FRACTURES

OBJECTIVES

By end of lecture student identify following :-

Definition and causes of fractures

Classifications of fractures

Assessment\ Diagnosis

emergency management

complications

FRACTURES

A fracture is a break in the continuity of bone.

Direct force.

Crushing forces.

Sudden twisting motions.

Extreme muscle contractions.

Classifications of fracture

a)According to extent break of bone:(

1)Complete fracture:-

The break is across the entire width of the bone in such a way that the bone is divided into two distinct sections

2)Incomplete fracture:- The fracture does not divide the bone into two

portion, because the break is through only

part of the bone

(b)According to soft tissue damage

CLOSED (SIMPLE)

skin (mucous membranes) not broken

OPEN (COMPOUND):DIVIDED INTO

Grade I

Least severe injury, skin damage is minimal.

Grade II

Open fracture is accompanied by skin and muscle contusion

Grade III

Most severe injury, skin damage’ muscle, nerve tissue, and blood vessels’.

OPEN (COMPOUND

(c)According to shape of bone

1.TRANSVERSE

Transverse : straight across the bone.

2.oblique

Oblique : at an angle across the bone

3.GREENSTICK

Greenstick: one side of the bone is broken and

the other side is bent.

4.SPIRAL

Spiral : twists around the shaft of the bone.

5.Comminuted

Comminuted : bone splintered into more than

three fragments.

6.Depressed

Depressed : fragments are driven inward (seen in

fractures of the skull and facial bones).

Impacted

Impacted : fragment of bone wedged into other

bone fragment.

CLINICAL MANIFESTATIONS

Swelling from local hemorrhage, ----)Deformity1 muscles spasm ”limb shortening”

edema may appear----)Swelling2

from subcutaneous ----)Bruising ”ecchymosis”3bleeding

)Muscles spasm4

)Pain5

)Tenderness6

from pain, and nerve ----)Loss of function7

damage.

caused by ----)Abnormal mobility& crepitus8

fracture fragments rubbing together

result from ----changes Nurovascular)9

damage of peripheral nerves

bone fragments may lacerate ----)Shock10

blood vessels

Diagnostic evaluation

and other imaging studies to determine ray-X

integrity of bone.

Blood studies [CBC]

may show decreased hemoglobin level and hematocrit. in blood loss and extensive muscle damage

Arthroscopy: to detect joint involvement.

Angiography if associated with blood vessel injury.

Nerve conduction and electromyogram: studies to detect nerve injury

Immobilize the body part before the patient is

moved.

Adequate splinting, including joints adjacent to

the fracture, is essential.

Immobilization of the long bones of the lower

extremities may be accomplished by bandaging

Legs together, with the unaffected extremity

serving as a splint for the injured one the

.

In an upper extremity injury, the arm may be

bandaged to the chest, at an injured forearm may

be placed in a sling.

With an open fracture, the wound is covered with a

clean (sterile) dressing to prevent contamination of

deeper tissues.

The clothes are gently removed, first from the

uninjured side of the body and then from the

injured side.

The fractured extremity is moved as little as

possible to avoid more damage.

The management process is a three-step

process:

.1Reduction : setting the bone; refers to

restoration of the fracture fragments into

anatomic position and alignment

.2Immobilization : maintains reduction until

bone healing occurs

.3Rehabilitation : regaining normal function of

the affected part

Approaches to management

(1) Closed reduction

(2)Traction

(1) CLOSED REDUCTION

(Cast).

(2)Traction

Pulling force applied to accomplish and

maintain reduction and alignment

Used for fractures of long bones.

Techniques of traction

-Skin traction:

force applied to the skin using foam rubber, tape.

Skeletal traction:-

force applied to the bony skeleton directly, using

wires, pins. or tongs placed into or through the bone

Complications of fractures

Muscle atrophy.

Loss of ROM

Pressure sores

Psychosocial compromise

D VT

Infection

Shock

Pulmonary emboli