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Fractures

Dr Ayman Soliman Isamail
Common Outdoor Injury
Management
Objectives







Review mechanisms and patterns of
traumatic injury
Illustrate the types of injury that
occur to the skeleton, soft tissue,
and skeletal support structures
Explain the general principles of
wound care and the emergency
care for musculoskeletal injuries
Mechanism of Injury
Mechanism of Injury
Types of Trauma
Mechanism of Injury
Types of Trauma

 Penetrating

Trauma
 Compression (Blunt)
Trauma
 Bending Trauma
Hyperflexion
Hyperextension
Nail in Index Finger
Mechanism of Injury
Types of Trauma

 Penetrating

Trauma
 Compression (Blunt)
Trauma
 Bending Trauma
Hyperflexion
Hyperextension
Severe Contusion of Foot
Mechanism of Injury
Types of Trauma

 Penetrating

Trauma
 Compression (Blunt)
Trauma
 Bending Trauma
Hyperflexion
Hyperextension
Cervical
(C5-C6)
Fracture
Dislocation
Mechanism of Injury
Types of Trauma

 Penetrating

Trauma
 Compression (Blunt)
Trauma
 Bending Trauma
Hyperflexion
Hyperextension
Dorsal
Dislocation,
Long Finger
Middle Joint
(PIP Joint)
Mechanism of Injury
Types of Trauma

 Rotational

Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acceleration Trauma
Normal
Tibia
Left

Spiral
Fracture
Tibia
Right
Mechanism of Injury
Types of Trauma

 Rotational

Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acceleration Trauma
Dislocation of Right
Shoulder
Mechanism of Injury
Types of Trauma

 Rotational

Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acceleration Trauma
Train Crush Injury, Leg
Mechanism of Injury
Types of Trauma

 Rotational

Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acceleration Trauma
Deceleration Trauma
Mechanism of Injury
Types of Trauma

 Rotational

Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acceleration Trauma
Car struck from behind
“accelerates” passengers,
producing an extension injury
to the neck!
Trauma

Acceleration
Mechanism of Injury
Types of Force
Mechanism of Injury
Types of Force

 Direct

Force
 Indirect Force
 Twisting Force
 High Energy Force
Direct
Mid-Shaft Fracture, Femur
Mechanism of Injury
Types of Force

 Direct

Force
 Indirect Force
 Twisting Force
 High Energy Force
Indirect
Posterior Dislocation,
Elbow
Mechanism of Injury
Types of Force

 Direct

Force
 Indirect Force
 Twisting Force
 High Energy Force
Twisting
Subtalar Dislocation, Ankle
Mechanism of Injury
Types of Force

 Direct

Force
 Indirect Force
 Twisting Force
 High Energy Force
High Energy
Fractured Pelvis
Types of Injury
Types of Injury
Fracture

•

Any break in the continuity
of a bone
•

May vary from a simple
crack to a completely
shattered bone
Fracture Classification
Closed/Open
Incomplete/Complete
Non-Displaced/Displaced
Closed Fracture,
Base of Thumb

Closed
Dorsally
Angulated
Forearm Fracture
Open Fracture, Tibia

Open Fracture, Forearm
Open Fractures Are
More Serious!
 Blood
 Potential

loss

contamination
with risk of infection
Fracture Classification
Closed/Open
Incomplete/Complete
Displaced/Displaced
Incomplete Fracture,
Distal Radius
Complete Fracture, Femur
Fracture Classification
Closed/Open
Incomplete/Complete
Non-Displaced/Displaced
Non-Displaced Fracture,
Distal Tibia and Fibula
Displaced Forearm Fractures
Other Types of Fracture
Comminuted – fractured into
more than two segments
Pathologic – fracture through
diseased bone
Epiphyseal – fracture passes
through the growth plate
Comminuted Femur
Fracture
Other Types of Fracture
Comminuted – fractured into
more than two segments
Pathologic – fracture through
diseased bone
Epiphyseal – fracture passes
through the growth plate
Pathologic

