1. Bone is composed of cortical and cancellous bone, with cells including osteoblasts, osteoclasts, and osteoprogenitors. Bone remodeling occurs through the actions of osteoblasts and osteoclasts. 2. There are two types of bone formation: endochondral ossification and intramembranous ossification. Fractures can be classified based on location, displacement, and whether the skin is broken (open vs closed fracture). 3. Fracture healing consists of hematoma, proliferation, callus formation, and remodeling phases. Treatment depends on fracture type and may include splinting, casting, traction, closed or open reduction, and internal or external fixation. Management of

1. ORTHOPAEDIC TRAUMA :ORTHOPAEDIC TRAUMA :
FROM BASIC TO CLINICFROM BASIC TO CLINIC

2. BONE HISTOLOGYBONE HISTOLOGY
a/. Cortical bone : 80% of skeletal systema/. Cortical bone : 80% of skeletal system
b/. Cancellous bone : less compactb/. Cancellous bone : less compact
Cells : - OsteoblastCells : - Osteoblast
- Osteocyst- Osteocyst
- Osteoclast- Osteoclast
- Osteoprogenator- Osteoprogenator
Matrix : - 40% organicMatrix : - 40% organic
- 60% inorganic (mineral)- 60% inorganic (mineral)

3. CORTICAL BONE DETAILCORTICAL BONE DETAIL

4. BONE REMODELINGBONE REMODELING
Osteoblast from new BoneOsteoblast from new Bone
Bone resorbed byBone resorbed by
osteoclasticosteoclastic
Osteoblast becomeOsteoblast become
incorporate into boneincorporate into bone
as osteocytesas osteocytes

5. MATRIXMATRIX
Organic ComponentOrganic Component
CollagenCollagen
ProteoglycanProteoglycan
Matrix proteinMatrix protein
Calcium hydroxyapatiteCalcium hydroxyapatite
Calcium phosphateCalcium phosphate

6. Bone is formed in two waysBone is formed in two ways
a/. By endochondral ossificationa/. By endochondral ossification
b/. By intra membrane ossificationb/. By intra membrane ossification

7. Growth and Ossification of Long Bones (humerus, midfrontal sections)Growth and Ossification of Long Bones (humerus, midfrontal sections)

8. Zonal structure and pathologic defects of cellular metabolismZonal structure and pathologic defects of cellular metabolism

9. INTRA MEMBRANS OSSIFICATIONINTRA MEMBRANS OSSIFICATION
➣➣ Without a cartilage modelWithout a cartilage model
➣➣ Undifferentiated mesenchymalUndifferentiated mesenchymal
cell aggregate into layer (or membrane)cell aggregate into layer (or membrane)
➣➣ This cell differentiated into osteoblastThis cell differentiated into osteoblast
and deposit organic matrixand deposit organic matrix
➣➣ Examples of intramembranes bone formationExamples of intramembranes bone formation
pelvis, clavicula and skullpelvis, clavicula and skull

10. ➣➣ Proliferasi zone is weakest pointProliferasi zone is weakest point
by traumaby trauma  epiphysiolysis occurepiphysiolysis occur
➣➣ Classification on radiology dividedClassification on radiology divided
in 5 type by Salter Harrisin 5 type by Salter Harris

11. Salter-Harris Classification of injuriesSalter-Harris Classification of injuries

12. Distal FemoralDistal Femoral
Salter-Harris IIISalter-Harris III
FractureFracture
Distal Femoral Physeal FractureDistal Femoral Physeal Fracture

13. FRACTURE HEALINGFRACTURE HEALING
Consists several phasesConsists several phases
- Phase of Hematom- Phase of Hematom
- Phase of Proliferation- Phase of Proliferation
- Phase of Callus formation- Phase of Callus formation
- Phase of Remodeling- Phase of Remodeling

14. Fracture HealingFracture Healing

15. Fracture RepairFracture Repair
Fracture Repair : a). Fractures; b). Union; c). Consolidation;Fracture Repair : a). Fractures; b). Union; c). Consolidation;
d). Bone remodelingd). Bone remodeling
The fracture must be protected until consolidatedThe fracture must be protected until consolidated

