2. LEARNING OUTCOME
• By the end of this lecture:
- Able to understand the 4 concepts of fracture fixation
based on the AO concept
- Understand the methods applied to achieve these
principles
10. Fracture reduction
• What?
- The act of restoring a fracture or dislocation into its
normal position in the body
• When?
- Presence of displacement – 2 types
11. Fracture reduction – displacement
• Medial or lateral and
anterior or posterior
• Shortening or
lengthening
12. Fracture reduction – displacement
• Internal or external
rotational malalignment
• Valgus or varus
malalignment
• Flexion or extension
malalignment
14. Fracture reduction – aim
• ANATOMICAL REDUCTION
- To restore the bony anatomy and morphology
- Intra-articular fractures
‘Steps’ and ‘gaps’
must be avoided
15. Fracture reduction – aim
• FUNCTIONAL REDUCTION
- To restore the relationship
between the proximal and
distal main fragments of the
fracture
- To restore the length,
alignment and rotation
- Mechanical and anatomical
axis as reference
- Often in diaphyseal
fractures
18. Fracture fixation
• What?
- The fracture is held through absolute or relative
stability as the personality of the fracture, the patient
and the injury requires
• Goals?
- To maintain the reduction
- To create sufficient stability:
• Allow early and optimal function of limb
• Minimizes pain
19. Fracture fixation
• ABSOLUTE STABILITY
- no movement at fracture site, rigid
- Achieved through interfragmentary compression; e.g
lag screws, compression plates
- Often in intra-articular fractures
- No callus forms, fracture heals through direct healing
20. Fracture fixation
• RELATIVE STABILITY
- Micro-movement at fracture
site
- No fragment compression,
splinting or bridging between
fragments
- Fracture heals through callus
formation
- Often in diaphyseal fractures
22. Preserving blood supply
• How?
- Care of soft tissue around fracture
- Maintaining bone blood supply
23. Preserving blood supply – soft tissue
• Ensure only devitalised and
dead tissues are removed
• Attempt to preserve a good
soft tissue envelope around
bone as long as risk of
infection NOT compromised
• Minimal and gentle soft
tissue handling
• Keep exposed tissues
moist
• MIPO technique
24. Preserving blood supply – bone
• Reducing periosteal stripping
• Attempt indirect reduction whenever possible
• Selection of implants that preserve blood supply e.g: low
contact DCP, lock plates, ring fixators
• Implants that leave the least ‘footprints’
26. Early and safe mobilization
• How early is early?
- Immediate post op – provided is safe enough and not
jeopardizes fixation
• Why?
- Promotes bone and soft tissue healing
- Helps to prevent immobilization problems, e.g: DVT,
pressure sores, disuse atrophy
27. • To restore function to injured part and patient as a
whole
• Objectives:
- Reduce oedema
- Preserve joint movement
- Restore muscle power
- Guide patient to normal activity
Early and safe mobilization – exercise
28. • Elevate and exercise
• Never dangle, never force
Prevent oedema
29. • Helps to:
- Pump away oedema
- Stimulate circulation
- Prevent soft tissue adhesion
- Promotes fracture healing
• On cast – static muscle contraction
• Off cast – mobilize joints and build muscle
Active exercise
30. • Especially in fractures around the joint
Assisted movement
31. • Once fracture healed enough, normal daily activity need
to be retaught:
- Walking
- Getting in and out of bed
- Bathing
- Dressing
• For hand injuries: role of occupational therapists
Functional activity
32. SUMMARY
• Why principles of fracture fixation important:
- To ensure fracture heals well and properly
- To ensure patient returns to normal function as quickly
as possible
- To reduce early and late complications of fracture
