General Surgery
Mosul university- College of dentistry-oral & maxillofacial surgery departmentOrthopedics and bone infections
Fracture is a structural break in normal continuity of bone (bone wound)
FractureMosul university- College of dentistry-oral & maxillofacial surgery department
Bones are very active tissues. Each bone is made up of several types of tissues and so is an organ. Bone functions include: muscle attachment, protection and support, blood cell production, and storage of minerals.
Bone tissue
Mosul university- College of dentistry-oral & maxillofacial surgery department
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A. Support and Protection B. Body Movement - Levers C. Hematopoiesis D. Storage of Inorganic Salts - Calcium phosphate
Bone Functions
Mosul university- College of dentistry-oral & maxillofacial surgery department
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* Right Humerus
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* CopyrightThe McGraw-Hill Companies, Inc. Permission required for reproduction or display.
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Direct Indirect Types of fracture Simple , compound , comminuted , complicated , pathologic, green stick.
Mechanism of bone fracture
Mosul university- College of dentistry-oral & maxillofacial surgery department
look feel move X-ray Clinical presentation
General principles of examinationMosul university- College of dentistry-oral & maxillofacial surgery department
Haemorrhage Inflammation Hematoma Provisional callus Definitive callus Remodeling
Healing of bone fractureMosul university- College of dentistry-oral & maxillofacial surgery department
1- general factors increasing age Disease : eg DM Drugs : eg steroids Deficiency : malnutrition 2- local factors Infection Foreign body Mobility Poor vascularity irradiation
Factors affecting fracture healing
Mosul university- College of dentistry-oral & maxillofacial surgery department
1- emergency treatment ABC 2- definitive Debridment Reduction Closed Traction Open Fixation External (External pin) Internal non rigid( transosseous, intramedulary pin), rigid (screw) Immobilisation Functional rehabilitation
Management
Mosul university- College of dentistry-oral & maxillofacial surgery departmentInfection hematoma ( 5p: pain ,pallor, pulseless, paresthesia, paralysis) Shock Crush syndrome Compartment syndrome Non union Delayed union Malunion Disuse osteoporosis Myositis ossificans
Complication of bony fractures
Mosul university- College of dentistry-oral & maxillofacial surgery departmentOsteomyelitis: Inflammation of bone and marrow Types 1-Pyogenic osteomyelitis: Always caused by bacteria Routes of infection Hematogenous spread Extension from a contiguous site Direct implantation 2- Tuberculous osteomyelitis
Osteomyelitis
Mosul university- College of dentistry-oral & maxillofacial surgery departmentMosul university- College of dentistry-oral & maxillofacial surgery department
OsteomyelitisSequestrum (necrotic bone) Involucrum (new bone) Signs and Symptoms Constant bone pain Swelling Tenderness Warmth at site Continuous Drainage
Mosul university- College of dentistry-oral & maxillofacial surgery department
Osteomyelitis
Lab study:WBC May be elevated, Usually normal C-Reactive Protein (CRP) Erythrocyte Sedimentation Rate (Usually is elevated at presentation Falls with successful therapy)Blood cultureImagingRadiology:NormalSoft tissue swellingPeriosteal elevationLytic changeSclerotic change Mosul university- College of dentistry-oral & maxillofacial surgery department
Diagnosis:
Vigorous and prolonged intravenous (IV) antibiotic therapy Treatment of choice for acute osteomyelitis As long bone ischemia has not occurred Cultures or bone biopsy should be done if possible Delaying antibiotic treatment may require surgical debridement and decompression Hyperbaric oxygen therapy with 100% oxygen as adjunct therapy Stimulate circulation and healing Orthopedic prosthetic devices, if source of infection must be removed Muscle flaps, skin grafting provide wound coverage over dead space (cavity) in bone
Mosul university- College of dentistry-oral & maxillofacial surgery department
Treatment :