orthopaedic Fracture disease

1. Fracture diseases
Dr. Arhab Alshabi
Resident Orthopaedic Surgery

2. Definition:
it is the complication of fracture treatments due to
prolong immobilisation .

3. Principle of fracture treatment:
- anatomical reduction
- rigid fixation
-preservation of soft tissue
-Early Active Mobilisation

5. The fracture Diseases include:
- Musculoskeletal.
-Cardiovascular.

6. Musculoskeletal:
-muscle weakness, atrophy
- Soft tissue Contracture.
- Osteoporosis
- Joint Stiffness.
- Skin Atrophy
Cardiovascular:
- Increase the hart rate ,circulatory dysfunction.
- Orthostatic hypotension.
- venous Thromboembolism, pulmonary problem.

7. Muscle weakness:
- it is the most obvious effect of prolonged Immobilisation
,muscle at complete rest loss about 10-15 % of it’s strength
in each week.
- Half of normal strength loss within 3-5 weeks of
immobilisation .
- First muscle become weak and atrophy are those of lower
extremities .
- muscle strength can be maintain without loss or gain with
daily muscle contraction.
- Unfortunately the rate of recovery from weakness is slower
than rate of loss.

8. Muscle Atrophy :
-It is the loss of muscle mass.
normal muscle at rest loss half of their bulk after 2 months .
Soft tissue Contracture :
The connective tissue contain collagen fibbers that maintain
the muscle length if frequently stretching , but shorten if
immobilised which lead to contracture.

10. Disuse Osteoporosis:
Like connective tissue ,bone is dynamic tissue ,the constant
equilibrium is maintain between the bone formation and desorption of
bone density depend on force that act upon bone.
Joint stiffness:
- it’s limitation of movement , after periods of inactivity.
Skin atrophy :
- decrease circulation in skin due to pressure in immobilisation
patient then ischemia ,skin breakdown and ulcer .

12. Cardiovascular:
Prolonged immobilisation stimulate sympathetic nerve system
activity ,increase the heart rate ,less diastolic filling time ,shortened
systolic ejection end by circulatory dysfunction.
venous thromboembolism and pulmonary
problem :
Due to venous stasis in the leg following decrease contraction of
Gastrocnemius ,solus muscle the emboli formation.
may occur within 7-10 days of immobilisation.
characteristic by pain, tenderness, swelling, venous distension, in
the calf muscle and confirm by Doppler study .

14. Prevention:
-Proper fixation (rigid fixation)
-free pain early mobilisation and as soon as pt.'s can.
-Daily muscle stretching ,contraction for 20-30 seconds.
- ROM of adjacent joint below and above the fracture.
-leg stocking to prevent DVT
-anticoagulant ,antiplatelet drugs
-change patient position every 2H.

16. Thank You
Prepared by :Arhab Alshabi