Treatment of fracture Taiz University,faculty of medicine and health sciences By Dr : Abdulmalik Alselwi

1. Diagnosis of Fractures
BY : 1- Clinical features
( History & Physical examination )
2- investigation

2. HISTORY
There is usually a history of injury , followed by
inability to use the injured limb.
But beware! The fracture is not always at the site of
the injury.
and. The patient’s age
and mechanism of injury are important.
The common symptoms are :Pain, bruising and
swelling ,but they do not distinguish a fracture from a
soft-tissue injury.
Deformity is much more suggestive

3. HISTORY
Always enquire about symptoms of associated
injuries: pain and swelling elsewhere (it is a
common mistake to get distracted by the main
injury, particularly if it is severe), numbness or
loss of movement,
skin pallor or cyanosis, blood in the urine,
abdominal pain , difficulty with breathing or
transient loss of consciousness

4. PHYSICAL EXAMINATION
The examination actually begins from the moment we set eyes on
patient. We observe his or her general appearance, posture and gait.
When we proceed to the structured examination, the patient must
be suitably undressed, if one limb is affected both limbs must be
exposed so that thy can be compared
1-Swelling,
2- bruising and
3- deformity may be obvious, but
the important point is whether the skin is intact; if
the
skin is broken and the wound communicates with the
fracture, the injury is ‘open’ (‘compound’). Note also
the posture of the distal extremity and the colour of
the skin (for signs of nerve or vessel damage).
Inspection or
look

5. Palpation OR fell
localized tenderness. Some fractures would be missed if
not specifically looked for, e.g. the classical sign
(indeed the only
clinical sign!) of a fractured scaphoid is tenderness on
pressure precisely in the anatomical snuffbox . .
The common and characteristic associated injuries should
also be felt for, even if the patient does not complain
of them. For example, an isolated fracture of the proximal
fibula should always alert to the likelihood of an
associated fracture or ligament injury of the ankle, and
In high-energy injuries always examine the spine and
pelvis. Vascular and peripheral nerve abnormalities
•should be tested for both before and after treatment
PHYSICAL EXAMINATION

6. MOVE
Crepitus and abnormal movement should be
tested for only in unconscious patients .
Usually it is more important to ask if the
patient can move the joint distal to the
injury
PHYSICAL EXAMINATION

7. INVESTIGATION
X-RAY
X-ray examination is mandatory. Remember the rule of twos:
•Two views– (anteroposterior and lateral) must be taken ..
•Two joints–. Because it may be fractured or dislocated,
•Two limbs–; x-rays of the uninjured limb are needed for
comparison. •
Two injuries– Severe force often causes injuries at
more than one level. Thus, with fractures of the calcaneum or femur it is
important to also x-ray the
pelvis and spine.
•Two occasions– Some fractures are notoriously difficult to detect soon after
injury, but another x-ray
examination a week or two later may show the
lesion.

8. INVESTIGATION
Computed tomography (CT) and Magnetic resonance
imaging (MRI) are useful for displaying fractures
patterns in difficult sites such as vertebral column ,
the acetabulum and the calcaneum.
MRI may be the only way of showing whether a
fractured vertebra is threatining to compress the
spinal cord .
Radioistope scanning is helpful in diagnosing a
suspected stress fracture or other occult fracture ..

9. GOALS OF FRACTURE
TREATMENT
 Restore the patient to optimal
functional state.
 Prevent fracture and soft-tissue
complications.
 Get the fracture to heal, and in a
position which will produce optimal
functional recovery.
 Rehabilitate the patient as early as
possible.

10. GENERAL
Follow the guidelines of trauma life support ..
The following are of special importance with
treatment of fractures :
1-Pain. Relived by Immobilization , local
splinting , analgesics
2-Blood
loss
3-Attension to associated injuries
N.B : the management of the internal hemorrhage and visceral
injury takes priority over a limb fracture ..
4-Tetanus toxoid & Antibiotics
In compound fractures

11. Local
1-Reduction 2-fixation 3-Rehablitation
Reduction: is restoration of normal anatomy
To achieve a Reduction
The following steps usually are advised:
1) Apply traction in the long axis of the limb.
2) Reverse the mechanism that produced the
fracture;
3) Align the fragment that can be controlled with
the one that cannot.
Reduction is not necessary when the displacement is trivial e.g. …
Or when the displacement is of a nature that will leave no functional or cosmetics disability e.g…
,But is urgent when the fracture is complicated by vascular or nerve injury

12. Types are : closed and open
Closed reduction by :1- gravity ,2- closed
manipulation ,3- traction
Contraindication to closed reduction
 when:
. 1.There is no significant displacement
2. The displacement is of little concern
(e.g., humeral shaft).
3. No reduction is possible (e.g., comminuted
fracture of the head and neck of humorous).
4. The reduction, if gained, cannot be held
(e.g., compression fracture of the vertebral
body).
5. The fracture has been produced by a
traction force (e.g., displaced fracture of

13. 6-Pathologic Fractures
7-Associated Vascular Injury
8-Multiple Injuries
9-Mobilization
10-Reconstruction
Open (surgical reduction)

14. Immobilization
Once a satisfactory reduction has been
achieved, it must then be maintained
until primary union has taken place.
 Plaster-of-Paris Casts†

15. Immobilization by
Continuous Traction
Skin Traction.
Skeletal Traction

16. Complications of Plaster
Casts and Traction
Plaster
Sores. The Tight Cast.
Volkmann's
ischemia

17. Complications of Plaster
Casts and Traction
1) Plaster Sores.
2) The Tight Cast
3) Thermal Effects of Plaster.
4) Thrombophlebitis and Equinus Position
5) The Cast Syndrome
6) Infection Secondary to Cast
Application.
7) Allergic Reactions
8) Traction Hazards

18. External Fixation of
Fractures
Hoffman External fixator
misdirection by Wegner leg-
lengthening
Othofix external fixator

21. Complications of
External Fixation
 Pin Tract Infection
Pin tract infections may be classified, in
ascending order of severity, as:
Grade I-Serous drainage
Grade II-Superficial cellulitis
Grade III-Deep infection
Grade IV-Osteomyelitis.

22. 1- wires
2- screws
3- plate and screws
4-intramedullary nail
5- compression screw and plate for a
fractured neck of femur

24. 3-Plates
Plate fixation
Type of plates
1-Dynamic Compression Plates.
2-Limited Contact-Dynamic
Compression Plates.
3-Curved Plate
4-Angled Plates
5-Buttress Plates
6-Reconstruction Plates
7- Wave Plate
4-Staples

25. Interamedulary fixation
Russell Taylor complete nails
system
X-ray of interlocking system

28. Complication of
operative treatment
 Complication of anesthesia
 Complication of surgery
 Complication postoperative
1. Infection
2. Failure of hard ware(implants
breakage & loosening )
3. Failure of healing
(pseudoarthrosis)