bone fractures and management

1. Fracture

2. INTRODUCTIONS
Bones protect the body soft tissues against
external forces,
Bones aid movement of different parts of the
body,
Bones are also responsible for the production of
bone marrow which in turn produce blood cells

3. Bones undergo changes under hormonal influence,
Parathyroid hormone increase blood calcium level by
leeching calcium from bones,
Calcitonin hormone has the opposite effect allowing
bones to accept calcium from blood.

4. WHAT IS A BONE FRACTURE
A BONE FRUCTURE is a medical condition in which
there is a break in the continuity of the bone cortex.
It is abbreviated FRX, FX, or #

5. STATISTICAL EVIDENCE
Fractures of extremities are most common.
More common in men up to 45yrs.
More common in women over 45yrs.
Before 75yrs wrist fracture most common(colles fractures).
After 75yrs hip fractures most common

6. ETIOLOGY/causes
 Traumatic – blow, fall, MTA.
 Stress – repeated excessive force over the bone.
Pathological – infections, bone tumors.
 Metabolic – excess protein and phosphorous ingestion.
Hormonal – osteoporosis.
Congenital – osteitis deformans, osteopetrosis

7. CLASSIFICATION
Classified into four categories:
OTA, (OTHOPAEDIC TRUAMA ASSOCIATION)
Orthopedic
Anatomical
Classification in children

8. OTA CLASSIFICATION
This classification was devised by orthopedic surgeons to enable accurate
location and treatment .
There are five codes.
bone involved e.g. femur.
Location of the fracture e.g. mid shaft.
Type of the fracture e.g. comminuted.
Group- refers to the geometry e.g. transverse, oblique.
Sub group- describes the displacement of the fracture e.g. angulation or
shortening

9. CLASSIFFICATION.
Orthopedic
Closed/simple,
Open /compound,
Compressed,
Complete,
Incomplete,
Avulsion.
Oblique,
Spiral,
Comminuted,
Impacted.
Transverse,
Linear,

10. Spiral Fracture
A fracture, sometimes called torsion
fracture, in which a bone has been twisted
apart.

11. Comminuted Fracture
A fracture, in which bone is broken,
splintered or crushed into a number of
pieces.

12. Transverse Fracture
A fracture, in which the break is across the
bone, at a right angle to the long axis of the
bone

13. Compound Fracture
A fracture in which the bone is sticking
through the skin. Also called an open
fracture

14. Compression Fracture
A fracture caused by compression, the act
of pressing together. Compression fractures
of the vertebrae are especially common with
osteoporosis.

15. Avulsion: fracture which occurs when a
fragment of bone tears away from the main
mass of bone.
• Depressed: A fracture in which fragments
are driven inward (seen frequently in
fractures of skull and facial bones)
Pathologic: it occurs through an area of
diseased
bone (eg, osteoporosis, bone cyst, bony
metastasis, tumor); can occur without
trauma or a fall
• Stress: A fracture that results from
repeated loading without bone and muscle
recovery

17. ANATOMICAL
SKULL,
Basilar skull #
Blowout #
Mandibular#
Nasal#
Le fort #- fracture of the maxillary bone.

18. Conti…
Spinal fractures-
Jefferson fracture- fracture through spinous process.
Hangmans fracture- fracture through C2 pedicle
ARM FRACTURES.
Galleazi fracture - # of radius with dislocation of distal radioulnar joint
Colles fracture - # of distal radius with dorsal displacement of wrist and hand.
HAND FRACTURES.
Scaphoid fractures,
Boxers fractures- # of the neck of metacarpal bone.

19. Cont…
PELVIC FRACTURES.
Fracture of the hip bone,
Duverneys fracture - # of the iliac wing
FEMORAL FRACTURES
Fractures of the femoral neck.
Fractures of the femoral shaft.
PATELLAR FRACTURES
Transverse.
Vertical.
TIBIA FRACTURES
Segond fracture – avulsion fracture of the lateral tibial condyle.

