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FRACTURE PPT.pptx
This document discusses the classification of fractures in veterinary medicine. It defines a fracture as a break in bone continuity and classifies fractures based on several factors, such as simplicity, completeness, location, displacement of fragments, soft tissue involvement, and bone affected. Common types of fractures described include simple, compound, incomplete, complete, avulsion, complicated, greenstick, and comminuted fractures. Diagnosis involves clinical examination findings as well as radiography, bone scans, CT, micro CT, and MRI. Classification systems provide a standardized way to describe fractures aiding in prognosis and treatment planning.
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FRACTURE PPT.pptx
- 1. INDIAN VETERINARY RESEARCHINSTITUTE, IZATNAGAR CLASSIFICATION OF FRACTURE FRACTURE HEALING Dr Rekha Pathak and Prarthana R Division of Veterinary Surgery & Radiology IVRI
- 2. FRACTURE • Defination : •Break in the continuity of bone with or without displacement of fragment • The type of fracture and degree of soft tissue involvement mainly depend on : • Cause of fracture • Bone involvement • The site of fracture • Temperament of animal • The time that lapsed between the infliction of the injury and treatment given
- 3. • ETIOLOGY 1) Directcause I. Intrinsic causes II. Extrinsic causes 2) Indirect cause
- 4. DIRECT CAUSE • INTRINSICCAUSE: • These are related to either violent muscle contractions and local or systemic disease • Muscular contraction : 1. Violent contraction of muscle cause avulsion fracture 2. Avulsion fracture : eg – Acromion ,greater humeral tubercle , olecranon, Ischial tuberosity, trochanter major, cranial tibia tuberosity and calcaneous bone.
- 5. • EXTRINSIC CAUSE: • These causes are mainly related to various types of trauma and the forces that may act on a bone 1. Direct violence : Trauma is the most common cause of fracture – automobile injury , falling from a height 2. Indirect violence : Indirect trauma because of bending , torsional , compression and shearing force transmitted to a weak point within the bone – running , jumping or falling of an animal
- 6. INDIRECT CAUSE 1. Fracturecommon in – superficial position - Shape - Osseous structure 2. Smooth road and slippery floor 3. Disease condition of bone 4. Old age
- 7. CLASSIFICATION OF FRACTURE •Simple • Compound • Complicated • Incomplete • Complete • Avulsion
- 8. SIMPLE FRACTURE • Doesnot communicate outside • no wound on skin
- 9. COMPOUND FRACTURE • Communicatewith open wound on skin
- 10. INCOMPLETE FRACTURE • Doesnot extend through complete thickness of bone 1. Green stick 2. Partial or Splintered 3. Fissured 4. Deferred
- 11. Green stick fracture •It is characterized by partial loss of continuity and displacement is minimal • Part of the bone remain intact • Green stick fracture • Bone is partially broken like bent green stick • Young animals
- 12. FISSURED FRACTURE • Fissure(crack) extending through the bone without causing any displacement of the fragments • Undisplaced fragments which may displace at operation or under stress • Longitudinal, transverse or oblique
- 13. DEFFERED FRACTURE • Separationof fragments occur only after a varying period after the incident • Violence, strain or concussion
- 14. COMPLETE FRACTURE • Boneis broken completely through its thickness • Single • Double • Multiple
- 15. a)Single b)Double c)Communited
- 16. AVULSION FRACTURE • Tearingof bony prominance (tuberosity) by forcible pull of its tendinous or muscular attachments
- 18. COMPLICATED FRACTURE • Aclosed fracture in which there is considerable injury to important neighboring vessels ,nerves or joint involvement • Accompanied by the opening of a joint or visceral cavity • Example : Complicated fracture of rib
- 19. Others • Based onportion of bone involved- 1. Diphysary 2. Epiphysary 3. Supracondylar 4. Condylar 5. Transcondylar 6. Intercondylar 7. Articular
- 20. • Articular fracture •Fracture involving subchondral bone & articular cartilage • Extra articular • Not involving the joint surface
- 21. • Based ondirecion of Fracture 1. Transverse 2. Longitudinal 3. Oblique 4. Spiral
- 22. • 1)Transverse fracture •The fracture line is at right angle to the long axis of bone • Most caused by bending force
- 23. • 2)Oblique fracture •The line of the fracture is diagonal to the long axis of bone • Caused by bending with axial compression
- 24. • 3)Spiral fracture •The fracture line is spiral along the long axis of bone • caused by torsional twisting or rotational force
- 25. • 4)Comminuted fracture •It comprises of at least three fracture lines and all of them meet at a common point • Caused by high energy trauma
- 26. • 6)Avulsion fracture/ apophyseal •A fragment of bone at the site of muscle insertion is detached due to its forceful contraction • Pulled by tendon or ligament
- 27. Correction of Avulsionfracture
- 29. • Depending onrelationship between fragments 1. Impacted 2. Distracted 3. Depressed 4. Over-riding 5. Compression
- 30. IMPACTED FRACTURE • Oneend of broken bone is driven into other end or one bone is driven into the fracture site of another • Union is rapid but bone is shortened
- 31. DISTRACTED FRACTURE • Afracture resulting in increased overall bone length,is due distraction of bone component
- 32. DEPRESSED FRACTURE • Thefragments are displaced and produce a cavity • Especially part of the skull
- 33.
