This document provides information about fracture classification and treatment. It discusses describing fractures based on anatomy seen on radiographs. Key details include location of the fracture line, bone condition, and deformities. Treatment may involve conservative methods like traction, casting, or bracing to immobilize the fracture for healing. The goal is healing the fracture in proper anatomical position while allowing function.

1. Ukris Gunadham, MD. FRCOST.
Department of Orthopaedics
Trang Hospital
Lecture for 5th year medical student

2.  Disruption of a bone’s normal structure or
“wholeness”
 Crack, break, or rupture in a bone
 There are many how’s and why’s to bony
fractures
 Terms used to describe each are related

3. “Fracture is a soft tissue injury which happened
to have a broken bone inside”
Thomas Rüedi
AO trauma 2013

4.  Direct force
 Tapping, crush, gunshot
 Indirect
 Traction
 Bending
 Rotation
 compression

7.  Should be two joints
 One joint above, one joint below
 At least two planes
 AP, Lateral, (or Oblique)
 May be two times
 Seperately
 May be two sides (Rt. + Lt.)
 Especially in children

8.  Reading a radiograph is essentially describing
the anatomy of a certain structure
 to be universal and understandable for
others, clarity and precision are essential
 A fracture is described based on the
findings of the physical exam and a review
of radiographs

9. 1. Say what it is- what anatomic structure are
you looking at and how many different
views are there
2. Regional Location- Diaphysis (rule of 1/3),
Metaphysis, Epiphysis including intra and
extra-articular
3. Direction of the fracture line-Transverse,
Oblique, Spiral

10. 5. Condition of the bone- comminution (3 or
more parts), Segmental (middle fragment),
Butterfly segment, incomplete, avulsion,
stress, impacted
6. Deformity-Displacemtent (distal with
respect to proximal), angulation (varus,
valgus), rotation, shortening (in cm’s),
distraction

11. The goal is to obtain union of the fracture in
the most anatomical position compatible
with maximal functional return of the
extremity.
 Conservative
 Operative

12.  Treat the Patient, not only the fracture
 Restriction of movement
 Prevention of displacement
 Pain relieve
 Promote soft-tissue healing
 Try to allow free movement of the
unaffected parts
 Splint the fracture, not the entire limb

13.  Methods of holding reduction:
Sustained traction
Cast splint
Functional bracing
Internal fixation
External fixation

14.  ดึงไม่เข้า
 3-4
 ข้อ
 ต่อ
 ไม่ติด
 Pa..
 ..Part..
 ต้องผ่า
 Open fx
 N-V injury

15.  Traction
 Casting
 Bracing

16. Traction is the application of a pulling force to a
part of the body
Purposes
 Reduce fracture / dislocation
 Minimize muscle spasm
 Relieve pain
 Reduce deformity / muscle contracture

17.  Buck’s traction
 ≤1/10 BW or ≤ 5 kg. (starting 2 kg)
maintained by direct application of a pulling force on
the patient’s skin .
 Generally temporary measure
 To reduce muscle spasms / reduce pain
 To maintain immobilization before surgery
 May use in children
 Alertness / awareness

18.  Do not apply traction to skin with:
 Abrasions
 Lacerations
 Surgical wounds
 Ulcers
 Loss of sensation
 Peripheral vascular disease

21.  applied to bone by means of a pin or wire
inserted into the bone,
 providing a strong steady, continuous pull
 can be used for prolonged periods
 proximal tibia, distal femur, calcaneal
 ≤1/6 BW or ≤ 10 kg. (starting 5 kg)

22. Thomas
Braun
Hamilton-
Russel
Perkins
Fisk
90-90

24.  Gardner-WellsTong
 Starting 10 lbs, 5 lbs for each spinal level

25.  Plaster of Paris
 CaSO4(2H2O)

26.  Utilization of intact
soft tissues
 Three-point fixation
 Hydrostatic pressure

28.  Compartment syndrome
 Pressure sore
 Disused atrophy
 Joint stiffness
 Skin maceration

32.  James’ position
 Functional position
 40°Wrist extension
 90° MCP flexion
 0° PIP, DIP
 Stretch collateral
ligaments of MCP, PIP,
DIP

34. PatellarTendon Bearing Cast