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.
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
7.
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
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.
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
