General principles of fractures
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General Principles of Fractures
Muhammad ShahiduzzamanProfessor and Head
Department of Orthopaedic SurgeryDhaka Medical College
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Definition
• Break in the continuity of bone.
• It is basically a soft tissue trauma where the bone happens to be broken.
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Types of Fractures
• Simple or ClosedBone can break within its soft tissue envelope and may not communicate to the exterior.
• Compound or OpenWhen the fracture haematoma communicates with the exterior.
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Types of fracture..
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Types of fracture
Based on extent of fracture line:• Incomplete Fracture• Complete Fracture – Displaced, Undisplaced
Based on fracture pattern :• Linear fractures- Transverse, oblique, spiral• Comminuted Fractures.• Segmental fractures
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Types of Fracture
• Atypical Fractures1. Greenstick fractures2. Impacted fractures3. Stress or fatigue fractures4. Pathological fractures5. Hairline or crack fracture6. Torus fracture
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Types of Fracture
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Types of Fracture
Depressed # Compression #
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Remember
• Greenstick fracture-occurs in children.• Stress fracture- common in athletes.• Fatigue fracture- in occupation like police• Pathological fractures-usually seen in elderly.
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Approach to Orthopaedic injury
• History• Age: Birth, early childhood, Late childhood
Adult, Elderly.• Sex • Mechanism of injury
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Clinical Features
Symptoms: Pain, Swelling, deformity, inability to use the
affected part.O/E Look – Deformity, swelling, ShorteningFeel: Tenderness, Move : Abnormal mobility, Crepitus
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Remember
• Clinical manifestation in a fracture is due to : Fracture per se ,Its complications
or bothImpendening vascular damage is detected by
five ‘P’ Pain, Pallor, Paraesthesia, Pulselessness, Paralysis
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Investigations in Orthotrauma
• Radiography- most important diagnostic tool for fractures. Minimum two views (AP and Lateral) are required.
• Sometimes an oblique and other special views are required.
• CT Scan and MRI – both are noninvasive and extremely useful in detecting both soft tissue and bony injury.
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Remember the rules in X-ray• Better no X-ray than one
view X-ray• X-ray is a shadow. It
conceals and distorts so Interpret x-ray with caution.
• A joint above and joint below should be included with the fracture under study.
• Read x-ray holding it in anatomical position.
• Exposure should be adequate.
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Management of Fracture
• The goal of fracture management is to restore the anatomy back to its normal or near to normal as possible.
• The responsibility of the doctor is to ensure that there is no functional disability to the patient following the treatment of fracture.
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Management of fractures
Can be discussed under the following :
• Management of closed uncomplicated fracture
• Management of open fracture• Management of complicated fracture.
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Management of closed fracture
• Managed by conservative or operative methods.
• Conservative methods :• For undisplaced #,incomplete #,Impacted # :
Collar and cuff sling, Strapping, plaster slab, • For displaced fracture : the aim is to restore
anatomy as near as possible by either closed or open reduction.
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Management of Closed fracture
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Management of # by closed reduction
• Resuscitation, • Reduction • Retention• Rehabilitation
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Fracture management by open reduction
• Where closed reduction fails• Displaced intra articular fractures• Type III and IV epiphyseal injuries• Major avulsion fracture• Nonunion• Multiple fractures
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Retention after open reduction• Fracture fragments invariably needs to be fixed by
various implants.
Choice of implants• K-wire• Intramedullary nails• Plate and screw• Interlocking nail• Hip implants, Spine implants, Steel wires
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Implants for Retention
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Remember
Success by open reduction depends on :
• Proper indication• Proper timing• Proper Surgical approach• Proper technique• Proper selection of implant• Proper Surgeon
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Thank Youfor
your attention