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FRACTURES AND DISLOCATIONS            Dr VARUN SHARMA        RESIDENT IN ORTHOPAEDICS AND TRAUMATOLOGY                  OS...
Definition of trauma: Injuries which are caused by external force or violence. They may range from minor to major, obvious...
When a bone fractures, there is usuallydamage to the surrounding area whichmay include:          •   Damage to muscles    ...
Signs of fracture:    •   limited or no movement of a limb    •   swelling at the site of injury    •   pain at, or distal...
Deformity of a limb    Clinical    indication    of    dislocation
Fracture Healing    Healing begins when swelling     occurs.    Blood, lymph, & tissue fluids form     a fibrin clot aroun...
Healing (continued)    Calcium is deposited around the      fracture forming a callus.    *The callus is the first phase o...
Factors affecting healing:       •   Patient age       •   general health       •   nutrition       •   circulation at sit...
Terminology   A/A or MVA    Fracture   abrasion      hematoma   amputation    sprain   concussion    luxation   crepitus  ...
Examples of dislocation
Example of subluxation
General types of fractures    • Complete vs. Incomplete      Entire cross section of the      bone fractures vs. not      ...
General fracture types (cont.)    • Closed (simple) vs.      compound    Bone does not pierce     through the skin    vs. ...
Closed vs compound fractures
General types of fractures(cont.)    • Direct vs Indirect      fracture occurs at the site of      trauma vs away from the...
Fracture Alignment        Displacement or apposition =          misalignment of a fracture(seenote)   Other terms denoting...
OUCH!
Varus or Valgus?
ANOTHER OUCH !
Overlapping fx.
Specific types of fractures    LINEAR - straight lines
Transverse fx
Transverse fx.
Longitudinal (cleft)
Oblique fx    (also an    oblique fx    because of    the direction    of the    fracture line)
Spiral fx   Fracture line   rotates around   the bone,   usually from a   twisting force
Spiral fx.
Comminuted fx    2 or more fracture    lines = 3 or more    fragments
Crush fx           Severe           communited !
Impacted fxFracturedends getpushed      Typical of a front seatinto one     passenger in a caranother            crash !
Impacted fx.
Splinter fx     Fracture ends are     thin shards or     splinters like     wood.     (gunshot wounds)
Stellate fx   Specific to the   patella-   fracture lines   radiate out from   a center point in   a star-like   pattern.
Compression fx  Specific to the  vertebrae -  vertebral body  collapses, anterior  aspect is reduced in  height.  From tra...
Burst fx  C1 ring is        C - 1 (atlas)  broken,  fragments move  outward.  Football  injuries, heavy  object dropped  o...
Blowout fx Orbital floor collapses from direct blow to eyeball (fist, baseball)
Depressed fx Section of bone pushed into center of an area (skull, sternum)
Complicated fx    Fractured bone causes    damage to an internal    organ. Ex. - rib pierces    lung
Avulsion fx (chip fx)  Caused by stress to a  joint, ligament, or  tendon. Small piece of  bone is torn away.  Often seen ...
NON-TRAUMA FRACTURES   1. Pathologic - bone is weakened by   disease, spontaneous fx’s   (cancer, osteomalacia, osteomyeli...
Pediatric fractures  1. Greenstick (torus) - incomplete  fx, bones more flexible, bends &  fractures only outer edge.  2. ...
THE END !!
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Fractures

