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Fracture of Bone  Define of Fracture Any break in the continuity of a bone cortex  To Classify a Fracture Which bone? Where in the bone is the fracture? Which type? Which group? Which subgroup? No...

Fracture of Bone  Define of Fracture Any break in the continuity of a bone cortex  To Classify a Fracture Which bone? Where in the bone is the fracture? Which type? Which group? Which subgroup? Normal Spiral Tibia Fracture Tibia  Which Where bone?in the bone?  Grouping-Type A 1. Spiral 2. Oblique 3. Transverse  Grouping-Type B 1. Spiral wedge 2. Bending wedge 3. Fragmented wedge  Grouping-Type C 1. Spiral multifragmentary wedge 2. Segmental 3. Irregular Proximal & Distal Segment Fractures Type A – Extra-articular Type B – Partial articular Type C – Complete disruption of the articular surface from the disphysis Why must be describe the fracture ? 1. To detect other associated injuries 2. To identify the possible complications 3. To choice the ideal investigations 4. To select the proper treatment Closed Fracture, Closed Base of Thumb Dorsally Angulated Forearm Fracture  Compound (Open) Fractures A break in the skin and underlying soft tissue leading directing into or communicating with the fracture and its hematoma FRACTURE HEALING Sequence of fracture healing Inflammation Repair Remodeling Fracture Healing Inflammation Fracture damages the bone, blood vessels, bone matrix and surrounding soft tissue -Dilatation blood vessel Haematoma - Plasma exudat Inflammatory - inflammatory cells mediators Release by - PMN lecocytes platelets inj.cells - Macrophages - Lymphocytes FRACTURE HEALING INFLAMMATIO N Inflammatory Necrosis Tissue and Exudate Resorbed Fibroplasty & Chondrocytes Appears Produce new matrix (The fracture callus) BONE HEALING REPAI R Growth factors Fibroblast Growth factor Angiogenesis Osteoclast Osteoblast Bone formation Mesenchymal cells Hard callus intramembranous bone Soft callus endochondral ossification Fracture callus matrix glycosaminoglycans, proteoglycans and collagen type I & III BONE HEALING Remodelling Replacement of woven bone by lamellar bone Resorption of unneeded callus mechanical Stability History and Physical examination  Seven Signs of Fracture The presence of any one of the seven fracture signs just listed is sufficient to assess this injury!  Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb  Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb Severe Contusion of Foot Fractured Patella  Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb Angulated Fracture, Radius and Ulna  Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb  Crepitus In a complete fracture, the sounds of bone ends clicking or rubbing against each other; denotes an unstable fracture!  Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb Open Ankle Fracture  Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb  False Motion The unusual visual sensation of observing motion at a long bone fracture site where “there is no joint!”  Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb  Mechanism of Injury Types of Trauma Penetrating Trauma Compression (Blunt) Trauma Bending Trauma Hyperflexion Hyperextension Mechanism of Injury Types of Force Direct Force Indirect Force Twisting Force  Twisting Subtalar Dislocation, Ankle  Indirect Posterior Dislocation, Elbow Principles of Musculoskeletal Injury Management ABCD’s Evaluate distal neurovascular function Dress all wounds Splint all suspected injuries Prepare patient for transport Splinting Immobilizes the Injury to : Reduce Pain Facilitate Transport Prevent further damage to blood vessels, nerves and skin adjacent to the injury Decrease Bleeding  When standard splints are unavailable, improvisation is better than doing nothing!  Fiberglass cast applied with proper technique and split/spread is excellent way to safely immobilize limb, maintain reduction and accommodate swelling Complications of Fractures  COMPLICATION OF FRACTURE General Local Early Late General Complications  General Complication Shock Diffuse Coagulopathy Respiratory Dysfunction Metabolic Response Crush Syndrome Venous Thrombosis and Pulmonary Embolism Tetanus Gas gangrene Fat Embolism  Early Complication Local Visceral Injury Vascular Injury Nerve Injury Compartment Syndrome Haemarthrosis Infection Gas gangrene LATE COMPLICATIONS Joint instability Delayed union Muscle contracture Non-union (Volkmann’s contracture) Malunion Tendon lesions Joint stiffness Nerve compression Myoisitis ossificans Growth disturbance Avascular necrosis Bed sores Algodystrophy Osteoarthritis  COMPLICATIONS Malunion Malunion: A fracture that does not heal in a normal alignment is called a malunion 1- Primary Neglected # 2- After Reduction! Watch X-Ray After 10 Days Thank You!