prof. mamoun kremli almaarefa college principles of fractures & fracture management
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Prof. Mamoun KremliAlMaarefa College
Principles of Fractures& Fracture Management
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Trauma History
Mechanism of injuryDate, time, type, method of impact, …
Consciousness
Function of injured part
Open wound / bleeding
Other injuries
Anti-Tetanus status (if skin breached)
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Type of injury
Mechanism of injury helps expect theExtent and type of bone injuryExtent of soft tissue injurySuggests treatment and reduction techniqueExpected prognosis
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Type of injury
Fall: height, point of impact, twist
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Type of injury
Fall: height, point of impact, twist
Sport: type, direction of force
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Type of injury
Fall: height, point of impact, twist
Sport: type, direction of force
Road traffic accident (RTA)):Car (MVA) , motorcycle, pedestrian
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Type of injury
Fall: height, point of impact, twist
Sport: type, direction of force
Road traffic accident (RTA)):Car (MVA) , motorcycle, pedestrian
Heavy object fall: TV, wall, metal, earthquake
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Type of injury
Fall: height, point of impact, twist
Sport: type, direction of force
Road traffic accident (RTA)):Car (MVA) , motorcycle, pedestrian
Heavy object fall: TV, wall, metal, earthquake
Assault & firearms / blast
http://simple.wikipedia.org/wiki/Blast_injury
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Mechanism of Injury
Low velocity
High velocity
Direction of force
Blunt / Sharp
Open / Closed
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Mechanism of Injury
Low velocity
High velocity
Direction of force
Blunt / Sharp
Open / Closed
http://eorif.com/
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Kinetic Energy = ½ MV2
If a Simple fall = 1
Skiing injury = 3-5
High-velocity gunshot = 20
Car bumper (25 km/hr) = 100
Energy dissipated during injury
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What is a fracture?
A fracture is a break in the structural continuity of boneAlways associated with some soft tissue
injury
A fracture is a soft tissue injury in which bone is broken!
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Fracture Classification
According to site of Fracture:DiapyhsealMetaphysealArticular
Epiphyseal (in children)
Epiphysis
Metaphysis
Diaphysis
(Shaft)
Physis
Articular Surface
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Fracture Classification
According to fracture line:Complete (usual)
Cortex fractured on both sides
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Fracture Classification
According to fracture line:Complete (usual)
Cortex fractured on both sidesIncomplete (green stick) (Torus)
One cortex fractured, the other intactIn children
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Fracture Classification
According to fracture pattern:SimpleWedge comminutedComplex comminuted
multifragmentedA
SimpleB
WedgeC
Complex
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Fracture Classification
According to type of injury (force):Ordinary fracture
Expected from force of injuryStress fracture
Repetitive stressPathological fracture
Force too weak to cause fractureBone is pathologically weak
Avulsion fractureResisted muscle action, where ligaments and
tendons pull a bone fragment off
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Stress Fractures
Bone reacts to repeated loading, may become fatigued & a crack develops
Fatigue fracturesAbnormal stress or torque on a bone that has normal
elastic resistanceExamples:
military recruits, athletes, ballet dancers
Insufficiency fracturesNormal muscular activity stresses a bone that is
deficient in mineral or elastic resistance
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Stress Fractures
Fatigue fractures2nd metatarsalTibiaFibula
Insufficiency fracturesIn osteopenia, osteomalaciaNeck of femurRibsNeck of humerusScapula
www.sanluispodiatrygroup.comwww.imaging.birjournals.org
www.studyblue.com
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Pathological fractures
Fractures may occur even with normal stresses if the bone has been weakened by a change in its structure. Seen in:
Local bone diseaseOsteomyelitisBenign tumors and Bone cystsMalignant tumors and matastasis
Generalized diseaseMetabolic: osteoporosis, riketsCongenital: osteogenesis imperfectaOthers: Paget’s disease
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Avulsion fractures
Part of bone separated by forceful sudden resisted muscle actionCaused by ligament or tendon pull on bonePart of bone avulsed – bone weaker than
tendon/ligament
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Type of injury
DirectSimple contusion or severe comminutionSoft tissue more injured
IndirectPattern of fracture depends on force directionLess soft tissue injury
Penetrating Missiles
Low velocity < 300 m/s - damage along the tractComminution
High velocity: >300m/s - sever comminutionComminution with wide soft tissue damage
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Force & fracture pattern
Fracture pattern suggests mechanism of force
Spiral: (twisting)
Short oblique: (compression)
Wedge: (compression + bending)
Transverse: (angulation) (avulsion)
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Force & fracture pattern
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AO/OTA fracture classification
A comprehensive universal classification system that describes the injury, guides treatment, and suggests prognosis
Based on a five-part code:
— .Bone Segment Type Group Subgroup
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AO/OTA fracture classification
Bone:
— .Bone Segment Type Group Subgroup
1 2 3 4
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AO/OTA fracture classification
Location:
1
2
3
1
2
3
— .Bone Segment Type Group Subgroup
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AO/OTA fracture classification
Type:
ASimple
BWedge
CComplex
— .Bone Segment Type Group Subgroup
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AO/OTA fracture classification
Group:
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— .Bone Segment Type Group Subgroup
1 2 A 2
AO/OTA fracture classification
Humerus
Diaphysis
Simple
Oblique
Bone
Segment
Type
Group
1
2
A
2
Subgroup
Middle 2
2
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Displacement
Described as: Distal in relation to proximal
Un-displaced
ShiftSidewaysShorteningDistraction
Angulation In all planes
Rotation
SHIFT ANGULATION /TILT
TWIST/ROTATION
Sideways Overlap Impaction