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Alvin B. Ramirez

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I.F.

44 years old

Single Filipino

Roman Catholic

Residing in Sta. Cruz, Manila

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Pain on left knee

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10 hours PTA pulled over service road of EDSA

lost balance

motorcycle fell on left thigh

rushed to hospital

x-ray: comminuted fx of left tibia

transferred to our institution

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No history of previous hospitalizations and surgeries

Non-Hypertensive

Non-DM No heart diseases

No pulmonary diseases

No allergies to foods and drugs

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(+) HPN: maternal lineage

(+) DM: maternal lineage

No other heredofamilial diseases

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Patient is an Operations Engineer

Non-smoker

Occasional alcoholic beverage drinker Denies illicit drug use.

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General: no fever, no weight loss

Skin: no pruritus, no rashes

Head: no headache, no dizziness Eyes: no blurring of vision, no diplopia

Ears: no vertigo, no tinnitus, no hearing loss

Nose: no epistaxis, no colds

Throat: no dysphagia

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Respiratory: no cough, no difficulty of breathing

Cardiovascular: no chest pain, no orthopnea, no

palpitation GIT: no diarrhea, no vomiting, no nausea

Genitourinary: no dysuria, no hematuria, no nocturia,no frequency

Musculoskeletal: (+) pain on left knee area

Nervous system: no loss of consciousness, no seizures

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General Survey: The patient is awake, conscious,coherent and not in cardio-respiratory distress.Patient was transferred to our institution viaambulance, stretcher-borne with posterior splint onleft knee area.

Vital Signs:BP: 130/90 mmHg HR: 88 bpm

RR: 18 cpm T: 36.7 C

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Skin: no rashes, good skin turgor HEENT: anicteric sclerae, pink palpebral conjunctiva; no

nasoaural discharge, no tonsillopharyngeal congestion, nocervical lymphadenopathy. Chest/Lungs: Symmetrical chest expansion, no retraction,

clear breath sounds

Heart: Adynamic precordium, normal rate, regularly

rhythm, no murmur

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Abdomen: flabby, normoactive bowel sounds, soft,non-tender.

Extremities: (+) splint on left lower extremity

(+) limitation of ROM of left knee

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BUN Creatinine

Na

K

Blood exam

ECG

X-ray

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Closed, complete, comminuted intercondylar fracture

of left tibia 2 to vehicular accident

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Break in the continuity of bone, cartilage, or both

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CLOSED (SIMPLE) Fracture: skin intact

no communication with outside environment

OPEN Fracture: disruption of skin

allows communication with the outside environment

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COMPLETE Fracture: Entire circumference or cortical surfaces have been

disrupted.

INCOMPLETE Fracture: Break in cortex does not extend completely through the

bone

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Bowing plastic response, usually to longitudinal stressin a bone

Greenstick perforates one cortex and ramifies withinthe medullary bone

Torus (buckling) results from an injury insufficient inforce to create a complete discontinuity of bone butsufficient to produce buckling of the cortex

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TYPES OF LINEAR FRACTURES

Transverse

Oblique

Oblique-Transverse

Spiral

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COMMINUTED Fracture:

Fracture with more than two fracture fragments

The greater the applied force and the more rapid itsapplication, the greater the energy absorption by thebone and the more severe the comminution.

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Butterfly fragment:

Segmental fracture:

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Occurs when an osseous fragment is pulled from the

parent bone by a tendon or ligament.

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Results when one fragment of bone is driven into an

opposing fragment

Types:

Depression fracture

Compression fracture

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PATHOLOGIC Fractures:

The bone is disrupted at the site of preexistingabnormality, frequently by a stress that would not have

fractured a normal bone.

Absence of a history of trauma or fracture pain and thepresence of signs and symptoms of preexisting

abnormality, such as angular deformity, painlessswelling, or generalized bone pain, are clinical aids todiagnosis.

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STRESS Fracture:

Can occur in normal or abnormal that is subjected torepeated cyclic loading with a load less than that whicj

causes acute fracture of bone.

TYPES:

Fatigue fracture application of abnormal stress on abone with normal elastic resistance

Insufficiency fracture normal stress is placed on a bonewith deficient elastic resistance

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I. REACTIVE PHASE

A. Inflammatory phase

B. Granulation tissue fromation

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II. REPARATIVE PHASE

A. Cartilage callus formation

B. Lamellar bone deposition

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REMODELLING PHASE

A. Remodelling to original bone contour

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A. Delayed Union

B. Nonunion

C. Malunion

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control hemorrhage

provide pain relief

remove potential source of contamination closed reduction

casting

traction (skin and skeletal)

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Treatment goals:

A. Anatomic reduction of the fracture fragments: For thediaphysis, anatomic alignment ensuring that length,angulation, and rotation are corrected is required,

whereas intra-articular fractures demand an anatomicreduction of all fragments.

B. Stable internal fixation to fulfill biomechanical demands

C. Preservation of blood supply to the injured area of the

extremityD. Active, pain-free mobilization of adjacent muscles and

joints to prevent the development of fracture disease

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Open Reduction Internal Fixation (ORIF)

The objectives of ORIF include adequately exposing

the fracture site and obtaining a reduction of thefracture. Once a reduction is achieved, it must bestabilized and maintained.

Use of Kirschner wires (K wires) Use of plates and screws

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Thank You!