1.
PRINCIPLES OF FRACTURE
MANAGEMENT
Dr Saseendar S, MS Ortho, DNB Ortho, MNAMS,
Dip SICOT(Belgium), FISOC(US), FASM (Sing),
Shoulder, Elbow and Knee Arthroscopy Surgeon,
Chettinad Super Speciality Hospital,
Chettinad Health City, Chennai

2.
TOPICS COVERED
 Definition
 Mechanism of fractures
 Fracture types
 Complete
 Incomplete
 Types of displacements
 Fracture healing
 Stages
 Treatment of fractures
 Closed fractures
 Open fractures

3.
DEFINITION
 An interruption in the continuity of
the bone which may be a
complete break or an incomplete
break.

4.
MECHANISMS
 Single traumatic event
 Repitive stress – Stress fractures
 Pathological – Insufficiency fractures

5.
HIGH-ENERGY
INJURY

6.
 High-energy injury

7.
LOW ENERGY INJURY

8.
Low-energy injury

9.
PATHOLOGIC FRACTURES
 Often need surgery
 diagnostic workup
important
 prognosis dependent
on biology of lesion

10.
Polyostotic Fibrous Dysplasia

11.
MECHANISMS OF FRACTURES
 Direct – Bending / Crushing
 Indirect

12.
MECHANISMS OF FRACTURES - INDIRECT
 Twisting causes a spiral fracture;
 Compression causes a short oblique fracture;
 Bending results in fracture with a triangular
'butter-fly‘ fragment;
 Tension tends to break the bone transversely

13.
CLASSIFICATION OF FRACTURES
 Complete/ Incomplete
 Fracture pattern
 Soft-tissue cover
 Displacement
 Comminution

14.
COMPLETE/ INCOMPLETE

15.
GREENSTICK FRACTURES
 Bending mechanism
 Failure on tension side
 Incomplete fracture,
plastic deformation on
compression side
 May need to complete
fracture to realign

16.
BUCKLE OR TORUS FRACTURE
 Compression failure
 Stable
 Usually at
metaphyseal /
diaphyseal junction

17.
CLASSIFICATION OF FRACTURES
 Closed fractures
 There is no communication between the external
surface of the body and the fracture

18.
 Open fractures
 There is a communication between the fracture and the
skin.
 From inside-out
 From outside-in
 High risk of infection/
neurovascular injury

19.
OPEN FRACTURES

20.
OPEN FRACTURES

21.
DISPLACEMENT
 Angulation
 Translation
 Rotation

22.
DISPLACEMENT
UNDISPLACED DISTAL RADIUS FRACTURE

23.
MINIMALLY DISPLACED DISTAL RADIUS FRACTURE

24.
DISPLACED FEMUR FRACTURE

25.
HEALING OF FEATURES
 Stage of haematoma
 Stage of cellular proliferation
 Stage of callus formation
 Stage of consolidation
 State of remodelling

26.
PRINCIPLES OF MANAGEMENT
 General condition
 Temporary stabilisation
 Definitive treatment
 Reduce
 Hold
 Exercise

27.
TEMPORARY STABILISATION

28.
DEFINITIVE TREATMENT
 Closed reduction
 Open reduction
 Immobilisation
 Internal/ External fixation

29.
CLOSED REDUCTION

30.
HOLD/ MAINTAIN REDUCTION
 Traction
 Slab/ Cast
 Brace

31.
MAINTAIN
Fixation
 Internal Fixation
 Screws
 K wires
 Plates and screws
 Nails
 External Fixation

32.
TENSION BAND WIRING

33.
PLATES AND SCREWS
 Extramedullary internal
fixation

34.
INTERLOCKING NAIL
 Intramedullary internal
fixation

35.
EXTERNAL FIXATION

36.
SKELETAL TRACTION – SKULL TONGS

37.
SKELETAL TRACTION
– UPPER TIBIAL PIN TRACTION

38.
SKELETAL TRACTION
– UPPER TIBIAL PIN TRACTION

39.
SKIN TRACTION
– GALLOWS TRACTION

40.
EXTERNAL FIXATOR

41.
PLASTER OF PARIS
- ABOVE ELBOW CAST

42.
EXTERNAL STABILISATION
– BUDDY STRAPPING

43.
BOHLER BRAUN FRAME

44.
OPEN FRACTURES
PRINCIPLES
 IV antibiotics,
tetanus prophylaxis
 emergent irrigation &
debridement
 skeletal stabilization
 soft tissue coverage

45.
LAWNMOWER INJURIES
 probably most common
cause of open fractures
in children
 most children are a
rider or bystander
(70%)
 high complication rate -
infection, growth
arrest,amputation
 > 50% unsatisfactory
results (Loder)

46.
LAWNMOWER INJURIES – OFTEN
RESULT IN AMPUTATIONS

47.
PHYSIOTHERAPY DURING
IMMOBILIZATION
 Reduce oedema – to prevent the adhesion formation
 Assist the maintenance of the circulation – active
exercise either by static or isotonic muscle activity
 Maintain muscle function by active or static
contraction
 Maintain joint range where possible
 Maintain as much function as allowed by the particular
injury and the fixation
 Teach the patient how to use special appliances such
as crutches, sticks, frames, and how to care for these
or any other apparatus

48.
PHYSIOTHERAPY AFTER THE
REMOVAL OF FIXATION
 To reduce any swelling
 To regain full range of joint movement
 To regain full muscle power
 To re-educate full function

49.
THANK YOU

50.
 Information contained in this presentation are intended for
academic purpose only for the students of orthopaedic
surgery.
 The guidelines mentioned cannot be used absolutely for
management of patients.
 I am not responsible for any controversies that arise out of
this presentation.
 For clarifications/ suggestions please contact
ssaseendar@yahoo.co.in or call at 91-9500366970.