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Principles of fracture management Saseendar

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Principles of fracture management Saseendar

  1. 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. 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. 3. DEFINITION  An interruption in the continuity of the bone which may be a complete break or an incomplete break.
  4. 4. MECHANISMS  Single traumatic event  Repitive stress – Stress fractures  Pathological – Insufficiency fractures
  5. 5. HIGH-ENERGY INJURY
  6. 6.  High-energy injury
  7. 7. LOW ENERGY INJURY
  8. 8. Low-energy injury
  9. 9. PATHOLOGIC FRACTURES  Often need surgery  diagnostic workup important  prognosis dependent on biology of lesion
  10. 10. Polyostotic Fibrous Dysplasia
  11. 11. MECHANISMS OF FRACTURES  Direct – Bending / Crushing  Indirect
  12. 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. 13. CLASSIFICATION OF FRACTURES  Complete/ Incomplete  Fracture pattern  Soft-tissue cover  Displacement  Comminution
  14. 14. COMPLETE/ INCOMPLETE
  15. 15. GREENSTICK FRACTURES  Bending mechanism  Failure on tension side  Incomplete fracture, plastic deformation on compression side  May need to complete fracture to realign
  16. 16. BUCKLE OR TORUS FRACTURE  Compression failure  Stable  Usually at metaphyseal / diaphyseal junction
  17. 17. CLASSIFICATION OF FRACTURES  Closed fractures  There is no communication between the external surface of the body and the fracture
  18. 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. 19. OPEN FRACTURES
  20. 20. OPEN FRACTURES
  21. 21. DISPLACEMENT  Angulation  Translation  Rotation
  22. 22. DISPLACEMENT UNDISPLACED DISTAL RADIUS FRACTURE
  23. 23. MINIMALLY DISPLACED DISTAL RADIUS FRACTURE
  24. 24. DISPLACED FEMUR FRACTURE
  25. 25. HEALING OF FEATURES  Stage of haematoma  Stage of cellular proliferation  Stage of callus formation  Stage of consolidation  State of remodelling
  26. 26. PRINCIPLES OF MANAGEMENT  General condition  Temporary stabilisation  Definitive treatment  Reduce  Hold  Exercise
  27. 27. TEMPORARY STABILISATION
  28. 28. DEFINITIVE TREATMENT  Closed reduction  Open reduction  Immobilisation  Internal/ External fixation
  29. 29. CLOSED REDUCTION
  30. 30. HOLD/ MAINTAIN REDUCTION  Traction  Slab/ Cast  Brace
  31. 31. MAINTAIN Fixation  Internal Fixation  Screws  K wires  Plates and screws  Nails  External Fixation
  32. 32. TENSION BAND WIRING
  33. 33. PLATES AND SCREWS  Extramedullary internal fixation
  34. 34. INTERLOCKING NAIL  Intramedullary internal fixation
  35. 35. EXTERNAL FIXATION
  36. 36. SKELETAL TRACTION – SKULL TONGS
  37. 37. SKELETAL TRACTION – UPPER TIBIAL PIN TRACTION
  38. 38. SKELETAL TRACTION – UPPER TIBIAL PIN TRACTION
  39. 39. SKIN TRACTION – GALLOWS TRACTION
  40. 40. EXTERNAL FIXATOR
  41. 41. PLASTER OF PARIS - ABOVE ELBOW CAST
  42. 42. EXTERNAL STABILISATION – BUDDY STRAPPING
  43. 43. BOHLER BRAUN FRAME
  44. 44. OPEN FRACTURES PRINCIPLES  IV antibiotics, tetanus prophylaxis  emergent irrigation & debridement  skeletal stabilization  soft tissue coverage
  45. 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. 46. LAWNMOWER INJURIES – OFTEN RESULT IN AMPUTATIONS
  47. 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. 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. 49. THANK YOU
  50. 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.

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