Dislocation of joints and fracture of bones
- 1. Complications of Fracture / Dislocations Non union, Malunion, Avascular Necrosis
- 2. Complication of fractures ( early ) • Visceral injury • Neurovascular injury • Compartment syndrome • Gas gangrene • Hemarthrosis • Wound infection
- 3. • Delayed union • Non union • Malunion • Volkman’s Contracture • Avascular necrosis • Osteoarthritis Complication of fracture ( late)
- 4. Non Union When a broken bone fails to heal
- 5. ● Contact ○ was there sufficient contact between the fragments ● Alignment ○ Was the fracture adequately aligned, to reduce shear? ● Stability ○ Was the fracture held with sufficient stability? ● Stimulating ○ Was the fracture sufficiently ‘stimulated’? (e.g. by encouraging weightbearing). Patient-related reasons ● Poor soft tissue (from either the injury or surgery) ● Drug abuse ● Antiinflammatory or immunosuppressant medication ● Non-compliance Causes
- 6. Hypertrophic non-union ● Bone ends enlarged. ● Osteogenesis still active but not capable of bridging the gap Atrophic non-union ● bone ends are tapered or rounded with no suggestion of new bone formation. ● osteogenesis seems to have ceased Types of non-union
- 7. Management Conservative Operative ● If asymptomatic, no treatment is needed or at most, a removable splint is needed ● If symptomatic and hypertrophic, functional bracing may be sufficient but splintage is often prolonged ● If symptomatic and atrophic, pulsed electromagnetic fields (PEMF) and low intensity pulsed ultrasound (LIPU) can also be used to stimulate union ● If hypertrophic, very rigid fixation may be sufficient to aid union ● If atrophic, fibrous tissue in the fracture gap, sclerotic bone ends is excised and bone grafts are packed around the fracture
- 8. Malunion Occurs when the fragments join in an unsatisfactory position (unacceptable angulation, rotation or shortening)
- 9. 1. Failure to reduce a fracture adequately 2. Ineffective immobilization 3. Gradual collapse of comminuted or osteoporotic bone Causes ● Swelling ● Pain ● Tenderness ● Difficulty bearing weight ● Obvious deformity ● Rotational deformity Clinical Features
- 10. ADULTS ● Fractures should be reduced as near to the anatomical position as possible. ● Angulation of more than 10-15 degrees in a long bone or noticeable rotational deformity may need correction by re-manipulation, or by osteotomy and fixation Management CHILDREN ● Angular deformity near the bone ends will usually remodel with time ● Rotational deformity will not LOWER LIMB SHORTENING ● Shortening <2cm - compensated by shoe raise ● Shortening >2cm - limb length equalizing procedure may be indicated
- 12. A vascular necrosis ? Avascular necrosis is a disease that results from the temporary or permanent loss of blood supply to the bone. When blood supply is cut off, the bone tissue dies and the bone collapses.
- 13. 1st 2nd 3rd Pelvic , femoral head knee, talus, and humeral other bones of the body, such as the carpus and jaw Common Sites
- 14. Causes of Avascular necrosis Mnemonic : AVASCULAR ~ Aspirin and other NSAID ~ Vasculitis ~ Alcoholism ~ Sepsis and steroids ~ Cushing ‘s / conception ~ Under water diving ~ Liver diseases ~ Abnormal bleeding ~ Radiotherapy
- 17. Clinical finding of AVN Neurological deficicit Joint deformity and swelling Initially will be asymptomatic and unrevealing Tenderness around the affected joint Restricted and painful of active and passive movements 04. 05. 01. 02. 03.
- 18. Xray finding 1. Area of lucency 2. Flattening of joint surface
- 20. 3.
- 22. 4.Crescent sign refers to a linear cleft due to a subchondral fracture
- 26. MRI Finding
- 29. Management & treatment The gold of the treatment is to reduce the pain and ensure the function of the affected join and reduce the progression of bone damage
- 32. CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon, and infographics & images by Freepik Thanks!