fractures general considerations

1. Fractures: General Considerations
G.S.Patnaik
MS(Orth), FAOI(USA),PhD
www.drgspatnaik.com

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

5. Description
 Described and classified according to:
Type
Communication or noncommunication
with external environment
Anatomic location

6. Description
 Described and classified according to:
Type
Communication or noncommunication
with external environment
Anatomic location

7. Types of Fractures
Fig. 61-4

8. Classification by Communication with
External Environment

9. Classification by Fracture Location

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

11. Description
 Closed (also called simple)
 Open (also called compound)

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

13. Description
 Unstable fractures
Grossly displaced
Poor fixation

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

15. Fracture Healing
 Reparative process of self-healing (union)
occurs in the following stages:
1. Fracture hematoma (d/t bleeding, edema)
2. Granulation tissue → osteoid (3 – 14 days
post injury)
3. Callus formation (minerals deposited in osteoid)

16. Fracture Healing
 Reparative process of self-healing (union)
occurs in the following stages:
4. Ossification (3 wks – 6 mos)
5. Consolidation (distance between fragments
decreases → closes).
6. Remodeling (union completed; remodels to
original shape, strength)

17. Bone Healing

18. Collaborative Care
 Overall goals of treatment:
Anatomic realignment of bone fragments
(reduction)
Immobilization to maintain alignment
(fixation)
Restoration of normal function

19. Collaborative Care
Fracture Reduction
 Closed reduction
Nonsurgical, manual realignment
 Open reduction
Correction of bone alignment through a
surgical incision

20. Collaborative Care
Fracture Reduction
 Traction (with simultaneous counter-traction)
Application of pulling force to attain
realignment
Skin traction (short-term: 48-72 hrs)
Skeletal traction (longer periods)

21. Collaborative Care
Fracture Immobilization
 Casts
Temporary circumferential immobilization
device
Common following closed reduction

22. Casts
Fig. 61-9

23. Collaborative Care
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

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

26. Collaborative Care
Fracture Immobilization
 Purpose of traction:
Prevent or reduce muscle spasm
Immobilization
Reduction
Treat a pathologic condition

27. Complications of Fractures
Infection
 Open fractures and soft tissue injuries have 
incidence
 Osteomyelitis can become chronic

28. Complications of Fractures
Infection
 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 extemities

34. Complications of Fractures
Compartment Syndrome
 Clinical Manifestations
Absence of peripheral pulse = ominous late
sign
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

38. Complications of Fractures
Venous Thrombosis
 Precipitating factors:
Venous stasis caused by incorrectly applied
casts or traction
Local pressure on a vein
Immobility
 Prevent with anticoagulant medications

39. Complications of Fractures
Fat Embolism Syndrome (FES)
 Characterized by the presence of fat globules in
tissues and organs after a traumatic skeletal
injury

40. Complications of Fractures
Fat Embolism Syndrome (FES)
 Fractures that most often cause FES:
Long bones
Ribs
Tibia
Pelvis

41. Complications of Fractures
Fat Embolism Syndrome (FES)
 Clinical Manifestations
Usually occur 24-48 hours after injury
Interstitial pneumonitis
Produce symptoms of ARDS

42. Complications of Fractures
Fat Embolism Syndrome (FES)
 Clinical Manifestations
Symptoms of ARDS:
Chest pain
Tachypnea
Cyanosis
 PaO2

43. Complications of Fractures
Fat Embolism Syndrome (FES)
 Clinical Manifestations
Symptoms of ARDS:
Dyspnea
Apprehension
Tachycardia

44. 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

45. 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

46. Complications......
Malunion
Non Union
Osteomyelitis
Avascular Necrosis
Shortening

47. THANKS