This document discusses functional cast bracing for fractures. It provides that functional cast bracing allows continued function during fracture healing, which encourages bone growth and tissue healing while preventing joint stiffness. It is based on the concepts that rigid immobilization is not needed for healing and some loss of anatomical reduction is acceptable to restore rapid function. The document outlines the theoretical basis of functional cast bracing, including how motion, vascular invasion, thermal environment, mechanical forces, and electrical environment interact to enhance tissue healing. It also discusses indications, contraindications, application timing and results of functional cast bracing.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Guidelines on the use of plaster of paris in fracture management. Quite useful for orthopedic residents, GPs, plaster techs, orthopedic care nurses, rehabilitation physicians, physiotherapists
fracture is the breakdown in the continutity of the bone alignment this has many types as the fracure this topic include its definition , etiology, pathophysiology, clinical menisfestation, diagnosis and its treatment which can be used by nursing students for taking care of the patient suffering from fracture and for learning for their examination and knowledge purpose
What is fixation?
Fixation in orthopedics is the process by which an injury is rendered immobile. This may be accomplished by internal fixation, or by external fixation.
What is internal fixation?
Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone
What is osteosynthesis?
Osteosynthesis is the reduction and internal fixation of a bone fracture with implantable devices that are usually made of metal. It is a surgical procedure with an open or per cutaneous approach to the fractured bone. Osteosynthesis aims to bring the fractured bone ends together and immobilize the fracture site while healing takes place. In a fracture that is rigidly immobilized the fracture heals by the process of intramembranous ossification
INDICATIONS for internal fixation
History of Fracture Treatment and Development Of Modern Osteosynthesis
In the Preantibiotic era, closed reduction of fractures was understandably the rule for most fractures. However, when closed reduction was insufficient, external fixation appliances served to maintain skeletal units in position, frequently without the need for MMF (Maxillo-mandibular fixation) .Following the development of antibiotics, the open treatment of fractures began to be used on a more frequent basis.
Rigid internal fixation (RIF) is “Any form of fixation applied directly to the bones which is strong enough to permit active use of the skeletal structure during the healing phase and also helps in healing”.
Bone fractures have been treated with various conservative techniques for centuries and it was not until the eighteenth century that internal fixation was first documented.
Icart, a French surgeon in Castres, performed ligature fixation with brass wire on a young man with a humeral fracture.
1886, when Hansmann of Hamburg published a technique using retrievable metal bone plates with transcutaneous screws.
Soon after, a Belgian surgeon, Albin Lambotte, improved these techniques and coined the term internal fixation.
Lambotte developed and manufactured a variety of bone plates and screws and much of his armamentarim remained in use until the 1950s.
In the twentieth century, Sherman improved on Lambotte’s designs and created parallel, threaded, finepitched, self-tapping screws. This hardware was made of corrosion-resistant vanadium steel, which was a strength improvement over silver and ivory fixation materials.
BIOLOGY OF BONE AND BONE HEALING
Bone is a complex and ever-evolving connective tissue and serves multiple purposes. Besides being the main constituent of the human skeletal system, bone is highly metabolically active and essential for the regulation of serum electrolytes—namely, calcium and phosphate.
Marrow cavities are filled with hematopoietic elements necessary to manufacture and maintain blood components and regulate the immune system. Bone is comprised
2. INTRODUCTIONINTRODUCTION
A closed method of treating fractures
based on the belief that continuing
function while a fracture is uniting ,
encourages osteogenesis, promotes the
healing of tissues and prevents the
development of joint stiffness, thus
accelerating rehabilitation
Not merely a technique but constitute a
positive attitude towards fracture healing.
3. CONCEPTCONCEPT
The end to end bone contact is not
required for bony union and that rigid
immobilization of the fracture fragment
and immobilization of the joints above and
below a fracture as well as prolonged rest
are detrimental to healing.
4. It accepts that the loss of the anatomical
reduction of a fracture is a small price to
pay for rapid healing and the restoration
of function, without compromising the
appearance of the limb by operative scars.
It complements rather than replaces other
forms of treatment.
5. HISTORYHISTORY
1855 – H.H.Smith designed appliance for
nonunion proximal femoral fractures.
1910 – Lucas Championniere “ LIFE IS
MOTION”.
1926 – Gurd [ # of foot and ankle].
1950s – Dehne [# tibia].
1963 – Sarmiento began his systemic
study,
6. THEORETICAL BASISTHEORETICAL BASIS
Elimination of movt at a fracture site is
not mandatory for a fracture to unite,
STABILITY – needed
1. Reduce the pain
2. Maintain alignment
3. Prevent deformity.
7. External bridging callus: situated at
distance from the axis of potential movt, it
has a greater mechanical advantage than
medullary callus, stronger early repair.
