-to-day practice fall into this category e.g.,
fractures caused by a fall, road traffic accident, fight etc.

5. 2. Pathological fracture:
A fracture through a bone which has been made weak by some
underlying disease is called a pathological fracture.
• A trivial or no force may be required to cause such a fracture
• e.g., a fracture through a bone weakened by metastasis.
• Although, traumatic fractures have a predictable and generally
successful outcome, pathological fractures often go into non-union.
3. Stress Fracture :
This is a special type of fracture sustained due to chronic repetitive
injury (stress) causing a break in bony trabeculae.
• These often present as only pain and may not be visible on X-rays

6. ON THE BASIS OF DISPLACEMENTS
1. Undisplaced fracture: These fractures are easy to identify by
the absence of significant displacement.
2. Displaced fracture: The factors responsible for displacement
are: •
(i) the fracturing force
(ii) the muscle pull on the fracture fragments
(iii) the gravity.
While describing the displacements of a fracture, conventionally, it
is the displacement of the distal fragment in relation to the
proximal fragment which is mentioned.
The displacement can be in the form of shift, angulation or
rotation

8. ON THE BASIS OF RELATIONSHIP
WITH EXTERNAL ENVIRONMENT
1. Closed fracture:
• A fracture not communicating with the external environment,
i.e., the overlying skin and other soft tissues are intact, is called a
closed fracture.
2. Open fracture:
A fracture with break in the overlying skin and soft tissues,
leading to the fracture communicating with the external
environment, is called an open fracture.
• A fracture may be open from within or outside, the so called
internally or externally open fracture respectively.

9. a) Internally open (from within):
The sharp fracture end pierces the skin from within,
resulting in an open fracture.
b) Externally open (open from outside):
The object causing the fracture lacerates the skin and soft
tissues over the bone, as it breaks the bone, resulting in an
open fracture.
• Exposure of an open fracture to the external environment
makes it prone to infection. This risk is more in externally
open fracture.

11. ON THE BASIS OF COMPLEXITY OF
TREATMENT
1. Simple fracture:
• A fracture in two pieces, usually easy to
treat, is called simple fracture,
• e.g. A transverse fracture of humerus.
2. Complex fracture:
A fracture in multiple pieces, usually difficult
to treat, is called complex fracture,
e.g. a communited fracture of tibia

12. ON THE BASIS OF QUANTUM OF
FORCE CAUSING FRACTURE
1. High-velocity injury:
These are fractures sustained as a result of severe trauma force, as in traffic accidents.
• In these fractures, there is severe soft tissue injury (periosteal and muscle injury).
• There is extensive devascularisation of fracture ends.
• Such fractures are often unstable, and slow to heal.
2. LOW-VELOCITY INJURY:
These fractures are sustained as a result of mild trauma force, as in a fall.
• There is little associated soft tissue injury, and hence these fractures often
heal predictably.
• Lately, there is a change in the pattern of fractures due to shift from low-
velocity to high- velocity injuries.
• More complex fractures, which are difficult to treat.

13. ON THE BASIS OF PATTERN
1. Transverse fracture:
• In this fracture, the fracture line is perpendicular to the
long axis of the bone.
• Such a fracture is caused by a tapping or bending force
2. Oblique fracture :
In this fracture, the fracture line is oblique.
• Such a fracture is caused by a bending force which, in
addition, has a component along the long axis of the
bone.

14. 3. Spiral fracture:
In this fracture, the fracture line runs spirally in more than one plane.
• Such a fracture is caused by a primarily twisting force.
4. Comminuted fracture:
• This is a fracture with multiple fragments.
• It is caused by a crushing or compression force along the long axis of
the bone.
5. SEGMENTAL FRACTURE :
In this type, there are two fractures in one bone, but at different
levels.
• A fracture may have a combination of two or more patterns.
• For example, it may be a comminuted but primarily a transverse

16. ON THE BASIS OF EXTENT OF ORGAN
DAMAGE
• complicated;
• non-complicated
Complicated (open) fractures are those with local damage to the skin and
subcutaneous fat, which allows microorganisms to enter the wound and cause
inflammation. Fractures accompanied by the damage to the major vessels,
neural trunks, and viscera (e.g. the lungs, pelvic organs, the brain and spinal
cord, joints) are all examples of complicated ones.
It is noteworthy that closed fractures lack skin defects.