20. CLASSIFICATION IN CHILDREN.
.
• Greenstick fracture-A fracture in which one
side of a bone is broken
while the other is bent (like a green stick).,

21. Pathophysiology
Due to any etiology(crushing movement)
Fracture occurs , muscle that were attached to bone are disrupted and cause spasm
Proximal portion of bone remains in place, the distal portion can become displaced in
response to both causative force & spasm in the associated muscles
In addition, the periosteum and blood vessels in the cortex and marrow are disrupted
Soft tissue damage occurs, leads to bleeding and formation of hematoma between the
fracture fragment and beneath the periosteum
Bone tissue surroundings the fracture site dies, creating an intense inflammatory response
release chemical mediators histamins,prostaglandins
Resulting in vasodilation, edema, pain, loss of function, leukocytes and infiltration of WBC

22. Clinical manifestations
pain
loss of function
deformity
shortening
crepitus
swelling and discoloration

23. Diagnosis of fracture
• History collection
• Physical examination
• X ray
• CT scan
• MRI scan

24. MANAGEMENT
1.Reduction
Reduction of a fracture (“setting” the bone)
refers to restoration of the fracture fragments
to anatomic alignment and rotation
External/Internal fixation devices (metallic
pins, wires, screws, plates, nails, or rods) may
be used to hold the bone fragments in
position until solid bone healing occurs.

25. Difference between internal or
external fixation

26. 2.Immobilization
• Immobilization may be accomplished by
external or internal fixation.
• Methods of external fixation include
bandages, casts, splints, continuous
traction, and external fixators.
Metal implants used for internal fixation
serve as internal splints to immobilize the
fracture
Traction
Traction is the use of weights, ropes and
pulleys to apply force to tissues
surrounding a broken bone

27. Splinting
Splinting is the most common procedure for
immobilizing an injury
Why Do We Splint?
To decrease pain
Actually treat the injury
To stabilize the extremity
Guidelines for Splinting
Support the injured area.
2. Splint injury in the position that you find it.
3. Don’t try to realign bones.
4. Check for color, warmth, and sensation.
5. Immobilize above and below the injury.

28. MANAGEMENT CONTI….
Analgesics e.g. Ibuprofen
Surgery - ORIF with NAILS
PHYSIOTHERAPY MANAGEMENT.
AIMS OF TREATMENT:
Psychological support.
Maintain blood circulation.
Maintain joint range of motion.
Maintain muscle strength.
Mobilize the patient.
Prevent chest complications.
Promote healing.

29. PLANS OF TREATMENT
SHORT TERM PLANS:
Counseling.
Pumping exercises.
Isometric contraction of muscles within the
immobilized area.
Active movement of joints distal or proximal to
the area immobilized.
Resisted exercises of other non involved
muscles.
Gait training.
Breathing exercises.
Partial wt bearing, ultrasound etc.
LONG TERM PLANS.
Therapeutic heat and TENS to reduce pain
in the affected joints.
Passive/active mobilization of the
previously immobilized joints.
Gait training.
Assisted/Ressisted exercises to the
previously immobilized muscles.

30. STAGES OF BONE HEALING
Haematoma,
Blood vessels grow into the jelly like matrix of clot,
Phagocytosis,
Fibroblast produce collagen fibres,
Formation of bone matrix(calcium hydroxapitate),
Woven bone formation,
Lamellar bone formation(remodeling).

31. COMPLICATIONS OF FRACTURES,
INTRINSIC AND EXTRINSIC
Injury to adjacent vessels, nerves, tendons
etc.
Injury to viscera,
DVT,
fat embolism,
EXTRINSIC COMPLICATIONS
Delayed union,
Non-union,
Mal-union.
Shortening,
Compartment syndrome,
Infection.
DJD.
Myositis ossificans

32. FACTORS WHICH PREVENT BONE HEALING.
Inadequate immobilization.
Nicotine consumption.
Inadequate calcium intake.
Bone Cancers.
Too much meat consumption.
Entrapment of soft tissues in between the fractured bones.