Lytic lesion (darker = tumor)
in proximal phalanx of finger,
with associated transverse
fracture
Other Types of Fracture
Comminuted – fractured into
many pieces
Pathologic – fracture through
diseased bone
Epiphyseal – fracture through
the growth plate
Epiphyseal (growth-line)
Fracture,
Signs of a Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
Seven Signs of Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
Fractured Patella
Seven Signs of Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
Angulated Fracture,
Radius and Ulna
Seven Signs of Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
Crepitus
In a complete fracture, the
sounds of bone ends clicking or
rubbing against each other;
denotes an unstable fracture!
Seven Signs of Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
Open Ankle Fracture
Seven Signs of Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
False Motion
The unusual visual sensation
of observing motion at a long
bone fracture site where
“ there is no joint!”
Seven Signs of Fracture
 Tenderness
 Swelling

and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
Fracture, Right Clavicle
Right Arm Protected
Seven Signs of Fracture
The presence of
any one
of the
seven fracture signs just listed
is sufficient to assess this injury!
Types of Injury
Dislocation





Disruption of a joint such that
the bone ends are no longer in
normal contact
Must have torn ligaments and
joint capsule
Signs of Dislocation
 Tenderness
 Deformity

(usually marked)
 Swelling and Ecchymosis
 Loss of normal joint motion
Common Dislocations
 Shoulder
 Finger
 Hip
 Elbow
Anterior Dislocation, Right
Shoulder
Common Dislocations
 Shoulder
 Finger
 Hip
 Elbow
Dislocation, Middle Joint
(PIP Joint), Ring Finger
Common Dislocations
 Shoulder
 Finger
 Hip
 Elbow
Posterior Hip Dislocation
Common Dislocations
 Shoulder
 Finger
 Hip
 Elbow
Posterior Elbow Dislocation
Types of Injury

Fracture-Dislocation
A combined injury with
joint dislocation and an
adjacent bone fracture
Fracture–Dislocation, Ankle
Types of Injury
Sprain

 Partial

or complete
temporary joint dislocation
 Ligaments are torn
partially or completely
 May produce as much
structural damage as a
dislocation
Sprain, Left Ankle
Assessing
Musculoskeletal Injuries
ABC’s
 Injury History (“What happened?”)
 Palpation of injury site -

“ Take one finger and
show me where it hurts!”
DCAP-BTLS
 D eformities
 C ontusions
 A brasions
 P uncture
 B urns

Wounds

 T enderness
 L acerations
 S welling
Evaluation of Distal
Neurovascular Function
(CMS)

 Pulse

(circulation)
 Motor Function
 Sensation
Radial Pulse
Tibial
Pulse

Posterior
Evaluation of Distal
Neurovascular Function
(CMS)

 Pulse

(circulation)
 Motor Function
 Sensation
Extension
Flexion

Ankle Dorsiflexion

Ankle Plantar
Evaluation of Distal
Neurovascular Function
(CMS)

 Pulse

(circulation)
 Motor Function
 Sensation
Medial and
Foot
Lateral Hand

Medial Foot

Lateral
Principles of
Musculoskeletal Injury
Management

 ABC’s

 Evaluate

distal
neurovascular
function
 Dress all wounds
 Splint all suspected injuries
 Prepare patient for transport
Injury Management
All
open wounds
should be covered with a
dry sterile compression
dressing
Injury Management

Splinting Immobilizes the
Injury and:
 Reduces

Pain
 Facilitates Transport
 Prevents further damage to
blood vessels, nerves and
skin adjacent to the injury
 Decreases Bleeding
Principles of Splinting
Check and record CMS
 Dress all wounds
 Immobilize the joints above and
below a suspected fracture
 With injuries at or near joints,
immobilize the bones above and
below the injury
 Stabilize the injury site during
splint application

Principles of Splinting
Use gentle in-line manual traction
to realign displaced long bone
fractures
 Expect to encounter increased pain
and some resistance when
attempting to realign a deformed
limb
 Immobilize all suspected spinal
injuries in a neutral in-line position
on a spineboard

Total Body
Immobilization
When in doubt:
SPLINT!
Soft Splints
Air Splint
Splint

Sling and Swathe

Vacuum

Blanket Roll
Traction Splint
When standard splints
are unavailable,
improvisation
is better than doing
nothing!
UPPER
EXTREMITY
All fractures can
be immobilized
by securing the
extremity to the
chest!
LOWER EXTREMITY
All fractures can be immobilized by
securing the injured extremity to the
opposite lower extremity!
Gp lecture

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