Fracture Management Quiz

General Aspects of Fractures and Dislocations

• A fracture is a complete or incomplete break in the continuity of a bone or cartilage, resulting from excessive force.
• A dislocation is a disruption of the normal articulation between two bones, meaning one or more bones are displaced at a joint.
• Subluxation is an abnormal movement of one bone within a joint. It's not a complete dislocation but a partial one.

Fracture Aetiology

• Traumatic (Normal Bone):
  • Tubular Bone: Fractures can be direct or indirect.
  • Cancellous Bone: Fractures occur through compression and traction.
• Pathological (Abnormal Bone):
  • The integrity of the underlying bone is abnormal.
  • History often involves minimal trauma.
  • Local Causes: Osteomyelitis (OM), tumors, and cysts.
  • Generalized Causes: Osteoporosis, among others.
  • Stress fracture: Abnormal stress on normal bone.

Fracture Diagnosis

• Clinical Diagnosis:
  • A - History: Trauma history.
  • B - Symptoms: Pain, loss of function, deformity,
  • C - Signs: Swelling, tenderness, abnormal mobility, deformity, loss of function, crepitus (may be present!).
  • D - Examination: Neurovascular examination of the affected limb
• Radiological Examination:
  • A - The fractured bone.
  • B - Joints above and below the fracture.
  • C - Images in two planes at right angles to each other.
  • D - Special views when necessary.

Fracture Description

• Site: Diaphyseal (shaft), metaphyseal (growth plate region), epiphyseal (end of bone), intra-articular (within a joint).
• Complete: Involves both cortices (outer layers) of the bone.
• Incomplete: Involves only one cortex.
  • Greenstick: Incomplete break common in children, along the convex side of the bend.
  • Stress Fractures: Common in adults, caused by abnormal stress on normal bone.
• Orientation: Transverse, oblique, spiral, comminuted.

Fracture Displacement

• Distraction: The bone fragments are pulled apart.
• Impaction: The bone fragments are driven into each other.
• Over-riding: The bone fragments are overlapping.
• Rotation: The bone fragments are rotated.
• Translation: The bone fragments are shifted sideways.
• Angulation: The bone fragments are bent.

Fracture Soft Tissue Damage

• Simple (Closed): Skin is intact.
• Compound (Open): Fracture hematoma communicates with the outer air.
  • Classification: Types can be further described as compound from within or compound from without.

Fracture Management

• General Management (ABCDEs):
  • A - Airway: secure the airway.
  • B - Breathing: assess and support breathing.
  • C - Circulation: control, assess and maintain circulation.
  • D - Disability: monitor neurological status.
  • E - Exposure & associated injuries: manage associated injuries.
  • F- Other associated injuries, including tetanus, gas gangrene, fat embolism.
• Local Management:
  • A- Correction of displacement: aims to correct deformity using closed reduction (manipulation under general anesthesia) or open reduction (surgery) depending on circumstances. Reduction should occur as soon as possible with no rotation or angulation.
  • B- Stabilization: Various methods include casting, splinting, traction, and external fixation. Or internal fixation using techniques like plates, screws, nails, wires.
  • C -Rehabilitation: begin early after stabilization to regain functional use of the limb.
• Open Fracture Management: Prioritize removing foreign material and managing infection. No internal fixation.

Fracture Complications

• General Complications:
  • Shock, fat embolism, prolonged decumbency complications (resp problems, DVT), urinary calculi, bed sores, tetanus, or gas gangrene (open fractures only).
• Early Local Complications:
  • Skin injuries, vascular injuries (eg. kink, compression), nerve injuries, tendon or muscle injuries, infection, avascular necrosis, and visceral complications.
• Late Local Complications:
  • Malunion, delayed union or non-union of fracture (impaired blood supply, improper positioning, soft tissue interposition, infection), Sudek's atrophy, myositis ossificans, joint stiffness, growth disturbances, osteoporosis.

Fracture Terminology

• Callus: New bone formed at the fracture site.
• Remodeling: Reforming of callus to match the stress lines of the bone.
• Delayed union: Healing takes longer than usual, but ultimately heals.
• Non-union: Fracture fragments fail to unite because healing process stops.
• Mal-union: Fracture heals in an abnormal position, likely causing problems.