- 34. According to stabilityof fractured fragment • Charnley classification • Used to determine which fracture would respond to closed reduction and reduction 1. Stable Fracture 2. Unstable Fracture
- 35. • 1) Stableafter fracture : • The fragments more or less interlock after reduction • Maintain the approximate length of the segment • Eg – simple fracture ; fractured pieces of bone are well aligned and stable
- 36. • 2)Unstable fracture: • Fracture in which fragments of the broken bone are • misaligned & displaced • The fracture fragments are unstable after reduction • Fracture collapse as soon as reducing force is removed
- 37. Epiphyseal fracture orgrowth plate fracture • The most commonly used is the Salter- Harris system (salter & Harris, 1963 ) • Fracture of epiphysis occurs in mature animal after closure of the epiphyseal plate
- 38. • Type 1 •Complete , through the hypertrophied cartilage cell zone • Type 2 • Partially includes the metaphysis • Type 3 • Intra articular fracture to the hypertrophied zone and then along the epiphyseal plate to the edge Salter - Harris type I
- 39. • Type 4 •Intra articular fracture that traverses the epiphysis , epiphyseal plate and metaphysis • Type 5 • Crushing injury that causes destruction of growing cells • Type 6 • New bone bridges the growth plate Salter- Harris type III fracture
- 40. SPECIAL JOINT FRACTURE •Certain specific fractures have been classified to aid prognosis and treatment(importance in the racing Greyhound) • Accessory carpal bone • Type 1 – • Intra articular avulsion of the distal margin • Type 2 – • Intra articular fracture of the proximal margin
- 41. Type 3 – •Extra articular avulsion of the • distal margin
- 42. • Type 4– • Extra articular avulsion of the insertion of flexor carpi ulnaris at proximal palmer surface • Type 5 – Comminuted fracture of the body which may involve the articular surface
- 43. • Central tarsalbone • Type 1 – • Small dorsal stab fracture with minimal displacement • Type 2 – • Dorsal stab fracture with displacement • Type 3 – • One third to half of the bone fractured in the median plane and displaced medially or dorsally
- 44. • Type 4– • Combination of types 2 & 3 • Type 5 – • Sever comminution • Various combintions of fractures of the tarsus have been described as Triads ( Newton and Nunamaker)
- 45. • A systemfor classification of the soft tissue injury ( muller et al. 1992) • System is developed for humans • System may be too complicated for animals – can be used with little variation
- 46. • Integument closed(IC) • IC1 No injury • IC2 No laceration but contusion • IC3 Circumscribed degloving • IC4 Extensive closed degloving • IC5 Necropsis from contusion • Integument open (IO) • IO1 Skin breakage from inside out • IO2 Skin breakage from outside in > 5cm,devitalized edges • IO3 Skin breakage from outside in < 5cm, devitalised edges, • circumscribed degloving • IO4 Full thickness contusion, abrasion, skin loss • IO5 Extensive degloving
- 47. • Muscle tendon(MT) • MT1 No injury • MT 2 Circumscribed injury, one muscle group only • MT3 Extensive injury, two or more muscle groups • MT4 Avulsion or loss of entire muscle groups, • tendon laceration • MT5 Compartment syndrome/ crush syndrome • Neurovascular (NV) • NV1 No injury • NV2 Isolated nerve injury • NV3 Localized vascular injury • NV 4 Combined neurovascular injury • NV5 Subtotal / total amputation
- 48. • General classificationof fractures was developed by by Muller and others of the AO / ASIF group for human fractures . • System using alphanumeric classifications combined with electronically stored X- ray images • AO - Arbeitsgemeinschaftn fur Osteosynthesefragen • ASIF - Association for the study of internal fixation • This has been modified to use in small animals and horse Two systems for small animals • 1) Prieur ( Prier et al., 1990) • 2) Unger (unger et al., 1990)
- 49. • These fracturesdescribes the bone , the location and the type of fracture • Each of the proposed system creates a 4 digit record in a similar wat to the human AO system • The Prieur & Unger fracture classification system used only for long bones . • Not involving the skull , vertebral coloumn , pelvis or small limb bones. • Doesn’t involve soft tissue problems
- 50. • The prieursystem • This is simplest system – slightly less information • Digits are allocated under each fields • (Bone ; location ; fracture area ; fragment number ) • The location Zones of each bone are determined by drawing a square around the ends , of length and width equal to the widest dimension of the bone end
- 51. Field Number •Bone Humerus1 Radius & Ulna 2 Femur 3 Tibia 4 •Location Proximal segment 1 Middle segment 2 Distal Segment 3 •Fracture area( % of bone length ) < 5% (& or not involving articular cartilage) 1 5–25%(Specific fractures of femur neck) 2 > 25%(&/or involving articular surfaces) 3 •Number of fragments Two 2
- 52.
- 53. • The ungersystem • Simliar to Prieur system - Records more data by attempting to identify reducible or non reducible wedges or the direction of the fracture line. • Charts of both letters and numbers for each bone and codes allocated for various fractures
- 54. Clinical Signs • Pain •Dysfunction • Local trauma • Abnormal posture • Crepitus
- 55. Diagnosis • Based onhistory and clinical examination- Pain, Dysfunction , Local trauma , Abnormal posture,Crepitus • Radiography • Bone scan • Computed tomography scan(CT) • Micro CT • Magnetic resonance imaging (MRI) • Positron emission tomography(PET)
- 56. Treatment option foropen fracture K wire Intramedullary pin Interlocking nail Orthopedic wire Screw & plate Plate rod
- 57. FRACTURE HEALING • Indirectbone healing - callus formation present • Direct bone healing- without callus formation • Others- • Intramembranous bone healing- (Mesenchyme---- Osteoblast) • Trabecular bone healing • Physeal bone healing
- 58. STAGES OF HEALINGOF FRACTURE • Formation of hematoma ( within 24 hours) • Formation of soft callus (10-21 days) • Formation of primary bone callus (21 days -6 weeks) • Formation of secondary bone callus (6-8 weeks)
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