3 Fractures.pptx

TYPES OF FRACTURES Dr. Lorenzo di Mento Head of Trauma Unit Humanitas Research Hospital - Milan Contacts: [email protected] +39 348 6716290 How does it happen? How does it happen? Fracture occurs if the applied force (trauma) is over-physiologic or when bone has a pathological reduce...

TYPES OF FRACTURES Dr. Lorenzo di Mento Head of Trauma Unit Humanitas Research Hospital - Milan Contacts: [email protected] +39 348 6716290 How does it happen? How does it happen? Fracture occurs if the applied force (trauma) is over-physiologic or when bone has a pathological reduced resistance Clinical signs Signs and symptoms vary according to bone, age, patient’s health conditions and severity of trauma • • • • • Swelling Bruising Pain (increases with movement or palpation) Limb deformity Functional impairment • Crackling (fracture fragments’ friction) • Praeternatural movement Diagnostic/imaging • Joint impactions • Accurate findings • Think about potential problems Treatment • Temporary/immediate treatment: • Immobilise fractured bone • External fixator • Definitive treatment: • Conservative (cast, brace….) • Surgical (Plates, Nails or External fixators) 1. Span 3. Plan 2. Scan Why do they occur? • Traumatic fractures • Pathological fractures • Fragility fractures • Stress fracture Low energy trauma TRAUMATIC FRACTURES • Direct Trauma • Normal bone • High energy Most common type! PATHOLOGICAL FRACTURES • Low energy trauma • Phisiologic or paraphisiologic strain • Reduced bone resistance • Tumors (primitive or skip lesions) FRAGILITY FRACTURES Osteoporosis Normal bone Osteoporosis F, 78 yrs No trauma In-bed since 1y Courtesy Dr M. Arduini STRESS FRACTURES • Repeated microtraumatism • Sport activities • MRI How do they occur? • Direct force • Flexion Fracture occurs where the force has been applied • Indirect force • Torsion • Compression • Traction / Avulsion Fracture occurs far from where the force has been applied • Combined mechanism M a l l e o l a r f r a c t u re v s p i l o n f r a c t u re Morphology of fracture line depends on direction of the applied load FLEXION • Long bones • Direct trauma • High energy TORSION • Long bones • Indirect trauma • Torsional forces COMPRESSION • Cancellous bone • Meta/Epiphysis TRACTION When a ligament or a tendon applies a heavy and sudden traction to the bone. Fracture line is usually transversal. Es. Heel fracture due to Achille tendon traction or SIAS/quadriceps or V metatarsal bone/peroneous brevis COMBINED MECHANISM Usually related to high energy trauma (road traffic) • Multifragmentary fractures • Comminuted fractures Where are they? Long bones • Diaphysis • Metaphysis • Epiphysis (joint) How are they? Complete fracture Bone break is total Incomplete fracture Bone break is partial COMPLETE FRACTURES • Unifocal (two fragments) • Bifocal (three fragments) • Comminuted (several and small fragments) COMPLETE FRACTURES • Undisplaced • Displaced VALGUS IMPACTED FRACTURE • Cancellous bone impaction • Minimal deformation • Stable pattern UNCOMPLETE FRACTURES • Green stick fracture In very young patients elastic bone bends without breaking • Infraction CLOSED FRACTURES No direct communication between bone and outer space OPEN FRACTURES Direct communication between bone and outer space OPEN FRACTURES Gustilo Anderson Classification OPEN FRACTURES PEDIATRIC FRACTURES Obstetric fractures • Fractures and dislocations “around” the shoulder Pediatric fractures • Diaphyseal fractures • Physeal fractures Pediatric fractures Physeal fractures (meta-epy) • Growth plates involvement • Physeal union • Non-reversible outcomes Diaphyseal • Periostial lesion • Potentially on-growing • Reversible outcomes Diaphyseal fractures High remodelling/correction potential… …but not if torsional malunion! Diaphyseal fractures Types of fracture • Green-stick: cortex interruption on convex, no lesion on concave side Diaphyseal fractures Types of fracture • Buckle/torus: incomplete cortical lesion (compression fracture: bone looks «swollen») Diaphyseal fractures Types of fracture • Bowing fracture: plastic bone deformation without cortical interruption Examples of diaphyseal fractures Examples of diaphyseal fractures Examples of diaphyseal fractures Classification of physeal fractures Trattamento Diagnosi Physeal fractures Diagnostic • Standard imaging (X-rays) are enough • Difficult diagnostic in type I and V • Always compare to controlateral side Treatment Closed reduction • Conservative  Mostly  Stable fractures • Surgical  Less invasive possible  TEN, Kw, cannulated screws Open reduction • • • • • • Open fractures Politrauma Femural neck fractures Intra-articular fractures Not reducted closed Soft tissues lesions Physeal Complicazioni precoci localifractures Late complications due to growth plate lesion • Total lesion: dysmetria • Partial lesion: axial deviation