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Dr. MSM Shiffa
Definitions A fracture is a break in the continuity of a bone
TypesFractures may be transverse, oblique or spiral in shape.
In a greenstick fracture, only one side of the bone is fractured, the other simply bends (usually immature bones).
A comminuted fracture is one in which there are more than two fragments of bone.
In a complicated fracture, some other structure is also damaged (e.g. a nerve or blood vessel).
In a compound fracture, there is a break in the overlying skin (or nearby viscera) with potential contamination of the bone ends.
A pathological fracture is one through a bone weakened by disease, e.g. a metastasis.
Common causes Fractures occur when excessive force is applied to a
normal bone
or moderate force to a diseased bone, e.g. osteoporosis
Clinical features• Pain.
• Loss of function.
• Deformity, tenderness and swelling.
• Discoloration or bruising.
• (Crepitus, not to be elicited!)
Investigations• Radiographs in two planes (look for lucencies and
discontinuity in the cortex of the bone).
• Tomography, CT scan, MRI scan (rarely).
• Ultrasonography and radioisotope bone scanning. (Bone scan is particularly useful when radiographs/CT scanning are negative in clinically suspect fracture.)
ComplicationsEarly
• Blood loss.
• Infection.
• Fat embolism.
• DVT and PE.
• Renal failure.
• Compartment syndrome.
Late
• Non-union.
• Delayed union.
• Malunion.
• Growth arrest.
• Arthritis.
• Post-traumatic sympathetic (reflex) dystrophy.
ESSENTIAL MANAGEMENTGeneral
• Look for shock/haemorrhage and check ABC
• Look for injury in other areas at risk (head and spine, ribs and pneumothorax, femoral and pelvic injury).
The fracture
Immediate
• Relieve pain (opiates i.v., nerve blocks, splints, traction).
• Establish good i.v. access and send blood for group and crossmatch.
• Open (compound) fractures require debridement, antibiotics and tetanus prophylaxis.
Definitive• Reduction (closed or open).
• Immobilization (casting, functional bracing, internal fixation, external fixation, traction).
• Rehabilitation (aim to restore the patient to pre-injury level of function with physiotherapy and occupational therapy).
Kasar
It is a tafarruk-e-itisal of a bone, i.e. discontinuity of the bone
One bone is broken into two or more pieces
Asbab Asbab-e-Sabiqa
Cause in the bone itself
Asbab-e-Waasila
External impact
Asbab-e-Sabiqa Structure and the location of the bone
Dominant side
Long bone
Thin bone
Close to the body surface
Age
2-4 yrs, 5-6 yrs, 55- 80 yrs
Sex
2-5 more in girls, 5-15 Boys, elderly - females
Diseases
Niqras, Sartan, Khanazir, bone diseases
Asbab-e-Waasila External Impact
Direct Fracture
Indirect Fracture
Muscle action
Types Kasar baseet – Simple # K. muraqqab – Compound # K. Mustaqeem – Direct K. munharif – Indirect K. Kamil – Complete K. Naqis – Incomplete K. Juzu’ee – Partial K. Suqubi – Perforated K. Inkhifazi – depressed K. inshiqaqi – fissured/ cracked K. mutauddad – comminuted K. qaleel – small K. azeem - large
Usool-e-Ilaj Splinting
Reduction
Immobilisation
Maintaining Nutrition
Fasad
Mulayyint
Muhallilat
Musakkinat
Ilaj
Ghiza
Galeez and lazjat producing food (thick and viscous)
Goat
Calf leg
Cow’s fat
Egg
Rice
Fresh fish
Galeez sharab
Do not give barid sabziyan, bird’s flesh, baby goat’s mutton in the initial stage
K. qaleel
Light massage
Oil application – R.gul
Zimad
Bandage – not too tight
Safoof-e-as
Kasar Azeem Rabat/ Bandaging
3-4 layers of bandage
1st – on the # site
2nd – distal to proximal
3rd- keep small stick and apply third layer
If it is necessary 4th layer can be applied
Every day bandage can be changed if pain exist or open wound is there otherwise every other day
Apply zimad Mom zard khalis 35 g
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