principles of fractures(1)
DESCRIPTION
Introduction. Defintions. Mechanisms. Diagnosis. Classification. Fracture healing.TRANSCRIPT
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Principles Of Fractures(1)Principles Of Fractures(1) DR. FAWZI ALJASSIR, MD, MSc, FRCSCDR. FAWZI ALJASSIR, MD, MSc, FRCSC
Associate ProfessorAssociate ProfessorChairman, Department of OrthopedicsChairman, Department of Orthopedics
Director, Orthopedic Surgery Research ChairDirector, Orthopedic Surgery Research ChairMedical Director, Rehabilitation DepartmentMedical Director, Rehabilitation Department
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Introduction.Introduction.
• Defintions.
• Mechanisms.
• Diagnosis.
• Classification.
• Fracture healing.
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Fracture:-Fracture:- Break in the continuity of bone Break in the continuity of bone
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Defintions.Defintions.
CompleteIncomplete
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Defintions.Defintions.
• Closed fracture (simple).
• Open fracture (compound).
• Complicated fracture.
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Defintions.Defintions.
• Closed Fracture (simple ):-
Does NOT communicate with external environment
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Defintions.Defintions.
• Open Fracture (compound ):-
Communicate with external environment
Infection !!
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Defintions.Defintions.
• Complicated Fracture:-
Associated with damage to nerves, vessels or internal organs
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Defintions.Defintions.
• Dislocation.
• Subluxation.
• Fracture disloction.
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Defintions.Defintions.• Dislocation:-
Complete separation of the articular surface.
Distal to proximal fragment
Anterior, Posterior, Inferior, Superior
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Defintions.Defintions.• Subluxation:-
Incomplete separation
Joint Function in Anatomical position Only
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Defintions.Defintions.
• Fracture Dislocation:-
Association!
Always X-Ray Joint Above and Below
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Defintions.Defintions.
• Pathological Fracture:-
Fracture abnormal bone
Cyst, Tumour, Infection
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Defintions.Defintions.• Pathological fracture.
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MechanismsMechanisms
• Amount of Force:- * Trivial force = Pathological * Magnitude = Non-pathological
• Direction of Force:- * Direct Force * Indirect Force
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MechanismsMechanismsIndirect Force On Long
Bones:-
1) Twisting Force
Spiral Line
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MechanismsMechanisms
Indirect Force On Long
Bones:-
2) Angulating Force Transverse pattern
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MechanismsMechanismsIndirect Force on Long Bones
3) Angulating + Axial compression
Transverse line + Triangular
“Butterfly”
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MechanismsMechanismsIndirect Force on Long Bones
4) Angulating + Axial compression + Twisting forces
(short oblique pattern)
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MechanismsMechanismsIndirect Force On Long
Bones:-
5) Vertical compression
comminuted
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MechanismsMechanismsDirection of
ForceOn CancellousBones:-
Direct OR Indirect Comminuted
Pattern Burst
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MechanismsMechanismsForce due to Resisted
Muscle Action:-
“Avulsion” Transverse
pattern
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I- HISTORY
II- EXAMINAION A- General B- Local
III- INVESTIGATIONS
DiagnosisDiagnosis
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I- HISTORY 1) Trauma * Pathological (trivial) * Non-pathological ( magnitude)2) Mechanism * Fall from height, * RTA, pedestrian, Driver….?
DiagnosisDiagnosis
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I- HISTORY 3) Complaint: a) Pain sharp, increase by
movement, Not radiating b) Loss of Function c) Deformity d) Symptoms of complications e) Other organs: head, chest, abdomen
DiagnosisDiagnosis
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II- EXAMINATION
A- General examination
B- Local examination
DiagnosisDiagnosis
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A- General examination :
1) Signs resulting from fracture or trauma: a) Vital signs, Shock A,B,C b) Associated Head, Chest, Abdomen 2) Signs related to cause of fracture: Pathological # …CA Lung, Prostate..
DiagnosisDiagnosis
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B- Local Examination• LOOK : Skin damage, deformity, swelling• FEEL : Localized tenderness• MOVE : Abnormal movement, crepetus• DO : a) Special tests : Circulation & Nerves b) Measurements : shortening [Always compare]
DiagnosisDiagnosis
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DiagnosisDiagnosisINVESTIGATIONS X-RAY:-
A- Essential requirements: 1) Two views AP & Lateral.
2) Two joints Above & below #.
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INVESTIGATIONS X-RAY:-B- Occasional Requirements * Two Limbs “ Compare “ * Two Occasions “Scaphiod” * Special X-rays Stress, CT..
DiagnosisDiagnosis
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DiagnosisDiagnosis
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C- Description of X-ray : 1) Situation : side, site, localization 2) Pattern : line of fracture 3) Displacement : a) Shift : lateral,medial,anterior,posterior b) Tilt : angulations c) Twist : rotation , internal, external d) Shortening: overriding, impaction
DiagnosisDiagnosis
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Repair of FractureRepair of Fracture
A - Primary repair
• With Rigid Internal Fixation• No Callus formation• Active Haversian remolding• Long time
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Repair of FractureRepair of Fracture
B - Secondary Repair
• Without rigid fixation
• Commonest type even with I.F.
• Stages :
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Repair of FractureRepair of Fracture
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Time Factor- Perkin’s formulaTime Factor- Perkin’s formula
Union Consolidation
Upper limb Spiral 3Transverse 6
6 weeks 12 =
Lower Limb Spiral 6Transverse 12
12 = 24 =
Children Half this time is needed