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Fractures

  1. 1. FRACTURES AND DISLOCATIONS Dr VARUN SHARMA RESIDENT IN ORTHOPAEDICS AND TRAUMATOLOGY OSMANIA GENERAL HOSPITAL
  2. 2. Definition of trauma: Injuries which are caused by external force or violence. They may range from minor to major, obvious to not apparent, single injury to multiple.
  3. 3. When a bone fractures, there is usuallydamage to the surrounding area whichmay include: • Damage to muscles • Tearing of blood & lymph vessels • Severing of nerves • Damage to nearby organs • Laceration of the skin
  4. 4. Signs of fracture: • limited or no movement of a limb • swelling at the site of injury • pain at, or distal to, the injury • bruising at injury site • deformity of a limb • no pulse distal to the injury • loss of feeling at, and distal to, the injury
  5. 5. Deformity of a limb Clinical indication of dislocation
  6. 6. Fracture Healing Healing begins when swelling occurs. Blood, lymph, & tissue fluids form a fibrin clot around the fracture. Soon fibroblasts appear & begin granulation. Granulation process helps stabilize the fracture…….. (continued)
  7. 7. Healing (continued) Calcium is deposited around the fracture forming a callus. *The callus is the first phase of healing which can be demonstrated radiographically. Calcified area may be large at first, but will reduce with use. Fracture site may be stronger than before!
  8. 8. Factors affecting healing: • Patient age • general health • nutrition • circulation at site of injury
  9. 9. Terminology A/A or MVA Fracture abrasion hematoma amputation sprain concussion luxation crepitus subluxation dislocation
  10. 10. Examples of dislocation
  11. 11. Example of subluxation
  12. 12. General types of fractures • Complete vs. Incomplete Entire cross section of the bone fractures vs. not broken into separate pieces.
  13. 13. General fracture types (cont.) • Closed (simple) vs. compound Bone does not pierce through the skin vs. bone is through the skin
  14. 14. Closed vs compound fractures
  15. 15. General types of fractures(cont.) • Direct vs Indirect fracture occurs at the site of trauma vs away from the impact point
  16. 16. Fracture Alignment Displacement or apposition = misalignment of a fracture(seenote) Other terms denoting misalignment: • Varus • Valgus • Bayonet
  17. 17. OUCH!
  18. 18. Varus or Valgus?
  19. 19. ANOTHER OUCH !
  20. 20. Overlapping fx.
  21. 21. Specific types of fractures LINEAR - straight lines
  22. 22. Transverse fx
  23. 23. Transverse fx.
  24. 24. Longitudinal (cleft)
  25. 25. Oblique fx (also an oblique fx because of the direction of the fracture line)
  26. 26. Spiral fx Fracture line rotates around the bone, usually from a twisting force
  27. 27. Spiral fx.
  28. 28. Comminuted fx 2 or more fracture lines = 3 or more fragments
  29. 29. Crush fx Severe communited !
  30. 30. Impacted fxFracturedends getpushed Typical of a front seatinto one passenger in a caranother crash !
  31. 31. Impacted fx.
  32. 32. Splinter fx Fracture ends are thin shards or splinters like wood. (gunshot wounds)
  33. 33. Stellate fx Specific to the patella- fracture lines radiate out from a center point in a star-like pattern.
  34. 34. Compression fx Specific to the vertebrae - vertebral body collapses, anterior aspect is reduced in height. From trauma or demineralization of bone (old age).
  35. 35. Burst fx C1 ring is C - 1 (atlas) broken, fragments move outward. Football injuries, heavy object dropped on head.
  36. 36. Blowout fx Orbital floor collapses from direct blow to eyeball (fist, baseball)
  37. 37. Depressed fx Section of bone pushed into center of an area (skull, sternum)
  38. 38. Complicated fx Fractured bone causes damage to an internal organ. Ex. - rib pierces lung
  39. 39. Avulsion fx (chip fx) Caused by stress to a joint, ligament, or tendon. Small piece of bone is torn away. Often seen with dislocations.(see note)
  40. 40. NON-TRAUMA FRACTURES 1. Pathologic - bone is weakened by disease, spontaneous fx’s (cancer, osteomalacia, osteomyelitis, Pagets) 2. Stress - caused by prolonged running or marching - metatarsals fracture. Difficult to visualize.
  41. 41. Pediatric fractures 1. Greenstick (torus) - incomplete fx, bones more flexible, bends & fractures only outer edge. 2. Epiphyseal - fractures located at the site of an epiphysis. Sometimes with associated dislocation (slipped epiphysis)
  42. 42. THE END !!

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