1. Principles ofPrinciples of
Fracture TreatmentFracture Treatment

2. Definition of FractureDefinition of Fracture
• It is disruption of bone continuity.It is disruption of bone continuity.
Although most of #s occur as a resultAlthough most of #s occur as a result
of a single episode by a force powerfulof a single episode by a force powerful
enough to fracture a normal bone, thereenough to fracture a normal bone, there
are 2 types of # in which this is not so :are 2 types of # in which this is not so :
1.1. Pathological fract.Pathological fract.
2.2. Stress fract.Stress fract.

3. Pathological fracturePathological fracture::
It is one in which a bone isIt is one in which a bone is
broken through an areabroken through an area
weakened by pre-existingweakened by pre-existing
disease , & by a degree of forcedisease , & by a degree of force
that would have left normalthat would have left normal
bone intact e.g osteoporosis ,bone intact e.g osteoporosis ,
O.M. , bone tumours.O.M. , bone tumours.

4. Stress fractureStress fracture::
Bone , like other materials ,Bone , like other materials ,
reacts to repeated loading . Onreacts to repeated loading . On
occasion , it becomes fatiguedoccasion , it becomes fatigued
& a crack develops e.g military& a crack develops e.g military
installations , ballet dancers &installations , ballet dancers &
athletes.athletes.

5. DiagnosisDiagnosis
• Clinical pictureClinical picture
• RadiographyRadiography

6. Clinical Features ofClinical Features of
FractureFracture
• History of traumaHistory of trauma
• Symptoms & signs:Symptoms & signs:
1. Pain & tenderness 2. Swelling1. Pain & tenderness 2. Swelling
3. Deformity 4. Crepitus3. Deformity 4. Crepitus
5. Loss of function 6. Abnormal move.5. Loss of function 6. Abnormal move.
7. N.V. injuries7. N.V. injuries

8. Radiographic FindingsRadiographic Findings
• Plain x-ray: should show joint abovePlain x-ray: should show joint above
& joint below , in at least 2 views ,& joint below , in at least 2 views ,
special views on request.special views on request.
• C.T.C.T.
• MRI : It is not helpful in fract.MRI : It is not helpful in fract.
diagnosis other than delineatingdiagnosis other than delineating
associated injuries to the CNS , S.T.associated injuries to the CNS , S.T.
disruption or occasionally fatiguedisruption or occasionally fatigue
fract.fract.

9. FractureFracture
ClassificationClassification
• Anat. LocationAnat. Location
• Direction of fract.Direction of fract.
LineLine
• Wherther the fract.Wherther the fract.
Is linear orIs linear or
comminutedcomminuted
• Condition ofCondition of
overlying S.T.overlying S.T.
• Mechnism of injuryMechnism of injury
• AO classificationAO classification

10. AO ClassificationAO Classification
• A :A : Simple fract.Simple fract.
• B :B : Wedge fract.Wedge fract.
• C :C : Complex fract.Complex fract.

11. AO ClassificationAO Classification
A= simple fract.
A1 simple fract.
Spiral
A2 simple fract.
Oblique(≥30)
A3 simple fract.
Transverse(<30)

13. AO ClassificationAO Classification
B1 wedge fract
Spiral wedge
B2 wedge fract
Bending wedge
B= wedge fract.
B3 wedge fract
fragmented wedge
B= Wedge fract.
B1 wedge fract
Spiral wedge
B2 wedge fract
Bending wedge
B3 wedge fract
fragmented wedge

14. AO ClassificationAO Classification
C= complex fract.
C1 complex fract.
spiral
C2 complex fract.
segmental
C3 complex fract.
irregular

18. OPEN AND CLOSEDOPEN AND CLOSED
FRACTURESFRACTURES

20. Mechanism of InjuryMechanism of Injury
ClassificationClassification
• Direct traumaDirect trauma
• Indirect TraumaIndirect Trauma

21. Direct traumaDirect trauma::
• Tapping fracturesTapping fractures
• Crushing fracturesCrushing fractures
• Penetrating fracturesPenetrating fractures
- High velocity missiles > 2500 f/s- High velocity missiles > 2500 f/s
- Low velocity missiles < 2500 f/s- Low velocity missiles < 2500 f/s

22. Indirect TraumaIndirect Trauma::
• Traction or tension fract.Traction or tension fract.
• angulation fract.angulation fract.
• Rotational fract.Rotational fract.
• Compression fract.Compression fract.

