Fractures are breaks in the continuity of bone that are usually caused by trauma. They are described and classified based on their type, communication with the external environment, and anatomic location. The goals of treatment are to realign bone fragments through reduction, immobilize the bones to maintain alignment through fixation methods like casting, and restore normal function. Complications can include infection, compartment syndrome, venous thrombosis, fat embolism syndrome, malunion, non-union, osteomyelitis, avascular necrosis, and shortening.

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. CastsCasts
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