Treatment of fractures and dislocations including different between plaster cast and fiberglass cast base on swartz`s surgery 10th edition

1. GROUP – 1
Dr.Vekariya
kushal N.

2.  The majority of fractures are managed non surgically.
location and type of fracture
In some instances (such as a minimally displaced fracture of the middle phalanx of one
of the lesser toes) no treatment at all other than those for symptoms of pain generally
are necessary

3. Patient with splint on hand
Patient with sling arm

4. Patient with clavicle
brace
Patient with broken
finger or phalanges

5. Spinal brace Shoulder brace

7. To immobilize the fractured bone and avoid the
complications of
loss of reduction
neurovascular compromise
pressure ulceration of skin
the creation of joint contractures.
Non displaced fractures
generally are treated by
simple casting

8.  Should the fracture be unacceptably displaced, a closed reduction to
realign the bones precedes the application of the cast
To construct
a cast
first covered with a cloth sleeve or stocking.
Critically, the limb is then covered with a
generous amount of cast padding
Insufficient padding, particularly overlying a bony prominence, can cause skin erosion within the immobilizing cast,
a potentially devastating complication.

9.  After adequate padding is in place, plaster or fiberglass is gently
rolled on to the limb. The cast material is applied wet and will generate
heat while hardening
 Patients can sustain burns during application of thick casts or splints.
Several minutes are required, and for this reason, it is applied in layers
while maintaining reduction of the fracture.

10.  This is superior to plaster in terms of strength to weight ratio and has
largely replaced plaster for many casting applications. Fiberglass tape
itself it is a bit elastic and creates an extra potential hazard of creating
a cast too tight. This can lead to excessive compression to the limb.

11.   In minimally displaced fractures, a circumferential plaster or
fiberglass cast can be safely applied immediately.
 other injuries, definitive casts are applied 24 to 72 hours after the
acute injury because of the potential for ongoing swelling beneath the
cast, which all too frequently results in skin problems or neurovascular
compromise.
 Generally, the cast application, particularly if the casting involves
reduction maneuvers, are followed by immediate postprocedure x-ray
imaging, to verify a satisfactory alignment of the fracture fragments.

12.  Internal fixation refers to any device placed surgically to directly hold
bones in position.
 These can include sutures, wires and screws, plates, rods, or nails.

13.  Many times simply fixing two fractured bones together using individual
screws can be effective.
 The surgeon must choose an appropriate sized screw and place it
correctly with good purchase on the bone.
 Bone screws come in a variety of designs to address specific fracture
fixation problems.

14.  A cortical screw is a screw with a large inner diameter and shallow
screw threads.
 This screw is designed to have a high breaking strength for its total
diameter, and the screws threads are intended to engage cortical
bone. Purchase of shallow screw threads in cortical bone can be
excellent.

15.  Cancellous screws have a deeper thread pattern and a smaller inner shaft
diameter.
  They are designed to obtain fixation in less dense cancellous bone. Lag
screws also are commonly used.
 These are screws in which only the distal portion of the screw length is
threaded. These screws penetrate one bone fragment without thread
fixation.
 When a second fracture fragment is engaged by the threaded portion of
the screw, turning the screw head tight down to the cortex of the first bony
fragment will pull or "lag" the distal fragment toward the screw head.
Compression of the fractured bones is the result.

17.  Fractures of long bones are managed by intramedullary rods or nails.
 A metal rod is inserted into the medullary canal to obtain a tight and
secure fit to immobilize the fracture.
 Often, as in the femur, the medullary canal is sequentially reamed over
a guide wire to allow insertion of a stout rod.
 Frequently, the rod is further stabilized by inserting "locking screws"
that transfix the bone cortex and pass through appropriate holes in the
rod either distal, proximal, or both

19.  fractures of the bone usually do not occur with penetration of the skin.
 A more serious condition exists when the fracture hematoma communicated
with a wound of the skin. Such injuries are called open fractures.
 open fracture implies communication between external environment and the
fracture.
 soft tissue injury complicated by a broken bone.
  Penetrating trauma also can lead to open fractures, and bacterial
contamination must be assumed to be present in all cases.

20. All injury carry
serious risk of
Infection and ostiomlaytis
Open fracture treated by
Formal irrigation and debridement
procedure perform in operating
room

21.  Depending on the circumstances of each individual injury, the initial
debridement can be followed by simple splinting, or external fixation
(with definitive operative treatment performed at a later date), or by
definitive internal fixation.
 In severe injuries, with extensive soft tissue injury, the fracture
treatment usually is performed in stages.

25.  it is a clinical emergency and describes a clinical situation where
muscle tissue compartment edema constrained by the investing
muscle fascia results in increased muscle compartment pressures
sufficient to stop small vessel flow of blood.
Severe problems arise when the profusion pressure in the capillary bed
is approached or exceeded by the intracompartmental pressure. In this
situation, perfusion of the muscle is compromised and muscle necrosis
results.

27.  The diagnosis of a compartment syndrome is a clinical one, based
on complaints of local pain out of proportion to the apparent injury, in
association with pain, on passive stretch of the involved muscles.
  This situation can arise after a period of ischemia, after local blunt
trauma and in the presence of an acute fracture.

28. Stryker technique

29.  Measurement of compartment pressures, using one of a number of
commercially available devices, involves inserting a needle into the
suspected muscle compartments to measure pressure.
 Pressure measurements alone are not reliable to absolutely rule in or rule
out the diagnosis, but they can be a useful adjunct to clinical assessment,
particularly valuable in obtunded or unconscious patients.
 Pressure measurements that are greater than 30 mmHg or within 30
mmHg of the diastolic blood pressure are consistent, but not absolutely
diagnostic with the presence of a compartment syndrome.

30.  Treatment of a compartment syndrome is always surgical and involves
extensive skin incisions and fascial release of all suspected muscle
compartments.
 An untreated compartment syndrome will result in necrosis of
involved muscle compartments with subsequent contracture and
severe loss of function in the affected limb.
Treatmenr
Surgical
Extensive skin incisions
Fascial release of all suspected muscles (fasciotomy)

31. Performing fasciotomy
on patient with
compartment syndrome