Fractures and joint injuries can range from simple closed fractures to more complex open or comminuted fractures. The aim of treatment is to save life and restore function. Diagnosis involves history, clinical exam, and imaging like x-rays. Treatment depends on the fracture type but generally involves closed or open reduction and fixation using conservative splinting or surgical methods like plates/screws. Factors like adequate blood supply and immobilization influence healing. Children's fractures have special considerations due to the physis.

2. FRACTURES
AND
JOINT INJURIES

3. AIM OF TREATMENT
SAVE LIFE RESTORE ACTIVITY

4. Definition
Fracture is a break in the
continuity of bone ,
associated with variable
degrees of damage to the
overlying skin and soft
tissues.
 simple ( closed )
 compound ( open )

5. Simple fr Compound fr

6. Simple fr.
Compound fr.

7. Shape of the fracture line
 transverse
 oblique
 spiral
 comminuted
 segmental

8. Transverse fractures

9. Oblique fractures

10. Comminuted fractures

11. Comminuted fractures

12. Segmental fractures

13. Types of Fractures
 Traumatic fr.
 Pathological fr.:
- general causes : senile osteoporosis
endocrinal diseases:
( hyperparathyroidism, Cushing syndrome)
- local causes : inflammation
tumor
bone cyst, fibrous lesion
 Green-stick fr. ( in children )
 Stress fr.

14. Pathological fractures

15. Pathological fractures

16. Green-stick fractures

17. Stress fractures

18. Clinical Picture
♥ Pain and tenderness
♥ Swelling
♥ Bruises, in
subcutaneous bones
♥ Deformity
♥ Loss of function
♥ Crepitus

19. Diagnosis of Fractures
 History
 Clinical picture
 Special investigations :
- X- ray
- C.T.
- M.R.I.

20. X - ray

22. Complications
General AND Local

23. General Complications
 shock : - neurogenic
- oligaemic
 fat embolism
 complications of prolonged recumbency :
- osteoporosis
- pulmonary & U.T. infections
- D.V.T.
- bed sores
- joint stiffness
- psychosis

24. Bed Sore :
early late

25. Local Complications
 vascular injury
 nerve injury :
- neurapraxia
- axonotmesis
- neurotmesis
 visceral injury :
with - fr. pelvis
- fr. ribs

26.  infection : in compound fr.
 Avascular necrosis:
- fr. neck femur
- fr. scaphoid
- fr. talus
 Myositis ossificans
around the joints :
- elbow
- hip

27.  complications of union :
• Mal-union:
[angulation, shortening, rotation]
ttt. : corrective osteotomy + I.F.
• Delayed union
ttt. : further immobilization, then B.G.
• Non-union :(pseudo-arthrosis)
ttt. : I.F. + B.G.

28. Mal-union

29. Non-union

30. Healing of Fractures
Fr. hematoma, invaded by fibroblasts and
osteoblasts from surrounding tissues and
periostium, forms soft woven bone [ callus],
precipitation of calcium salts enhances the
formation of hard lamellae of trabecular
bone.
Remodeling restores the
original contour .

31. Factors influencing fracture healing
♥ Adequate blood supply
♥ Proper immobilization

32. Treatment of Fractures
Reduction
AND
Fixation
F0llowed by
rehabilitation

33. Reduction of Fractures:
♥ closed reduction :
usually U.G.A.
♥ open reduction :
* indications :
- failed closed reduction
- unstable fr.
- intra- articular fr.
* contra- indications : infection

34. Fixation of Fractures
♥ Conservative fixation [ Splintage ] :
- plaster
- traction
♥ Surgical fixation :
A - internal
B - external

35. Conservative Fixation ( Splintage)
♥ Plaster casts :
stable fr. in distal parts of the
limbs .
♥ Skin traction : [ Thomas splint ]
in fr. femur in children
and as a first aid in adults .
♥ Skeletal traction

36. Operative Fixation of Fractures
A- INTERNAL FIXATION :
many types of metallic
implants:
♥ interlocking I.M.N.
♥ plates and screws
♥ stainless-steel wire

37. Interlocking intramedullary nail

38. Plates and Screws :
♥ D.C.P.
dynamic compression
plate

39. ♥ T – plate
♥ Reconstruction plateReconstruction plate
♥ Stainless – steel wireStainless – steel wire

40. B - External Fixation
A number of thick metallic
pins inserted into each
bone fragment , then
connected together by
common rods.
♥excellent in comp., infected fr.
♥Used either as temporarily, or
definitive treatment.

42. Epiphyseal injuries :
epiphysis
metaphysis
diaphysis
physis
- Epiphyseal plate is the weakest
point in the child’s skeleton

43. Bone growth

44. Salter classification
2
3
4

45. Green-stick fractures :

46. The common fractures in children are :
- Fracture clavicle
- Supracondylar fr. humerus

47. Special characters :
- Green – stick fractures are common
- Healing is much faster than in adults
- Remodeling is much more pronounced
- Epiphyseal injuries are common