16. The stages of fracture healing in cortical boneThe stages of fracture healing in cortical bone

17. DEFINITION FRACTURE –DEFINITION FRACTURE –
DISCONTINUITY OF BONEDISCONTINUITY OF BONE
Classification fracture line :Classification fracture line :
- Complete- Complete
- Incomplete- Incomplete
Incomplete usually happen in childrenIncomplete usually happen in children
- Periosteum in children- Periosteum in children
- More thickness and strength than adult- More thickness and strength than adult
On radiologyOn radiology  manifestation likemanifestation like
greenstick fracture, torus fracture,greenstick fracture, torus fracture,
hairline fracturehairline fracture

18. Greenstick FractureGreenstick Fracture
of the radius and ulnaof the radius and ulna
in a childin a child

19. Buckle Fracture in the metaphysisBuckle Fracture in the metaphysis

20. Hairline FractureHairline Fracture

21. Incomplete FracturesIncomplete Fractures

22. ➣➣ In adult fracture lineIn adult fracture line
complete fracturecomplete fracture
➣➣ Trauma in adult produce fracture lineTrauma in adult produce fracture line
such as transverse, oblique, spiralsuch as transverse, oblique, spiral
comminution or segmentalcomminution or segmental

23. Transverse FractureTransverse Fracture Oblique FractureOblique Fracture

24. Spiral Fracture
of the femoral shaft

25. Comminuted FracturesComminuted Fractures

26. Complete FracturesComplete Fractures

27. ➣➣ Direct or indirectDirect or indirect
➣➣ Low or Height energyLow or Height energy
According of mechanism of injuryAccording of mechanism of injury

28. A Direct blow causes a transverse fractureA Direct blow causes a transverse fracture

29. An IndirectAn Indirect : Twisting force causes a spiral fracture: Twisting force causes a spiral fracture

30. Bone Fragment Displacement :Bone Fragment Displacement :
Apposition : Sifted side way back wardApposition : Sifted side way back ward
or to ward in relationor to ward in relation
Alignment : AngulatedAlignment : Angulated
Rotational : TwistRotational : Twist
Length : - DistractedLength : - Distracted
- Contracted- Contracted

31. Fracture DisplacementsFracture Displacements

32. Dislocation of the HipDislocation of the Hip

33. The open-book InjuryThe open-book Injury

34. Unilateral Injury

35. Unilateral Unstable FractureUnilateral Unstable Fracture

36. Fracture Classification :Fracture Classification :
- Closed- Closed
- Open- Open
Closed : - No wound around the fracture areaClosed : - No wound around the fracture area
Open : - Any wound around the fracture areaOpen : - Any wound around the fracture area

37. Open Fracture classified by GustilloOpen Fracture classified by Gustillo
In 3 grades :In 3 grades :
rade Irade I : Wound 1 cm or less clean, fracture line transversa: Wound 1 cm or less clean, fracture line transversal
or obliqueor oblique
rade II : Wound > 1 cm lacerate, fracture line transversalrade II : Wound > 1 cm lacerate, fracture line transversal
short oblique, minimal comminutiveshort oblique, minimal comminutive
rade III : Extensive soft tissue damage of muscle or skinrade III : Extensive soft tissue damage of muscle or skin
IIIA : Extensive soft tissue damage laceration adequateIIIA : Extensive soft tissue damage laceration adequate
bone coverage, segmental fracturebone coverage, segmental fracture
IIIB : Extensive soft tissue injury with poriosteal stripingIIIB : Extensive soft tissue injury with poriosteal striping
bone expose – associated with invasive comminutivebone expose – associated with invasive comminutive
IIIC : Vascular injury requiring repairIIIC : Vascular injury requiring repair

38. Clinical DiagnosisClinical Diagnosis
History :History : - Chief complaint- Chief complaint
- Pain, Swelling, Breathing- Pain, Swelling, Breathing
- Mechanism- Mechanism
- System associated injury- System associated injury
- Abdominal- Abdominal
- Urology- Urology
- Thoraks- Thoraks
- Brain- Brain
- GCS- GCS

39. General SignGeneral Sign ::
- Shock, Haemorrhage- Shock, Haemorrhage
- Damage brain- Damage brain
- Predisposition cause- Predisposition cause
Local Sign :Local Sign :
- Look : Swelling, deformity, wound- Look : Swelling, deformity, wound
- Feel- Feel : Tenderness, sensation, pulse: Tenderness, sensation, pulse
- Move : Abnormal movement- Move : Abnormal movement
- Measurement : - apparent length- Measurement : - apparent length
- True length- True length

