Introduction to Fractures pptx - D. Wahby

Introduction to Fractures

Dr. Wahby Ghalib
CABMS, FJMC, MRCS

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Fracture : breakage in the structural continuity of bone

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Comminuted fracture
# with more than two fragments
Comminution is caused by severe violence
union is delayed

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Segmental fracture
The bone is fractured at more than one level

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Types
Transverse : tension or direct force
Butterfly fragment : bending
Short oblique : compression
Long oblique : indirect force
Spiral : twisting

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Avulsion # : bone fragment is pulled off bone by ligament or muscle

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Special types in children
Green-stick # : one cortex fractured & the opposite is compressed
Buckle fracure
Plastic deformation

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Torus fracture

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Forces
Direct & indirect
Low & hi energy
The state of local soft tissues is very important for fracture healing

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Open (compound) fracture
There is communication between the # and the exterior (disruption of skin, intestine)
↑ Risk of infection

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Displacement
Shift (translation)
Tilt (angulation)
Twist (rotation)
Overlap
Impaction
Distraction

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Unstable fracture
# that is displaced or has the potential to displace

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Clinical features
Look : swelling, deformity, ecchymosis
Feel : tenderness
Move : loss of function
abnormal movement
crepitus

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Healing
Haematoma formation
Inflammation & granulation t.
Callus
Woven bone
Lamellar bone
Remodelling

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Union & consolidation
• Union
• Consolidation
• Healing
• Incompete
• Complete
• Callus
• Calcified
• Ossified
• Tendeness
• Yes
• No
• XR
• # visible, fluffy callus
• # invisible, callus well defined
• Put stress
• No
• Yes

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Perkin`s rule
Spiral # in upper limb unites in 3 w
consolidation x 2
lower limb x 2
transverse # x 2
Healing is quicker in children

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XR
2 views
2 joints
2 limbs
2 injuries
2 occasions (scaphoid,FN, physis, stress #)
2 brains

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Stress (fatigue) #
# that occurs in normal bone by repetitive stresses
> in athletes, ballet dancers & military recruits
Common sites: pars interarticularis of L5, FN, proximal tibial shaft, distal fibular shaft,calcaneum, MTBs

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XR: early : -ve… few weeks : transverse defect ± periosteal new bone

Bone scan
DDx: OM, OSa
Tx :immobilize & avoid painful activity

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Pathlogical fracture
# that occurs with trivial trauma in a bone weekened by a pathologic process
e.g. osteoporosis, Paget`s d.,infection, & tumours

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Physeal injuries
10% of fractures in children
Salter - Harris classification:
1: separation of the epiphysis usually thru the calcified zone
2: separation of epiphysis & triangular piece of metaphysis

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3: intra-articular # thru epiphysis then thru physis

4: intra-articular # thru epiphysis, physis, & metaphysis
5: crushing of physis  arrested growth

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# may not be visible initially

Types 1 & 2 : good Px except around the knee
Types 3 & 4: need perfect reduction & f/u for re-displacement

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Complications
Arrested growth
Accelerated growth
Asymmetrical growth

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Ligament injuries
Sprain : stretching of ligament but it is still anatomically intact
Partial tear : more pain, joint is stable
Complete tear : less pain , joint unstable
Tx : partial  immobilize & exercise
complete  surgical repair

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Joint injuries
Dislocation : complete loss of apposition of articular surfaces
Subluxation : partial loss
Fracture dislocation
Recurrent dislocation :chronic ligamentous & capsular injuries e.g. shoulder & patella
Habitual dislocation

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Tx : reduction & immobilization

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Haemarthrosis : blood accumulates inside the joint

Objectives :
Stressing the importance of managing fracture cases in general medical practice.
Clarification of the general principles of managing multitrauma cases.
Making the students familiar with the basic terms used in musculoskeletal traumatology.
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Objectives :

Clarifying the basic principles of use of XR in case of fractures and dislocations.
Developing basic skills to identify the severity of skeletal traumas so as to determine the line of management and the need to consult a senior.
Clarifying the special points in paediatric skeletal traumatology

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Introduction to Fractures