introduction to orthopaedics with definition, types, classification, eponyms, with clinical picture and examples

1. FRACTURE
Orthopaedic Trauma:
Introduction

2. Definition
 An injury to the musculo-skeletal system can result
in damage to bones, joints, muscles and tendons.
 In addition, the neurovascular bundle of the limb
may be damaged.
 A fracture is a break in the continuity of
bone.

3. Classification of fracture
 Traumatic fracture
 A fracture sustained due to trauma is called a traumatic
fracture*
 Pathological fracture
 fracture through a bone which has been made weak by some
underlying disease is called a pathological fracture
 Stress Fracture
 This is a special type of fracture sustained due to chronic
repetitive injury (stress) causing a break in bony trabeculae

4.  Complete fracture
 a break across the entire cross-section of the bone
 Incomplete fracture
 the break occurs through only part of the cross-section of the
bone

5.  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.
 An 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

6.  Simple fracture
 A fracture in two pieces, usually easy to treat, is called simple
fracture, e.g. a transverse fracture of humerus
 Complex fracture
 A fracture in multiple pieces, usually difficult to treat, is called
complex fracture, e.g. a communited fracture of tibia

11.  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
 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.

12.  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.
 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.
 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 fracture

13.  Green stick fracture
 A fracture in which one side of a bone is broken while the other
is bent (like a green stick).
 Compression Fracture
 A fracture caused by compression, the act of pressing
together. Compression fractures of the vertebrae are
especially common with osteoporosis.

14. FRACTURES WITH EPONYMS
 Monteggia fracture-dislocation:
 Fracture of the proximal third of the ulna, with dislocation of
the head of the radius
 Galeazzi fracture-dislocation:
 Fracture of the distal third of the radius with dislocation of
the distal radio-ulnar joint
 Night-stick fracture:
 Isolated fracture of the shaft of the ulna, sustained while
trying to ward off a stick blow.

16.  Colles’ fracture
 A fracture occurring in adults, at the cortico-cancellous
junction of the distal end of the radius with dorsal tilt and
other displacements
 Smith's fracture:
 A fracture occurring in adults, at the cortico-cancellous
junction of the distal end of the radius with ventral tilt and
other displacements (reverse of Colles').
 Barton's fracture:
 Intra-articular fractures through the distal articular surface of
the radius, taking a margin, anterior or posterior, of the distal
radius with the carpals, displaced anteriorly or posteriorly

18.  Chauffeur fracture:
 An intra-articular, oblique fracture of the styloid process of
the radius.
 Bennett's fracture-dislocation: (image B)
 It is an oblique, intraarticular fracture of the base of the first
metacarpal with subluxation of the trapezio-metacarpal joint
 Rolando fracture: (image C)
 Fracture of the base of the first metacarpal (extra-articular).
 Boxers' fracture:
 It is a ventrally displaced fracture through the neck of the 5th
metacarpal, usually occurs in boxers.

20.  Jone's fracture:
 Avulsion fracture of the base of the 5th metatarsal.
 March fracture:
 Fatigue fracture of the shaft of 2nd or 3rd metatarsal.
 Jefferson’s fracture:
 Fracture of the first cervical vertebra.
 Whiplash injury:
 Cervical spine injury where sudden flexion followed by
hyperextension takes place.

22. PATHOLOGICAL FRACTURES
A fracture is termed pathological when it occurs in
a bone made weak by some disease
 CAUSES
A bone may be rendered weak by a disease localised
to that particular bone, or by a generalised bone
disorder.
 Osteoporosis is the commonest cause of pathological fracture. The
bones most often affected are the vertebral bodies (thoracic and
lumbar).
 Other common fractures associated with osteoporosis are fracture of
the neck of the femur and Colles' fracture.

23. Localised Diseases
 Inflammatory
 Pyogenic osteomyelitis
 Tubercular osteomyelitis
 Neoplastic
 Benign tumours
 – Giant cell tumour, Enchondroma
 Malignant tumours
 – Primary
 Osteosarcoma, Ewing's tumour
 – Secondary
 In males: lung, prostate, kidney
 In females: breast, lung, genitals

24. Miscellaneous
 Simple bone cyst
 Aneurysmal bone cyst
 Monostotic fibrous dysplasia
 Eosinophilic granuloma
 Bone atrophy secondary to polio etc.
Generalised Diseases
 Hereditary
 Osteogenesis imperfecta
 Dyschondroplasia (Ollier's disease)
 Osteopetrosis
 Acquired
 Osteoporosis
 Osteomalacia
 Rickets
 Scurvy
 Disseminated malignancy in bones
 – Multiple myeloma
 – Diffuse metastatic carcinoma
 Miscellaneous
 – Paget's diseases
 – Polyostotic fibrous dysplasia

25. Pathological Fracture at different age
 At birth
 Osteogenesis imperfecta
 • 0-5 years
 Osteogenesis imperfecta
 Osteomyelitis
 • 5-20 years
 Osteomyelitis
 Simple bone cyst
 Primary bone malignancy
 • 20-50 years
 Cystic lesions of the bone
 Malignancy
 Osteomalacia
 Giant cell tumour
 • After 50 years
 Osteoporosis
 Multiple myeloma
 Secondaries in the bone

26. INJURIES TO LIGAMENT
An injury to a ligament is termed as a sprain.
This is to be differentiated from the term ‘strain’ which means
stretching of a muscle or its tendinous attachment.
CLASSIFICATION
Sprains are classified into three degrees (Fig-1.5):
 First-degree sprain is a tear of only a few fibres of the
ligament. It is characterised by minimal swelling, localised
tenderness but little functional disability.
 Second-degree sprain is the one where, anything from a
third to almost all the fibres of a ligament are disrupted. The
patient presents with pain, swelling and inability to use the
limb. Joint movements are normal

27.  Third-degree sprain is a complete tear of the
ligament. There is swelling and pain over the torn
ligament. Contrary to expectations, often the pain in
such tears is minimal. Diagnosis can be made by
performing a stress test, and by investigations such
as MRI or arthroscopy.

28.  Stress test :This is a very useful test in diagnosing
a sprain and judging its severity. The ligament in
question is put to stress by a manoeuvre

29. TREATMENT FOR SPRAIN
There has been a significant change in the treatment of
sprains. All sprains are treated initially with
 Rest,
 Ice therapy,
 Compression bandage,
 Elevation (RICE)
Suitable analgesics and anti-inflammatory
medication is given. This is enough for first-degree
sprains

30.  Second and third-degree sprains are immobilised in
a brace or a plaster cast for a period of 1-2 weeks,
mainly for pain relief
 In fact, early mobilisation and walking with support
enhances healing of ligaments. In some third-degree
sprains, surgery may be required.

31. TENDON RUPTURE
Muscles are ruptured more often than tendons in
young people, while the reverse is true in the elderly.
The most frequent cause of partial or complete
rupture of a muscle or a tendon is sudden vigorous
contraction of a muscle.
 A rupture occurs within a tendon only if it is
abnormal and has become weak, either due to
degeneration or wear and tear.
 Degenerative tendon ruptures commonly occur in
rheumatoid arthritis, SLE, senile degeneration

32. Common sites of tendon rupture
 Supraspinatus tendon
 Achilles tendon
 Biceps tendon – long head
 Extensor pollicis longus tendon
 Quadriceps tendon
 Patellar tendon

33. Clinical manifestations of fracture
 Pain
 Loss of function
 Deformity
 Shortening
 Crepitus
 Swelling and discoloration

34. Diagnosis of fracture
 History collection
 Physical examination
 X ray
 CT scan
 MRI scan

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