Principle of fracture management
- 1. PRINCIPLE OF FRACTURE MANAGEMENT Dr.Tusher Kanti Mozumder Assistant Registrar Dept.of Orthopaedics Sylhet Women’s Medical College Hospital
- 2. Fracture is a break in the continuity of bones and cartilage .
- 4. Principle of treatment Recognitation Resuscitation Reduction (displacement) Immobilization Follow up Rehabilitation
- 5. Clinically fractures are either Close Open / compound Aetiologicaly Pathological and Traumatic
- 8. Open fracture When fracture site communicates with external enviornment
- 10. Type 1
- 11. Type 2
- 12. Type 3
- 13. Once the initial assessment, evaluation, and management of any life-threatening injury are completed, the open fracture is treated. Hemostasis should be obtained if there is significant ongoing bleeding, though bone bleeding is best reduced by anatomic reduction.
- 14. Gross contaminants can be removed if possible and the soft-tissue wound can be covered by a sterile dressing moistened with normal saline. Tetanus immunization should be provided if the patient does not have current immunity.
- 15. Management of Open Fracture Emergency care of a fracture begins at the site of accident. In principle it consists of RICE ,which means Rest to the part by splinting Ice therapy, to reduce occurrence of swelling Compression to reduce swelling Elevation to reduce swelling
- 16. At the site of accidient The following measures are taken 1.The bleeding from the wound is stopped by applying firm pressure using a clean piece of cloth. 2.The fracture is splinted
- 17. In the emergency department 1.Wound care– The wound is washed with saline under strict aseptic condition and covering it with sterile dressing. 2. Limb is immobilized with appropriate splint 3. Prophylactic Antibiotic 4.Tetanus prophylaxis 5. Analgesics 6. X-ray of affected limb
- 18. Fracture management Surgical toileting & wound debridement Immobilization by: 1. Plaster 2.Pin and plaster 3.External fixation 4.Internal fixation In operation theater
- 19. Pathological fracture A fracture through a bone which has been made weak by some underlying disease
- 20. Causes of pathological fracture According to Age At Birth---Osteogenesis imperfecta 0-5 years--- Osteogenesis imperfecta , Osteomyelitis 5-20 years--- Osteomyelitis , simple bone cyst , primary bone tumour 20-50 years---Cystic lession of the bone, Malignancy ,Osteomalacia ,Giant cell tumour After 50 years---Osteoporosis, Multiple myeloma Secondary bone tumour
- 21. Treatment of Pathological Fracture According to cause
- 24. Common site Shoulder --- 1.Greater tuberosity 2.Lesser tuberosity Elbow--- 1.Medial epicondyler 2.Coronoid process Hand--- 1.Base of middle phalanx 2.Distal phalanx
- 25. Pelvis & hip Iliac crest Anterior superior iliac spine Anterior inferior iliac spine Greater trochanter Lesser trochanter Ischial tuberosity
- 26. Knee Intercondylar are Tibial plateau Inferior pole of patella Tibial tuberosity Head of fibula
- 27. Ankle & foot Calcaneal tuberosity 5th Metatarsal
- 28. Sign & symptoms of Avulsion Fracture History Pain Swelling Localised tenderness Difficulty in movement Limping
- 29. Diagnosis of Avulsion Fracture Pain Swelling Difficulty in movement X ray USG MRI
- 30. Treatment According to site of involvement
- 31. Clinical feature of Fracture History of trauma Symptoms & signs: 1. Pain & tenderness 2. Swelling 3. Deformity 4. Crepitus 5. Loss of function 6. Abnormal move. 7. N.V. injuries
- 33. Swelling
- 35. Bony crepitus
- 36. Deformity
- 38. History History of trauma : Due to RTA , Physical assault , etc
- 41. Investigation X-ray of affected site / limb : at least 2 joint and 2 views (a/p or l/v) CT scan MRI
- 43. Close reduction
- 46. Indication of OR Absolute 1.Failure of close reduction 2.Displaced intra articular fracture 3.Avulsion fracture 4.Non union
- 47. Relative 1.Delayed union/Malunion 2.Multiple fracture 3.Fracture with wide gap 4.Fracture with vascular injury
- 58. Haemorrhage
- 59. Joint stifness
- 60. Malunion
- 61. Nonunion
- 68. It is very difficult to communicate with children. children fracture are special type of fracture which needs special attension for diagnosis and management
- 69. There are some fracture which are more common in children, such as 1. Epiphyseal separation 2.Grenstick fracture 3.Supracondyler fracture of humerus 4.Torus fracture 5.Plastic deformity
- 73. Torus fracture
- 75. Principle of treatment Immature skeleton differs from that of the adult in both the normal and pathological states. Capable of plastic deformation before they fail. Comminuted fractures are rare.
- 76. Failure of union is rare. Few fractures require operative treatment. Presence of growth plate presents a challenge to the surgeon. Special considerations : Pathological fractures Child abuse
- 77. Though the principles of fracture management is described under some structured headings The practical scene is different.So each case should be considered on the basis of its own merit. Every trauma patient either with or without any fracture is to be managed on principle of “Total patient management.”Resucitation” of the pt.to normal is the most importance before going to fracture managemant.
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