Fracture & dislocation is well described in Ayurveda. Sushruta Samhita have a separate chapter for bhagna etiology, features, types, prognosis, Management by name of Bhagna-Kandabhagna-Sandhimukta. The basics principles and management of fracture are accurate as per modern orthopedics.

1. 15-09-2020
Fracture & Dislocation in Ayurved-Dr
Mahesh Kumar
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2.  To elaborate the Fracture & dislocation of ancient
classics in context to modern,
 View of clinical features, method of diagnosis &
principles of management, practically as well as
theoretically.
Fracture & Dislocation in Ayurved-Dr Mahesh Kumar 2
Purpose
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3. Introduction
• The history of traumatic surgery is probably as old as
the origin of mankind.
• Ayurveda have description of various types of
skeletal injuries.
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Fracture
(Kandabhagna
- break in the continuity
of bone) &
Dislocation
(Sandhimukta-
displacement of bone
from their own site).
Reference-
Sushruta Samhita(1000-1500
BC),
Sushruta Nidana chap.15,
Sushruta Chikitsa chap.03

4. 1.Kapala ( ) ,Flat bones
2.Rucaka ( ),Small cubical bones
3.Taruna ( ), Cartilages bones
4.Valaya ( ),Thin curved bones, without a
medullary cavity
5.Nalaka( ),Long bones,with medullary
cavity
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5. Effect of trauma upon bones
Su Ni.,15/16,17
According to Susruta,after a certain trauma the
• Cartilages bend;
• The long bones break ;
• Flat bones show multiple cracks (star shaped) and
• Small bones get fragment
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6. Causes of trauma in Ancient times
(Su.,Ni.,15/3.)
• Fall,
• compression,
• blow,
• throwing and
• specific traumas from teeth etc. of
ferocious(wild) or docile(tame) animals are
mentioned to cause various types of injury.
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7. Types of fractures
All skeletal injuries have been divided into two
groups:-
1.Savrana-bhagna [ Open or Compoumd fracture]
2.Avrana-bhagna [ Simple fracture ]
su.,Ni.,15/4 , 5 ),
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8. Sandhimukta(Dislocations) Kandabhagna (Fractures)
1. Utpista ) 1. Karkataka ( )
2. Vislista ( ) 2. Aswakarna ( )
3.Vivartita ( ) 3. Curnita ( )
4.Avaksipta 4. Piccita ( )
5.Atiksipta ( ) 5. Asthichallita ( )
6.Tiryakksipta( ) 6. Kandabhagna ( )
7. Majjanugata ( )
8. Atipatita ( )
9. Vakra ( )
10.Chinna ( )
11. Patita )
12. Sphutita ( )
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9. Sandhimukta(Dislocations)
• 1. Utpista - Fracture dislocation;
• 2. Vislista - Dislocations of joints due to
ligamental tears;
• 3. Vivartita - Anterior-posterior dislocation of the
head of the humerus;
• 4. Avakshipta - Downward displacement of the
head of the humerus;
• 5. Atikshipta - Marked displacement of any
articulation surface;
• 6. Tiryakshipta - Oblique dislocation in one of the
articulating bones.
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10. Individual fractures (Su.,Ni.,15/8)
1. Karkataka ( ) – Depressed Fracture
2. Aswakarna ( ) –Complete oblique Fracture
3. Curnita ( ) – Comminuted Fracture
4. Piccita ( ) -Fracture by compression
5. Asthichallita ( ) – Subperiosteal avulsion
6. Kandabhagna ( ) – Complete spiral Fracture
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11. 7.Majjanugata – Impacted Fracture
8. Atipatita – Complete compoumd Fracture
9. Vakra -Green stick Fracture
10.Chinna -Incomplete Fracture
11. Patita Comminuted fracture of the bones
12. Sphutita -Fissured Fracture
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12. Description of Individual Fracture
• Simple fractures (often called "closed") & Compound
fractures (commonly called "open")
• Complete & Incomplete
Fractures are termed complete if the break is
completely through the bone and described as
incomplete or "greenstick" if the fracture occurs partly
across a bone shaft.
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13. • A single fracture- one fracture in a bone
• Multiple fractures - more than one fracture occurrs
in the same bone.
• Fractures may named according to part of the bone
involved and the nature of the break.
• Types on basis of fracture as linear, oblique,
transverse, longitudinal, and spiral fractures.
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14. • On the basis of positions of bony fragments as
comminuted, non-displaced, impacted, overriding,
angulated, displaced, avulsed, and segmental.
• Fracture-dislocation when a fracture involves the
bony structures of any joint with associated
dislocation of the same joint.
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15. Sign & symptoms of sandhimuktaSu.Ni.15/6)
The features which suggest a dislocation are
• Inability to extend, flex, move sideways or
circumduct the limb;
• Severe pain
• Tenderness to touch.
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16. The clinical features of a fractures described by
Susruta are –
A. marked swelling;
B. tenderness to touch and movements or rotation ;
C. presence of crepitus ;
D. looseness of the parts;
E. different types of pain & no relief of pain in any
postures
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Sign & symptoms of kandabhagna
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17. TYPE OF
PATIENT
FRACTURE BONE
FRACTURE
SEASONAL VARIATION
AGE STATUS OF
SITE OF STATUS OF
PROGNOSIS OF FRACTURES
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18. PRINCIPLES OF MANAGEMENT
There are four basic principles which Susruta has mentioned while treating
a case of skeletal injury.(su.c.3)
They are :-
1. Anchana ( ) Traction
2. Pidana ( ) Manipulation by local pressure
3. Samksepa ( ) Apposition and stabilization
4. Bandhana ( ) Immobilization
These four objects are to be achieved in
every types of fracture or dislocation by
different methods.These methods may very in
an individual case under a particular situation
but the objective remains the sameFracture & Dislocation in Ayurved-Dr
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19. Management……..
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20. Principle of Fixation
Sushruta describe the various modalities of
treatment
Immobilization is an important part in treatment of
fracture.
The barks and clips of several trees were selected to
serve as splints.
The important woods, which commonly chosen and
applied for this purpose, are 1.Madhuka.
2.Udumbera. 3. Aswattha. 4.palasa 5.Kakubha.
6.Vansha.
Fracture & Dislocation in Ayurved-Dr Mahesh Kumar 2015-09-2020