40. Investigation :Investigation :
LaboratoryLaboratory ::
- Hemoglobin- Hemoglobin
- Hematocrit- Hematocrit
- Bleeding time- Bleeding time
- Clothing time- Clothing time
- Thrombocyte- Thrombocyte
RadiologyRadiology ::
- Plain photo : - AP / Lateral / Oblique- Plain photo : - AP / Lateral / Oblique
- AP / Outlet / Inlet- AP / Outlet / Inlet
- AP / Obutarator / Allow- AP / Obutarator / Allow
- CT-Scan- CT-Scan
- MRI- MRI

41. Polytrauma management should followPolytrauma management should follow
Advanced Trauma Life Support (ATLS) Protocol :Advanced Trauma Life Support (ATLS) Protocol :
Primary survey – evaluationPrimary survey – evaluation
➣➣ AirwayAirway
➣➣ BreathingBreathing
➣➣ CirculationCirculation

42. Management Polytrauma need a team :Management Polytrauma need a team :
(specially to treat multi trauma involving multi organ) :(specially to treat multi trauma involving multi organ) :
➣➣ Orthopaedic SurgeonOrthopaedic Surgeon
➣➣ Digestive SurgeonDigestive Surgeon
➣➣ UrologistUrologist
➣➣ Neuro SurgeonNeuro Surgeon
➣➣ Plastic SurgeonPlastic Surgeon
➣➣ Vascular SurgeonVascular Surgeon
➣➣ GynecologistGynecologist

43. Principle treatment in closed fracturePrinciple treatment in closed fracture
➣➣ SupportSupport : - Sling: - Sling
- 8 type bandage (ransel)- 8 type bandage (ransel)
- Crutch- Crutch
➣➣ Immobilization with splint or tractionImmobilization with splint or traction
(to treat undisplaced fracture, fracture femur)(to treat undisplaced fracture, fracture femur)
➣➣ Closed reposition and immobilization :Closed reposition and immobilization :
to treat : - Fracture dislocationto treat : - Fracture dislocation
- Joint dislocation- Joint dislocation

44. Simple sling for an upper limb injury and CrutchesSimple sling for an upper limb injury and Crutches
with non-weightbearing on an injured lower limbwith non-weightbearing on an injured lower limb

45. Immobilization by external splinting (without reduction)Immobilization by external splinting (without reduction)
Plaster-of-Paris casts of varying designPlaster-of-Paris casts of varying design

46. Closed reduction of a fracture by manipulationClosed reduction of a fracture by manipulation

47. Indication open reductionIndication open reduction
and internal fixationand internal fixation
1). Fracture cannot reduce1). Fracture cannot reduce
2). Unstable fracture2). Unstable fracture
3). Fractures can not unite3). Fractures can not unite
(column femur)(column femur)
4). Pathology fracture4). Pathology fracture
5). Multiple fracture5). Multiple fracture

48. Fractures that are bestFractures that are best
treated by open reductiontreated by open reduction
and internal fixationand internal fixation

49. Metallic devices usedMetallic devices used
for internal fixationfor internal fixation
of fractureof fracture

50. Management Open FractureManagement Open Fracture
immediately after accident (golden period)immediately after accident (golden period)
Debridement :Debridement :
- Wound cleaning by irrigation- Wound cleaning by irrigation
- Surgery : excite the dirty soft tissue- Surgery : excite the dirty soft tissue
and remove the necrotic tissueand remove the necrotic tissue
The GoalThe Goal of treatment of an open fracture areof treatment of an open fracture are
prevention of infection, healing of the fractureprevention of infection, healing of the fracture
and restoration of the function in the extremityand restoration of the function in the extremity

51. Grade I – II after debridementGrade I – II after debridement
the bone can be fixed by internal fixationthe bone can be fixed by internal fixation
Grade III after debridementGrade III after debridement
the bone can be fixed by external fixationthe bone can be fixed by external fixation
( - Monolateral external fixation( - Monolateral external fixation
- Circular external fixation- Circular external fixation
- Quadrilateral external fixation)- Quadrilateral external fixation)
➣➣ Soft tissue closed may carried out immediatelySoft tissue closed may carried out immediately
with skin graft or flap (primary repair)with skin graft or flap (primary repair)
if impossible to close the soft tissueif impossible to close the soft tissue
should be performed by delayed repairshould be performed by delayed repair

55. The reach a maximal functionThe reach a maximal function
it needs Rehabilitationit needs Rehabilitation
either active or passiveeither active or passive