ortho 03 principle of closed reduction in fracture and dislocation
108 likes20,752 views
The document discusses the principles of closed reduction for fractures and dislocations. It covers recognizing the pathology, adequate anesthesia, using proper technique, and achieving an acceptable reduction with the bones concentric and in proper alignment. Acceptable reductions are more achievable in younger patients and fractures farther from joints, while reductions are more likely to fail in displaced fractures involving both bones or fractures near joints.
ortho 03 principle of closed reduction in fracture and dislocation
- 1. Principle of closed reduction in fracture and dislocation Department of Orthopaedic Surgery Faculty of Medicine Siriraj Hospital Mahidol University
- 2. Principle of closed reduction Recognition the pathologies Associated injury Deforming forces Adequate anesthesia Good team Good technique Acceptable reduction Retention
- 3. Recognizing the pathology Type of fracture/dislocation Deformities (including the deforming forces)
- 4. Signs and symptoms of fracture/dislocation Pain Swelling Tenderness Deformities Limit ROM Stepping Crepitus
- 7. Mode of failure Tension
- 8. Mode of failure Compression
- 9. Mode of failure Shear
- 10. Mode of failure Bending Tension Compression
- 11. Mode of failure Torsion Tension Compression Shear
- 12. Mode of failure Crush Tension Compression Shear
- 14. Anesthesia Local Hematoma block Regional block General General anesthesia Sedation using morphine, benzodiazepine
- 16. Reduction technique with or without assistances
- 17. Principle of reduction Traction based technique Increase deformities Reverse mechanisms Forces using: Constance Shaking for muscle relaxation
- 18. Sequences of fracture reduction Traction Increase deformity Reverse deformity 3 point bending
- 19. Ligamentotaxis Tension applied across a fracture site Realign the fracture fragments by the surrounding intact soft tissue Soft tissue hinge eg. Periostium Perform early after injury
- 20. Shoulder dislocation Siriraj reduction technique Usually no need the anesthesia Supine position Gentle longitudinal traction and external rotation Gradual abduction Usually reduce around 120 deg of abduction
- 21. Traction based
- 22. Hip dislocation (Allis method)
- 23. Acceptable reduction? Mainly focus on fracture not dislocation Joint must be congruent and concentric
- 24. Acceptable reduction? Functional concern Mechanics Shortening Apposition Sagital, coronal plane malalignment Axial malalignment is not accepted (rotation)
- 25. Acceptable reduction? More acceptable in: Young age eg. Bayonette # Far from the joint Compensation Less acceptable in: # Near the joint Intraarticular involvement
- 26. Immobilization alone (no reduction needed) Non displaced fracture Isolated fibular fracture Acceptable alignment Pediatric # shaft of femur Bayonett apposition
- 27. High failure rate of reduction in: Avulsion fracture Unstable fracture Displaced fracture both bone of forearm But realign the fracture Except # BB in children Fracture that won’t heal Fracture neck of femur in elderly
- 28. Common fracture in upper extremities Distal end of radius Boxer’s (neck of 5 th MCB) Humerus Neck of humerus Shaft Supracondyle Clavicle
- 31. Common fractures in lower extremities Common Fracture in Adult Femoral shaft Tibia and fibular Ankle
- 33. Common fractures in lower extremities Common Fracture in Elderly Femoral neck Intertrochanteric
- 35. Fracture of the spine C-spine Odontoid Compression Burst Fracture dislocation Thoracolumbar Compression Burst Fracture dislocation
- 38. Commonly missed conditions Scaphoid fracture Perilunate dislocation Forearm fracture with radioulnar joint dislocation Pediatric fracture around the elbow Supracondyle Lateral condyle Medial condyle Nerve injury eg. Axillary nerve Occult fracture Obese patients Uncommon injuries eg. Posterior shoulder dislocation Impact fracture neck of femur
- 39. Occult fracture Not visible in an x-ray within 1-2 day of injury Become visible Within 3-4weeks At the time that healing
- 40. Obese
- 42. Management problems? Fracture dislocation Complex dislocation eg. MCP joint Fracture of necessity eg. Monteggia’s, Galeazzi’s
- 46. Fracture healing Clinical union Timing No false movement No local tenderness of #site Axial loading Bending Rotation Radiographic union Crossing trabeculae Absent fracture line