General Principles of Fractures

Muhammad ShahiduzzamanProfessor and Head

Department of Orthopaedic SurgeryDhaka Medical College

Definition

• Break in the continuity of bone.

• It is basically a soft tissue trauma where the bone happens to be broken.

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.

Types of fracture..

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

Types of Fracture

• Atypical Fractures1. Greenstick fractures2. Impacted fractures3. Stress or fatigue fractures4. Pathological fractures5. Hairline or crack fracture6. Torus fracture

Types of Fracture

Types of Fracture

Depressed # Compression #

Remember

• Greenstick fracture-occurs in children.• Stress fracture- common in athletes.• Fatigue fracture- in occupation like police• Pathological fractures-usually seen in elderly.

Approach to Orthopaedic injury

• History• Age: Birth, early childhood, Late childhood

Adult, Elderly.• Sex • Mechanism of injury

Clinical Features

Symptoms: Pain, Swelling, deformity, inability to use the

affected part.O/E Look – Deformity, swelling, ShorteningFeel: Tenderness, Move : Abnormal mobility, Crepitus

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

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.

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.

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.

Management of fractures

Can be discussed under the following :

• Management of closed uncomplicated fracture

• Management of open fracture• Management of complicated fracture.

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.

Management of Closed fracture

Management of # by closed reduction

• Resuscitation, • Reduction • Retention• Rehabilitation

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

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

Implants for Retention

Remember

Success by open reduction depends on :

• Proper indication• Proper timing• Proper Surgical approach• Proper technique• Proper selection of implant• Proper Surgeon

Thank Youfor

your attention