21. Principle of Fixation (S.Ch.3/6)
The aim of splints in Susruta period was
not only to provide an effective
immobilization but also to treat the
injured site by the medicinal properties
of these woods.
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22. 1. The limbs can exactly fit into the inner concave surface of the
barks
2. The outer surface of barks being rigid gives strength to the limb.
3. The inner surface of barks being soft, acts as a cushion to the
limb, there by avoiding any pressure sore from tight splintage.
• KUSHA BANDHANA (Application of P.O.P.cast or splint)
• Kusha bandhana is a technique that ancient Indian surgeons
practiced for fracture immobilization.
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23. Difinition of Ideal Bandhan
(S.,C.3)
•Sushruta emphasize that correct pressure in tying a splint/
bandaging required
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24. Principle of Rehabilitation
su.c.3/35
• The importance of physiotherapy in a limb-injury was also
appreciated by Susruta .
• Exercises starting in small doses which may be gradually
increased at any rate , and exercises should not be
prescribed all at once in the beginning.
• A. lighter objects may be held to begin with, e.g. a mud-ball , and
• B. then a heavier substance like a lump of rock-salt
c. finally still harder objects , e.g. Stones.
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25. Principle of Malunited Fracture
Su.C.3/52
In a case of transverse fracture, when it
has united in a curved position and even
when consolidated , it should be refractured,
set right and treated as an ordinary fracture.
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26. Prevention of Infection
• Primary aimis to no infection at fracture site.
• Avoid contamination and infection.
• Infected fracture bone is difficult job to manage
• Sushruta strongly recommended the adoption of
measures that would avoid suppuration.
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27. Definition of Ideally United Fracture
Sushruta drafts certain criteria of ideally united fracture and gives in
clear terms what a surgeon is to except in a case of ideally healed
fracture.
1. Absence of gap between the broken fragments.
2. Absence of shortening.
3. Absence of deformity.
4. Return of painless and easy movements.
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28. Drugs which can Promote healing (Su.C.3/13)
• Susruta also advised internal drugs
• These provide liberal amount of proteins, fats, calcium
and mineralo-vitamins.
The fractured patient take daily morning
• milk of a primiparous cow processed with ghrita,
• drugs of madhura group and laksa. It shoud be taken
after it is cool.
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29. “The milk of a primiparous cow is particularly rich in
proteins. The fats and other substances added to this
preparation strengthen the bones.”
ASTHIPOORANA (Bone Grafting)
CHAKRAYOGA (Skeletal Traction)
KAPATASHAYANA (Fracture Bed) VIDHI
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30. Nutrition
• Apart from the tonics, Susruta has paid due attention to
elevate the nutritional status of the patient to be taken in
the routine.
• For this purpose he has advocated a liberal use of Sali( )
rice , meat preparation, milk,ghee, pulses and other
elements as are supposed to enhance the process of
Brinhana ( ) that is regenaration of different tissues.
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31. CONCLUSION
• The medicines, formulations, rejuvenators, and dietary
restrictions for the rapid and complete healing of
fractures mentioned in Ancient Ayurveda.
• Orthopaedics in traditional Indian medicine was well
evolved and widely employed with desired results.
• The concepts of ancient orthopaedic principle are true
even in today’s practice.
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32. -Thanks for patience watching…
- Queries and suggestions/comments welcome……..
Thank you
15-09-2020
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Disclaimer - The video lecture is for educational purpose only
धन्यवाद ॥