Introduction to fractures
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This document provides a comprehensive overview of fractures, including definitions, mechanisms, classifications, management strategies, and healing processes. It differentiates between various types of fractures and their characteristics and outlines diagnostic techniques and treatment protocols. Complications such as non-union and delayed union, along with options for bone grafting, are also discussed.
![How to maintain the reduction after closed
reduction (CR)?
• Splints
• Cast
• External fixators (Ex. Fix.) [for specific indications]](https://image.slidesharecdn.com/introductiontofractures-180121171228/85/Introduction-to-fractures-55-320.jpg)
Introduction to fractures
- 1. Introduction to Fractures Dr. Yasser Alwabli
- 2. Contents • Definitions • Mechanisms • Classifications • Fracture description • Management – conservative or surgical • Fracture healing • Complications • Non-union and delayed union • Bone grafts
- 3. Axial skeleton vs Appenicular skeleton Long bone vs flat bone
- 4. What is a fracture? • Discontinuation in the bone cortex • A broken bone Normal Fractured
- 5. • fracture extends 360° of bone circumference (all around) Complete fracture
- 6. • Incomplete: seen almost in children: • Greensick Incomplete fracture
- 7. • Mechanism: • High energy vs. low energy • Multiple injuries vs. isolated injury. • Pathological fracture: normal load in presences of weakened bone (tumor, osteoporosis, infection) • Stress fracture: normal bone subjected to repeated load (military recruits).
- 8. Fracture patterns (descriptive classification) • Transverse • Oblique • Comminuted • Spiral • Segmental • Impacted • Avulsed
- 11. • Transverse: loading mode is bending
- 12. • Oblique: loading mode is compression.
- 13. • Spiral: loading mode is torsion.
- 14. • Fracture with Butterfly fragment: loading mode is bending and compression
- 15. • Comminuted fracture: 3 or more fragments • Segmental fracture
- 16. Fracture description Name of injured bone Integrity of skin Skeletal maturity Location Fracture pattern Alignment
- 17. Integrity of skin Closed fracture Open fracture
- 18. Integrity of skin • Closed fracture • Skinsoft tissues intact • Open fracture • Fracture exposed to the outside environment
- 19. Skeletal maturity • Pediatric • Adult • ? Geriatric
- 20. Why pediatric fractures are unique? • Thicker periosteum • Presence of growth plate • Anatomic reduction is not necessary • Time to heal is shorter • Think of child abuse
- 24. Classifications • Why we use classifications? • Ease of communication • Occasionally helps in treatment • Research uses
- 25. Classifications • Every fracture has a unique classification system • Unified classification system, e.g. AO classification
- 26. Example: Garden classification for femoral neck fractures Type 1 Type 2 Type 3 Type 4
- 29. Diagnosis: History Patients complain of pain and inability to use the limb (if they are conscious and able to communicate) What information can help you make the diagnosis?
- 30. Diagnosis: History Onset: When and how did the symptoms begin? Specific traumatic incident vs. gradual onset? If there was a specific trauma, the details of the event are essential information: Mechanism of injury? Circumstances of the event? Work-related? Severity of symptoms at the time of injury and progression after?
- 31. Diagnosis: Physical exam Inspection Swelling Ecchymosis Deformity If fracture is open: Bleeding Protruding bone
- 32. Diagnosis: Physical exam Palpation Bony tenderness
- 33. Diagnosis: Physical exam If a fracture is suspected what should we rule out? Neurovascular injury (N/V exam) Compartment syndrome Associated MSK injuries (examine joint above and below at minimum)
- 34. How to describe a fracture Clinical parameters Radiographic parameters
- 35. Clinical Parameters Open vs. closed ANY break in the skin in proximity to the fracture site is OPEN until proven otherwise Neurovascular status Presence of clinical deformity
- 36. Location Which bone? Which part of the bone? Epiphysis -intraarticular? Metaphysis Diaphysis -divide into 1/3s Use anatomic landmarks when possible e.g. medial malleolus, ulnar styloid, etc
- 37. Location • Epiphyseal • Metaphyseal • Diaphyseal • Physeal (growth plate) • Articular
- 38. Pattern Simple vs. comminuted Complete vs. incomplete Orientation of fracture line Transverse Oblique Spiral
- 39. Displacement Displacement is the opposite of apposition Position of distal fragment relative to proximal Expressed as a percentage
- 40. Angulation Deviation from normal alignment Direction of angulation defined by apex of Expressed in degrees
- 41. Fracture description: Summary Clinical parameters Open vs. Closed Neurovascular status Clinical deformity Radiographic parameters Location Pattern Displacement Angulation Shortening
- 42. Exercises
- 47. Bone healing
- 48. Fracture healing
- 49. • Primary bone healing : 1. Absolute fixation 2. No callus formation 3. Plate • Secondary bone healing : 1. Relative fixation 2. callus formation 3. Cast + Nail + EX- fix
- 52. Management • Reduction (if needed) • Maintain reduction • Rehabilitation
- 53. General scheme for fracture management • Follow trauma protocols • Immobilize the limb • X-Ray the injured bone • Determine the fracture pattern • Plan treatment accordingly • Reduce if needed (closed) • X-Ray after reduction • Immobilize and follow • Rehabilitate early
- 55. How to maintain the reduction after closed reduction (CR)? • Splints • Cast • External fixators (Ex. Fix.) [for specific indications]
- 58. What if closed reduction failed? • May need re-reduction • Other options? • Open reduction • aka needs Surgery
- 59. How to maintain reduction after open reduction (OR)? • Internal fixation = ORIF • The first surgery we learned is ORIF • Options • Intramedullary device, e.g. IM rod, wires • Extramedullary devices, e.g. plates and screws • Sometimes can be treated by external fixator
- 61. Summary of fracture treatment • Immobilization • Closed reduction and immobilization (stabilizationfixation) • Open reduction and external or internal fixation
- 62. Complications
- 63. Non-union and delayed union • Non-union when fracture never heals • Causes are diverse • Types • Treatment • Treatment is to optimize local and systemic factors • Almost always needs surgery • Delayed union when the fracture passes the typical time of healing of such fracture
- 64. Bone grafts • Adjuncts used to stimulate bone healing • Variety of types • Autografts • Allograft • Synthetic