23. FractureFracture
ManagementManagement

24. Fracture ManagementFracture Management
• Emergency careEmergency care –– (splinting)(splinting)
• Definitive fracture treatmentDefinitive fracture treatment
• RehabilitationRehabilitation

25. Emergency careEmergency care –– (splinting(splinting((
• Splint them where they lie.Splint them where they lie.
• Adequate splinting is desirable , why ?Adequate splinting is desirable , why ?
• Types of splints :Types of splints :
- improvised- improvised
- conventional- conventional

26. Definitive fractureDefinitive fracture
treatmenttreatment
The goal of fracture treatment is to obtain union
of the fracture in the most anatomical position
compatible with maximal functional return of the
extremity.
• ConservativeConservative
• OperativeOperative

27. ConservativeConservative
• Reduction : if displacedReduction : if displaced under G.A. theunder G.A. the
sooner the better.sooner the better.
steps :- traction , align (which fragment),steps :- traction , align (which fragment),
reverse mechanism of injury.reverse mechanism of injury.
• Immobilization : POP cast , slab ,Immobilization : POP cast , slab ,
traction (fixed or balanced).traction (fixed or balanced).
• Rehab.Rehab.

29. CLOSED, UNDISPLACED
CLOSED, REDUCIBLE
 CONSERVATIVE
TREATMENT
2- CAST
Below Knee
Above Knee

30. POPPOP (Plaster Of Paris(Plaster Of Paris((

31. POPPOP Slab or SplintSlab or Splint

32. TractionTraction

33. OperativeOperative
• ORIF (open reduction internalORIF (open reduction internal
fixat.)fixat.)
• Percutineous pinningPercutineous pinning
• External fixationExternal fixation

34. Indications of ORIFIndications of ORIF
- absolute- absolute
- relative- relative

36. Types of Internal FixationTypes of Internal Fixation
- Pin & wire fixat.- Pin & wire fixat.
- Screw fixat.- Screw fixat.
- Plate & screws fixat.- Plate & screws fixat.
- Intra-medullary fixat.- Intra-medullary fixat.

37. Plate & screws fixatPlate & screws fixat..
Functional types:Functional types:
• Compression platesCompression plates
• Neutralization platesNeutralization plates
• Buttress platesButtress plates
• Bridge platesBridge plates
• LC- DCPLC- DCP
• Liss platesLiss plates
• Locking plates & screwsLocking plates & screws

40. Intra-medullary fixatIntra-medullary fixat..
• Centro-medullaryCentro-medullary
- Unlocked- Unlocked
-Interlocking(static-Interlocking(static –– dynamicdynamic –– doubledouble
locked)locked)
• CondylocephalicCondylocephalic
• CephalomedullaryCephalomedullary

45. CONTRAINDICATIONS TO
SURGICAL REDUCTION AND
STABILIZATIONSituations in which there is a high probability for
failure with operative treatment are as follows:
1. Osteoporotic bone that is too fragile to allow
stabilization by internal or external fixation.
2. Soft tissues overlying the fracture or planned
surgical approach of such poor quality because of
scarring, burns,active infection, or dermatitis .
3. Active infection or osteomyelitis.
4. Fracture comminution to a degree that does not
allow successful reconstruction. This is most
commonly seen in severe intraarticular fractures.
5. General medical conditions that are contraindications
to anesthesia are generally contraindications to the
surgical treatment of fractures.
6. Undisplaced or stable impacted fractures in
acceptable position do not require surgical exposure
or reduction.
7. Inadequate equipment, manpower, training, and

46. RehabilitationRehabilitation
• When ?When ?
• How ?How ?

47. External fixatExternal fixat..
• Advantages.Advantages.
• Disadvantges.Disadvantges.
• Complications.Complications.
• Indications.Indications.

48. FrameFrame

51. Thank youThank you