Non operative management of fractures by Dr_KF Conservative management of fractures Young orthopedic surgeon MRH,KANDAHAR,AFGHANISTAN

2. Prepared by: Dr.Sayed Abdul Qahir
PGR2, Orthopedic surgery
MRH, Kandahar, Afghanistan
Supervisor: Dr. Niamatullah shehzad
Trainer specialist, Orthopedic surgery
MRH, Kandahar, Afghanistan

3. 1. Fracture and it’s types

4. Definition(2)
 A fracture is a break in the structural continuity of bone
 Fractures result from:
(1) injury (sudden force)
(2) repetitive stress
(3) abnormal weakening of the bone (a pathological fracture).
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5. Types(1,2)
 According to overlying skin: simple and compound
 Based on appearance: Complete and non-complete
 Based on fracture patterns: Linear fractures (transverse, oblique or spiral),
Comminuted fractures, Segmental fractures and Bone loss
 Muller classification (humerus=1, forearm=2, femur=3, leg=4),(proximal=1, shaft=2,
distal=3),(simple/extra articular=A, wedge/partial art.=B, Complex/complete art.=C)
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6. 2. Clinical and radiological
evaluation

7. Clinical evaluation(3)
Look, Feel and Move
 Look:
Scars/Swelling/skin color/Wound/Deformity
 Feel:
Temperature/Tenderness
 Move:
proximal and distal joint movements (active &
passive ) and ROM
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8. Radiological evaluation(3)
 X-ray:
= Rule of 2 (views, joints, limbs, injuries,
occasions)
= define the type and displacement
- translation, angulation, rotation,
shortening
= check the number of fragments
= check the joint involvement
 CT scan(usually beneficial for the selection of
treatment and type of surgery)
 MRI
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9. Aim of treatment(3)
 To restore the length and axis of the
limb
 To restore the function of the limb
Aim of immobilization:
 To decrease the pain
 To prevent the secondary injuries
 Transportation
 Prevention of complication and further
harming of the patient
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10. 3.Healing of fractures

11. Healing of fractures(2,3)
 Fractures heal by three methods
1. Destructive(ilizarove)
2. Direct:
The fracture site is bridged by direct
haversian remodeling which is almost a
direct osteon-to-osteon hook-up
3. Indirect(callus formation):
(Tissue destruction and hematoma
formation, Inflammation and cellular
proliferation, soft callus, hard callus,
Remodeling)
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12. 4. Conservative management

13. The principles of conservative
management(3)
 4 Rs
1. Recognize the fracture
2. Reduce the fracture
3. Maintain the reduction
4. Rehabilitation
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14. Closed reduction(2)
 Reduction means the restoration of
normal anatomical alignment of
fragments of fracture
 This procedure should be done under
GA
 the fracture is reduced by a three-fold
maneuver
1. traction
2. Disimpaction
3. Pressing fragment into reduced
position
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15. Maintenance of reduction(2)
 The maintenance of reduction is done
by immobilization with
- casting (full or partial)(POP, dyna)
- traction(manual, skin, skeletal)
- bracing
- internal/external fixation
 Fractures must be immobilized till the
union is complete
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16. Traction(2)
 Some fractures of extremities like
fracture of the shaft of the femur need
continuous traction to maintain the
reduction and to immobilize the
fragments
 This is particularly useful for shaft
fractures that are oblique or spiral and
easily displaced by muscle
contraction.
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17. Types of traction(2)
 Traction by gravity – This applies only to upper limb injuries. Thus, with a wrist sling the
weight of the arm provides continuous traction to the humerus..
 Skin traction –(no more than 4 or 5 kg).
 Skeletal traction – A stiff wire or pin is inserted(1kg per 10kg weight).
 In skin or skeletal traction, the fracture is reduced and held in one of three ways: fixed
traction, balanced traction or a combination of the two.
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18. 18

19. Functional brace(2)
 Functional bracing, using either plaster
of Paris or one of the lighter
thermoplastic materials, is one way of
preventing joint stiffness while still
permitting fracture splintage and
loading.
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20. 5. Complications

21. Complications of casting(2)
 Tight cast
 Pressure sores: Even a well-fitting cast may press upon the skin over a bony
prominence (the patella, heel, elbow or head of the ulna).
 Skin abrasion or laceration: This is really a complication of removing plasters
 Loose cast: Once the swelling has subsided, the cast may no longer hold the
fracture securely.
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22. Complications of fractures(3)
Immediate:
 Shock, nerve/vessels injuries
Delayed: (few days up to few weeks)
 Infection, fat embolism, volkmann’s
ischemia
Late:
 Malunion, Non union, delayed union,
joint stiffness, post traumatic
osteoarthritis, late nerve palsy, AVN,
Infection
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23. Causes of developing
Complications(3)
 Local factors:
compound fractures
comminuted fractures
velocity of injury
disruption of blood supply to bone
 Systemic factors:
Age, Hormonal factors, Diabetes, Anemia
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24. 6. References
 1.Campbell Operative Orthopedics, Frederick Azar, 13th edition
 2.Apley’s system of orthopedics and fractures, 9th edition
 3.John Ebnezar Textbook of Orthopedics,4th edition
 4.Miller’s review of orthopedics
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25. 25
The prophet S.A.W said
There is no disease that
Almighty Allah has created,
except that he also has
created its treatment
Sahih Bukhari