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General Principles of Fractures<br />Muhammad Shahiduzzaman<br />Professor and Head<br />Department of Orthopaedic Surgery<br />Dhaka Medical College<br />

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Definition<br />Break in the continuity of bone.<br />It is basically a soft tissue trauma where the bone happens to be broken.<br />

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Types of Fractures<br />Simple or Closed<br /> Bone can break within its soft tissue envelope and may not communicate to the exterior. <br />Compound or Open<br /> When the fracture haematoma communicates with the exterior.<br />

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Types of fracture..<br />

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Types of fracture<br />Based on extent of fracture line:<br />Incomplete Fracture<br />Complete Fracture – Displaced, Undisplaced <br /> Based on fracture pattern :<br />Linear fractures- Transverse, oblique, spiral<br />Comminuted Fractures.<br />Segmental fractures<br />

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Types of Fracture<br /><ul><li>Atypical Fractures</li></ul>Greenstick fractures<br />Impacted fractures<br />Stress or fatigue fractures<br />Pathological fractures<br />Hairline or crack fracture<br />Torus fracture<br />

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Types of Fracture<br />

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Types of Fracture<br /> Depressed # Compression #<br />

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Remember<br />Greenstick fracture-occurs in children.<br />Stress fracture- common in athletes.<br />Fatigue fracture- in occupation like police<br />Pathological fractures-usually seen in elderly.<br />

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Approach to Orthopaedic injury<br />History<br />Age: Birth, early childhood, Late childhood Adult, Elderly.<br />Sex <br />Mechanism of injury<br />

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Clinical Features<br />Symptoms:<br />Pain, Swelling, deformity, inability to use the affected part.<br />O/E<br />Look – Deformity, swelling, Shortening<br />Feel: Tenderness, <br />Move : Abnormal mobility, Crepitus<br />

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Remember<br />Clinical manifestation in a fracture is due to : <br />Fracture per se ,Its complications or both<br />Impendening vascular damage is detected by five ‘P’ <br />Pain, Pallor, <br />Paraesthesia, <br />Pulselessness, Paralysis<br />

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Investigations in Orthotrauma<br />Radiography- most important diagnostic tool for fractures. Minimum two views (AP and Lateral) are required.<br />Sometimes an oblique and other special views are required.<br />CT Scan and MRI – both are noninvasive and extremely useful in detecting both soft tissue and bony injury.<br />

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Remember the rules in X-ray<br />Better no X-ray than one view X-ray<br />X-ray is a shadow. It conceals and distorts so Interpret x-ray with caution.<br />A joint above andjoint below should be included with the fracture under study.<br />Read x-ray holding it in anatomical position.<br />Exposure should be adequate.<br />

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Management of Fracture<br />The goal of fracture management is to restore the anatomy back to its normal or near to normal as possible.<br />The responsibility of the doctor is to ensure that there is no functional disability to the patient following the treatment of fracture.<br />

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Management of fractures<br />Can be discussed under the following :<br />Management of closed uncomplicated fracture<br />Management of open fracture<br />Management of complicated fracture.<br />

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Management of closed fracture<br />Managed by conservative or operative methods.<br />Conservative methods :<br />For undisplaced #,incomplete #,Impacted # : Collar and cuff sling, Strapping, plaster slab, <br />For displaced fracture : the aim is to restore anatomy as near as possible by either closed or open reduction.<br />

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Management of Closed fracture<br />

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Management of # by closed reduction<br />Resuscitation, <br />Reduction <br />Retention<br />Rehabilitation<br />

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Fracture management by open reduction<br />Where closed reduction fails<br />Displaced intra articular fractures<br />Type III and IV epiphyseal injuries<br />Major avulsion fracture<br />Nonunion<br />Multiple fractures<br />

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Retention after open reduction<br />Fracture fragments invariably needs to be fixed by various implants.<br />Choice of implants<br />K-wire<br />Intramedullary nails<br />Plate and screw<br />Interlocking nail<br />Hip implants, Spine implants, Steel wires<br />

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Implants for Retention<br />

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Remember<br />Success by open reduction depends on :<br />Proper indication<br />Proper timing<br />Proper Surgical approach<br />Proper technique<br />Proper selection of implant<br />Proper Surgeon<br />

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Thank Youforyour attention <br />