FRACTURES FOR HOMOEOPATHIC STUDIENTS SURGERY

1. FRACTURE

2. FRACTURE DEFINITION:
A fracture is a
break in
continuity of a
bone. A
comminuted
fracture is one
with more than
two fragments.

3. SECURING THE STABILITY
Reduction :
The fracture will
re - displace if not
held in some way.
If the periosteum
is intact on one
side, this may be
used to help
secure stabilIty.

4. DISPLACEMENT
Displacement may
mean shortening,
rotation,
sideways shift or tilt,
and reduction of the
fracture
will usually involve
reversing these
various
displacements.

5. DISLOCATION
A dislocation is a
complete loss of
congruity of the
joint surfaces.

6. SUBLUXATION
A subluxation is
a partial loss of
contact of the
joint surfaces.
Either may be
associated with
a fracture and
may, of course,
be an open
injury.

7. INTRA -ARTICULAR
FRACTURE
An intra - articular
fracture is one in
which the
fracture involves the
joint surface.
Usually these
fractures require
operative anatomical
reduction if
there is displacement.

8. EPIPHYSEAL INJURY
Epiphyseal
injuries occur in
children.
In certain
circumstances
they may
interfere with
growth.

9. EPIPHYSEAL INJURY
The fracture line normally
runs through the calcifying
layer of the epiphysis on
the side away from the
germinal layer.

10. SALTER AND HARRIS
CLASSIFI CATION
Salter and
Harris
classification
is usually
used for
these
injuries.

11. Type I
The fracture line
passes cleanly along
the epiphyseal line
with no metaphyseal
fragment. This type
tends to occur in
young children or
babies and in
pathological
conditions such as
spina bifi da or
scurvy

12. Type II
The commonest
type, in which
the fracture line
runs across the
epiphyseal line
and then
obliquely,
shearing off a
small triangle of
metaphysis

13. Type III
The epiphysis
may be split
vertically and a
fragment
displaced
along the
epiphyseal line

14. Type IV
The fracture
extends through
the epiphyseal line
from the
metaphysis into
the epiphysis.
This type
may interfere with
growth because
union may take
place across the
growth plate

15. Type V
Severe crushing
of the epiphysis
may occur from
longitudinal
compression and
this is very likely
to
result in growth
arrest and
deformity

16. SALTER AND HARRIS
CLASSIFI CATION
The first three types
have a good
prognosis and are
usually easy to
reduce, provided
they are treated
early by
manipulation.

17. SALTER AND HARRIS
CLASSIFI CATION
The third type tends to
occur in older
children and
adolescents and,
since it is intra -
articular, may require
open reduction and
pinning in position.

18. Diagnosing fractures

19. History
Is essential in order
to assess the
mechanism of
injury and to raise
suspicion of other,
less apparent,
injuries.

20. If the violence has been minimal and
hardly sufficient to have caused
a fracture, then this may arouse a
suspicion
that the fractured bone has been
weakened by
disease or previous damage - called
pathological
fracture.

21. Pain.
This is the commonest
symptom, but
varies with the site and
instability of the fracture.
Individuals also vary greatly
in their response to
pain.

22. Loss of function.
There is almost always
some
impairment of function in
the injured area, so that
the patient may be unable
to move the limb at all,
or may use it with diffi
culty.

23. Some degree of function
may be retained.
Following a femoral neck
fracture, for example, the
patient may manage to
walk, but always limps
and there is always some
functional impairment.

24. Loss of sensation or motor power.
This is a
particularly important
symptom, suggesting nerve
or vascular complications. The
time of injury
should be ascertained as
accurately as possible,
especially with an open
fracture or where there are
signs of ischaemia.

25. Physical signs

26. Tenderness
Tenderness is almost
invariable with a recent
fracture, assuming the
patient is conscious. Its
exact distribution should
be determined.

27. Deformity
Deformity may or may not
be evident. The limb
may be bent or
shortened, or there may
be a step in
the alignment of the bone
or joint.

28. Swelling
Swelling is usual
when the fracture is
fairly
superfi cial; gross
swelling usually
implies a vascular
rupture.

29. Swelling
Swelling takes some time
to appear and
may increase over the
first 12 – 24 hours. It is
sometimes associated
with blistering of the skin.

30. Swelling
Swelling is partly due to
haematoma, partly due to
infl ammatory exudation.
There may be obvious
bruising.
A joint which is fractured may
fill with
blood haemarthrosis .

31. Local temperature
Local temperature
increase is essentially part
of the inflammatory
response which rapidly
follows the injury and may
be evident even if the
damage is confined to the
soft tissues.

32. Abnormal mobility or crepitus
Abnormal mobility or
crepitus , i.e. grating of
the fracture ends, may
be noticed.
Vigorous
attempts to elicit it
should be avoided

33. Loss of function
Loss of function is almost
always found to some
extent.
The patient usually has
difficulty in moving
the adjacent joints.

34. Having diagnosed a fracture or joint
injury, the
presence and extent of any wound
should be
noted, and the area examined for
evidence of
ischaemia and nerve or other
important soft – tissue damage.
This is essential routine in
examining
any injury of the musculoskeletal
system.

35. Radiological
Examination

36. The X - ray examination is
designed to give
information additional to
that obtained by clinical
Judgment.
X - rays in at least two
planes, usually at right
angles, are essential.
A fracture may be missed
if only one film is taken.