8. Optimal physiologicalOptimal physiological
environmentenvironment
Function in brace provides a milieu
wherein metabolic, mechanical, chemical,
thermal and electrical factors favorably
enhance tissue healing.
Intermittent loading strain in the
tissues electrical potentials for bone
formation.
Muscle activity increase in circulation
supply of nutrient & clearance of waste
maintains chemical milieu.
9. Irritating effect of motion at the # site &
deviatoric stains in the surrounding &
interposing tissue prolongs the
inflammatory response of s.s
hyperemia increase in temperature.
M.E streaming potentials through
capillary gradients & strain related
potentials through tissue deformation
enhancement of E.E.
10. E.E affects chemical reaction in the S.S
and has an effect on the rate, quantity
and orientation of tissues formation in
callus.
12. Role of soft tissuesRole of soft tissues
Early stages soft tissues transmit most of
the load.
Muscle compartment act as fluid mass
surrounded by an elastic container – deep
fascia.
Fluids are not compressible and fascia
can’t be stretched beyond confines of the
cast – HYDRAULIC FORCES.
After initial displacement, pressure and
load are transmitted without further
deformation.
13. Muscle contract bulge normally.
In FCB muscles are forced inwards
away from the rigid walls and against the
central fragments thus causing the
fragments to held more firmly.
14. Hydraulic forces of the soft tissues resist
the overlap and angulation until callus
forms.
Rotation is resisted by components of the
brace and or by tendency of muscle
contraction and Jt movt to align the
fragments.
15. SHORTENINGSHORTENING
Braces do not prevent shortening.
It is determined at the time of injury by
degree of soft tissue damage.
Shortening in closed # does not increase
beyond that that which develops immediately
following initial injury.
Movts are elastic no progressive deformity.
Control related to fit of brace and extent of
damage
16.
17. LOAD BEARINGLOAD BEARING
S.T. two major mechanisms for load
bearing and provision of stiffness to the
limb when encompassed in FCB.
I related to their incompressibility.
[ displace under load only until they have
filed all the gaps with in the container]
important in early post injury period.
II intrinsic strength S.T in tension as
they support the bony fragments at their
natural attachments.
19. CONTRA-INDICATIONCONTRA-INDICATION
Lack of co-operation by the pt.
Bed-ridden & mentally incompetent pts.
Deficient sensibility of the limb [D.M with
P.N]
When the brace cannot fitted closely and
accurately.
Fractures of both bones forearm when
reduction is difficult.
Intraarticular fractures.
20. Galeazzi fractures
Monteggia fractures
Proximal half of shaft of femur [tends to
angulate in to varus only used by expert]
Isolated # of tibia, fibula tends to cause
varus angulation and to delay in
consolidation of #. [ Proximal 1/3]
21. Time to applyTime to apply
Not at the time of injury.
Regular casts, time to correct any
angular or rotational deformity.
Compound # es , application to be
delayed.
Assess the # , when pain and swelling
subsided
1. Minor movts at # site should be pain
free
2. Any deformity should disappear once
D.F removed
22. 3. Reasonable resistance to telescoping.
4. Shortening should not exceed 6.0 mm
for tibia, 1.25 cm for femur.
23. For # tibia following low energy injury,
bracing can be done with in first 2 wks.
High energy injuries with more pain &
swelling needs an additional period of 1 or
2 more wks.
For humerus # es , most conditions
bracing can be done by 7-10 days time.
Median time of brace removal tibia 18.7
wks, humerus 10 wks.
24. OPEN FRACTURESOPEN FRACTURES
Does not preclude FCB.
Greater degree of soft tissue damage
increased instability of limb needs delay
in using FCB.
High degree of soft tissue damage &
shortening may require external fixation
for sometime before FCB.
25. RESULTSRESULTS
Shortening encountered in closed tibia
fracture rarely exceeds 1 cm. [won’t
cause limp].
Angular deformities usually < 5*.
Cosmetically and functionally acceptable
for most pts. OA changes doesn’t occur
from deformities of such magnititude.
26. Types of limb segmentsTypes of limb segments
Limb segments with two bones and
interosseous membrane surrounded by
muscular tissues with lesser amount of fat
in sub-cut region.
One limb segment with bulky muscle layer
with relatively large sub-cut fat.
First type is inherently stable ,well
controlled with FCB.
One bone seg, relatively unstable because
of sub cut fat provides lubrication.