Fractures are breaks or disruptions in the continuity of bone. They are classified based on type, communication with the external environment, anatomic location, appearance of fragments, and stability. Treatment goals are to realign bone fragments through reduction, immobilize through casting, traction, or fixation to maintain alignment, and restore function. Complications can include infection, compartment syndrome, venous thrombosis, and fat embolism syndrome. Early diagnosis and treatment of complications is important for proper healing and recovery from fractures.

1. Fractures
DR ANEELA ZIA
DPT
MS-OMPT (FRAHS)

2. Description
 A disruption or break in the
continuity of the structure of bone
 Traumatic injuries account for the
majority of fractures

3. Description
 Described and classified according
to:
Type
Communication or
noncommunication with external
environment
Anatomic location

4. Types of Fractures
Fig. 61-4

5. Classification by Communication with
External Environment
Fig. 61-5

6. Classification by Fracture Location
Fig. 61-6

7. Description
 Described and classified according
to:
Appearance, position, and
alignment of the fragments
Classic names
Stable or unstable

8. Description
 Closed (also called simple)
 Open (also called compound)

9. Description
 Stable fractures
Occur when a piece of the
periosteum is intact across the
fracture
External or internal fixation has
rendered the fragments stationary

10. Description
 Unstable fractures
Grossly displaced
Poor fixation

11. Clinical Manifestations
Immediate localized pain
 Function
Inability to bear weight or use
affected part
Guarding
May or may not see obvious bone
deformity

12. Fracture Healing
1. Fracture hematoma (d/t bleeding,
edema)
2. Granulation tissue → osteoid (3 –
14 days post injury)
3. Callus formation (minerals deposited in
osteoid)

13. Fracture Healing
4. Ossification (3 wks – 6 mos)
5. Consolidation (distance between
fragments decreases → closes).
6. Remodeling (union completed;
remodels to original shape, strength)

17. goals of treatment:
Anatomic realignment of bone
fragments (reduction)
Immobilization to maintain
alignment (fixation)
Restoration of normal function

18. Fracture Reduction
 Closed reduction
Nonsurgical, manual realignment
 Open reduction
Correction of bone alignment
through a surgical incision

19. open reduction

20. Fracture Reduction
 Traction Application of pulling force
to attain realignment

21. Fracture Immobilization
 Casts
 Temporary circumferential immobilization device
Common following closed reduction

22. Casts
Fig. 61-9

23. Fracture Immobilization
 External fixation
Metallic device composed of pins that
are inserted into the bone and attached
to external rods

24. Collaborative Care
Fracture Immobilization
 Internal fixation
Pins, plates, intramedullary rods, and
screws
Surgically inserted at the time of
realignment

26. Collaborative Care
Fracture Immobilization
 Traction
Application of a pulling force to an
injured part of the body while
countertraction pulls in the opposite
direction

27. Collaborative Care
Fracture Immobilization
 Purpose of traction:
Prevent or reduce muscle spasm
Immobilization
Reduction
Treat a pathologic condition

28. Complications of Fractures
Infection
 Open fractures and soft tissue injuries
have  incidence
 Osteomyelitis can become chronic
 Collaborative Care
Open fractures require aggressive
surgical debridement
Post-op IV antibiotics for 3 to 7 days
(prophylactic)

29. Complications of Fractures
Compartment Syndrome
 Condition in which elevated
intracompartmental pressure within a
confined myofascial compartment
compromises the neurovascular function
of tissues within that space
 Causes capillary perfusion to be reduced
below a level necessary for tissue
viability

30. Complications of Fractures
Compartment Syndrome
 Two basic etiologies create compartment
syndrome:
Decreased compartment size
(dressings, splints, casts)
Increased compartment content
(bleeding, edema)

31. Complications of Fractures
Compartment Syndrome
 Clinical Manifestations
Six Ps:
1. Paresthesia (unrelieved by
narcotics)
2. Pain (unrelieved by narcotics)
3. Pressure

32. Complications of Fractures
Compartment Syndrome
 Clinical Manifestations
 Six Ps:
4. Pallor (loss of normal color,
coolness)
5. Paralysis
6. Pulselessness (decreased/absent
pulses)

33. Complications of Fractures
Compartment Syndrome
 Clinical Manifestations
Six Ps:
Patient may present with one or all of
the six Ps
Compare extremities

34. Complications of Fractures
Compartment Syndrome
 Clinical Manifestations
Absence of peripheral pulse
Myoglobinuria
(Dark reddish-brown urine)

35. Complications of Fractures
Compartment Syndrome
 Collaborative Care
Prompt, accurate diagnosis is critical
Early recognition is the key
Do not apply ice or elevate above heart
level

36. Complications of Fractures
Compartment Syndrome
 Collaborative Care
Remove/loosen the bandage and
bivalve the cast
Reduce traction weight
Surgical decompression (fasciotomy)

37. Complications of Fractures
Venous Thrombosis
 Veins of the lower extremities and pelvis are highly susceptible to
thrombus formation after fracture, especially hip fracture
 Precipitating factors:
 Venous stasis caused by incorrectly applied casts or traction
 Local pressure on a vein
 Immobility
 Prevent with anticoagulant medications

38. Complications of Fractures
Fat Embolism Syndrome (FES)
 Characterized by the
presence of fat globules in
tissues and organs after a
traumatic skeletal injury
 Fractures that most often
cause FES:
 Long bones
 Ribs
 Tibia
 Pelvis
•Tissues most often affected:
Lungs
Brain
Heart
Kidneys
Skin
•Usually occur 24-48 hours
after injury

39. Complications of Fractures
Fat Embolism Syndrome (FES)
 Clinical Manifestations
 Symptoms of ARDS:
 Chest pain
 Tachypnea
 Cyanosis
  PaO2
 Dyspnea
 Apprehension
 Tachycardia

40. Complications of Fractures
Fat Embolism Syndrome (FES)
 Clinical Manifestations
Rapid and acute course
Feeling of impending disaster
Patient may become comatose in a
short time

41. Complications of Fractures
Fat Embolism Syndrome (FES)
 Collaborative Care
Treatment directed at prevention
Careful immobilization of a long bone
fracture
Most important preventative factor

42. Complications of Fractures
Fat Embolism Syndrome (FES)
 Collaborative Care (treatment)
Symptom management
Fluid resuscitation
Oxygen
Reposition as little as possible

43.  JAZAKAALLAH KHAIR