17. ON THE BASIS OF LOCATION
Based on the the position of the fracture line:
• diaphyseal
• epiphyseal
• metaphyseal

18. SIGNS OF FRACTURES
 Probable signs of fractures are as follows: pain and tenderness, swelling,
deformity and dysfunction, while absolute ones involve pathological
mobility of the limb at unusual sites and crepitation of bone fragments.
 Pain is an indispensable symptom localized, as a rule, at the fracture site;
it progresses on an attempt to move the limb. Firm but careful palpation
with one finger away from the expected fracture site helps find out
tenderness. Tenderness localized at one site is an important sign. It can
also be established by making light knocks along the axis of the limb e.g.
upon slight hitting on the heel, tenderness is elicited at the site of
fracture on the thigh

19.  Swelling may be due to bleeding, haematoma, blood or lymph
circulatory defect. The circumference of the affected limb may reach I
1/2, as much as that of the intact side.
 Deformation of the limb is elucidated on examination and depends
on the angular displacements of the bone fragments. The limb can
cither be distorted or shortened. The distal end of the limb can be
turned to either side (rotational displacement).
 Pathological movements are a reliable sign of a fracture. They must
be assessed very carefully and gently so as not to cause further
damage to the adjacent tissues and organs by the bone fragment

21. INSPECTION OF FRACTURES
 Measurement and palpation of the limb help determine the location or
displacement of the bone fragments
 The rotation of the distal end of a limb without a change in its length is
indicative of a rotational displacement of fragments
 lengthening or shortening of the limb may be found in displacement
along its length
 change in the axis of the limb, i.e. an angular twist at the fracture site at
an angle is indicative of an axial (angular) displacement and finally an
increase in the limb's size the limb suggests a transverse displacement .
 The exact type of the fracture and location of bone fragments of a
fracture are established with Xray pictures that are taken in two views

22. CONSERVATIVE TREATMENT OF
FRACTURES
 Conservative methods are commonly used to treat fracture.
 In both conservative and surgical treatment of fractures the
three main principles have to be followed.
1. Reposition of bone fragments;
2. Immobilization of repositioned bone fragments:
3. Use of agents and physical methods that promote formation
of new bone callus and bone consolidation

23. The successful repositioning of bone
fragments is achieved with adequate
analgesia, which removes the reflective
muscle contraction. Anaesthesia in
fracture cases is achieved by injecting
solutions of novocain, lidocaine, or
trimecain into the haematoma at the
fracture site.
Repositioning of displaced bone
splinters involves their accurate resetting
of the bone fragments along the fracture
line to provide for further consolidation.
The outcome of treatment will be
restoration of limb function, which
mainly depends on the accuracy of
repositioning

24. IMMOBILISATION WITH POP
 In the conservative treatment of fractures, the POP is widely used; it is the best
material for external fixation of fracture fragments and limb immobilization.
 The POP is widely used both as a separate method of treating fractures and also
to provide additional immobilization in metal osteosynthesis and to prolong
immobilization following the removal of traction.
 The POP (calcium sulphate) consists of tiny powder, which on mixing with water
forms some porridge-like mass that hardens within several minutes.

25. DISLOCATIONS
 Dislocation is a complete displacement of the joint ends of
bones in relation to each other
 partial dislocation may also occur
 Shoulder dislocation is one of the commonest types (50—60%
of all dislocations)

26. CLASSIFICATION OF DISLOCATION
 Dislocations arc divided into congenital and acquired.
 Acquired dislocations arc, on the other hand, subdivided into
traumatic and pathologic;
 complicated and non-complicated;
 open and closed.
 Habitual (repeated dislocations in one particular joint) are
also identified.

27. TREATMENT OF DISLOCATIONS
 Treatment of a dislocation or subluxation depends upon
its type,
 Acute traumatic dislocation: In acute traumatic
dislocation, an urgent reduction of the dislocation is of
paramount importance.
 Often it is possible to do so by conservative methods,
although sometimes operative reduction may be
required.
 The treatment of traumatic dislocations involves the three
stages:
• Reduction.

28.  a) Conservative methods:
A dislocation may be reduced by closed manipulative manoeuvres.
• Reduction of a dislocated joint is one of the most gratifying jobs an
orthopaedic surgeon is called upon to do, as it produces instant pain relief
the patient.
• Prolonged traction may be required for reducing some dislocations
b) Operative methods:
Operative reduction may be required in some cases.
• Failure of closed reduction, often because the dislocation is
late.
• Fracture-dislocation:
(i) if the fracture has produced significant incongruity of the joint
surfaces;
(ii) a loose piece of bone is lying within the joint;

29.  Dislocation of the elbow joint. A characteristic sign is the
projection of the olecranon (posterior dislocation) or the block
of the humerus (anterior dislocation). To reduce a posterior
dislocation, the assistant pulls on the forearm flexed at right
angles. In anterior dislocation, a big towel is applied and pulled
along the axis of the humerus, trying to pull the olecranon over
the humeral block. A click sound indicates a successful
reduction.
 Hip dislocation : This is characterised by the general clinical
symptoms of joint dislocation with the typical positioning of the
limb. Reduction is achieved by using the Kocher’s method under
general anaesthesia. The doctor holds the shin flexed in the knee
joint at right angles, and strongly pulls the thigh upwards
rotating it laterally at the same time

30.  Dislocation of the shin is accompanied by damage to the
ligaments of the joint and characterised by a typical
positioning of the shin. Reduction of this type of dislocation is
done under general anaesthesia by pulling on the limb along
its length. After reduction, the POP bandage is applied to
cover the limb from the ankle to the mid-third of the thigh.

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