principles of fracture management saseendar
TRANSCRIPT
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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
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TOPICS COVERED
Definition
Mechanism of fractures
Fracture types
Complete
Incomplete
Types of displacements
Fracture healing
Stages
Treatment of fractures
Closed fractures
Open fractures
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DEFINITION
An interruption in the continuity of
the bone which may be a
complete break or an incomplete
break.
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MECHANISMS
Single traumatic event
Repitive stress – Stress fractures
Pathological – Insufficiency fractures
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HIGH-ENERGY
INJURY
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High-energy injury
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LOW ENERGY INJURY
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Low-energy injury
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PATHOLOGIC FRACTURES
Often need surgery
diagnostic workup
important
prognosis dependent
on biology of lesion
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Polyostotic Fibrous Dysplasia
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MECHANISMS OF FRACTURES
Direct – Bending / Crushing
Indirect
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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
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CLASSIFICATION OF FRACTURES
Complete/ Incomplete
Fracture pattern
Soft-tissue cover
Displacement
Comminution
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COMPLETE/ INCOMPLETE
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GREENSTICK FRACTURES
Bending mechanism
Failure on tension side
Incomplete fracture,
plastic deformation on
compression side
May need to complete
fracture to realign
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BUCKLE OR TORUS FRACTURE
Compression failure
Stable
Usually at
metaphyseal /
diaphyseal junction
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CLASSIFICATION OF FRACTURES
Closed fractures
There is no communication between the external
surface of the body and the fracture
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Open fractures
There is a communication between the fracture and the
skin.
From inside-out
From outside-in
High risk of infection/
neurovascular injury
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OPEN FRACTURES
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OPEN FRACTURES
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DISPLACEMENT
Angulation
Translation
Rotation
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DISPLACEMENT
UNDISPLACED DISTAL RADIUS FRACTURE
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MINIMALLY DISPLACED DISTAL RADIUS FRACTURE
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DISPLACED FEMUR FRACTURE
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HEALING OF FEATURES
Stage of haematoma
Stage of cellular proliferation
Stage of callus formation
Stage of consolidation
State of remodelling
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PRINCIPLES OF MANAGEMENT
General condition
Temporary stabilisation
Definitive treatment
Reduce
Hold
Exercise
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TEMPORARY STABILISATION
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DEFINITIVE TREATMENT
Closed reduction
Open reduction
Immobilisation
Internal/ External fixation
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CLOSED REDUCTION
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HOLD/ MAINTAIN REDUCTION
Traction
Slab/ Cast
Brace
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MAINTAIN
Fixation
Internal Fixation
Screws
K wires
Plates and screws
Nails
External Fixation
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TENSION BAND WIRING
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PLATES AND SCREWS
Extramedullary internal
fixation
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INTERLOCKING NAIL
Intramedullary internal
fixation
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EXTERNAL FIXATION
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SKELETAL TRACTION – SKULL TONGS
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SKELETAL TRACTION
– UPPER TIBIAL PIN TRACTION
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SKELETAL TRACTION
– UPPER TIBIAL PIN TRACTION
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SKIN TRACTION
– GALLOWS TRACTION
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EXTERNAL FIXATOR
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PLASTER OF PARIS
- ABOVE ELBOW CAST
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EXTERNAL STABILISATION
– BUDDY STRAPPING
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BOHLER BRAUN FRAME
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OPEN FRACTURES
PRINCIPLES
IV antibiotics,
tetanus prophylaxis
emergent irrigation &
debridement
skeletal stabilization
soft tissue coverage
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LAWNMOWER INJURIESprobably 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)
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LAWNMOWER INJURIES – OFTEN
RESULT IN AMPUTATIONS
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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
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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
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THANK YOU
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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
[email protected] or call at 91-9500366970.