Fractures Lecture Notes PDF

Fractures Dr. Jagar Omar Doski  Bone Definition: Bone is a specialized connective tissue organized to act as the endoskeleton. Functions: I. mechanical: 1. Longitudinal growth of the body and the extremities. 2....

Fractures Dr. Jagar Omar Doski  Bone Definition: Bone is a specialized connective tissue organized to act as the endoskeleton. Functions: I. mechanical: 1. Longitudinal growth of the body and the extremities. 2. Support of body parts 3. Protection of vital soft tissues 4. Forming mechanical levers to transmit the action of the muscles into movements. II. Biochemical: 1. Reservoir for some minerals 2. Maintain homeostasis for certain ions III. Blood formation (Erythropoiesis by the bone marrow)  Types of Bones I. Cortical (compact) bone: is a dense bone present where support is needed. 1. Outer wall of all bones 2. Shaft of all tubular bones 3. Loading… Articular surfaces of bone ends. II. Cancellous (spongy, trabecular) bone: 1. It make the interior meshwork of all bones, 2. Ends of tubular bones (bone ends) 3. Body of the vertebrae  Fracture Definition: break in the structural continuity of the bone. How Fractures Occur? Mechanism of Injury: 1. Direct force 2. Indirect force 3. Combined Type of force: 4. Single strong force classical fractures 5. Repeated minor force stress fracture 6. Normal force of daily activities pathological fracture  Types of fractures I. Incomplete fracture: Crack Buckle fracture Greenstick fracture Loading… Compression (impacted) fracture II. Complete fracture: 2 fragment fracture (Transverse fracture, Oblique fracture, Spiral fracture) 3 fragment fracture (Butterfly fracture, Segmental fracture) > 3 fragment fracture (Comminuted fracture)  Displacement of Fractures Causes of fracture displacement: 1. Same mechanism of injury (force of injury) 2. Gravity 3. Pulling of the attached muscles Types of displacement: 4. Shift (translation) 5. Tilt (angulation) 6. Twist (rotation) 7. Length (shortening, lengthening)  Fracture Healing Stages of fracture healing: 1. Hematoma formation 2. Inflammation and granulation tissue formation 3. Callus formation 4. Consolidation 5. Remodeling  Clinical features of Fracture History (symptoms): Pain Swelling Deformity Limitation of movement Loss of function Bruise ? Examination (signs): 1. Look: swelling, deformity, bruise?, wound? 2. Feel: bone tenderness, crepitus? 3. Move: don’t do move unless distal to site of injury 4. Assessment of neuro-vascular state of the limb distally  Investigations X-ray CT-scan Loading…  Treatment of Fracture General treatment: 1. Analgesia 2. Fluid and/or blood replacement ? 3. Antibiotics ? Local treatment: 4. Reduction? (closed or open) 5. Hold reduction (splint, traction, internal fixation, external fixation) 6. Exercises ± elevation?  Complications of Fracture General complications: 1. Hypovolemia and shock 2. Leg deep vein thrombosis and pulmonary embolism 3. Bed sores 4. Urinary tract infection 5. Disuse atrophy and weakness  Complications of Fractures Local Complications: Early: 1. Vascular injury 2. Nerve injury 3. Visceral injury 4. Compartment syndrome 5. Hemarthrosis 6. Infection 7. Fracture blisters 8. Pressure sores  Complications of Fractures Late complications: 1. Delayed union 2. Non union 3. Malunion 4. Avascular necrosis 5. Joint stiffness 6. Heterotopic ossification 7. Growth disturbance 8. Nerve entrapment (compression) 9. Reflex sympathetic dystrophy 10. Osteoarthrosis Common Fractures of the Upper Limb  Fracture Clavicle Cause: direct or indirect trauma Cl.F.: pain and swelling X-Ray: medial segment displaced upward and lateral segment displaced downward Rx: arm sling  Fracture shaft of Humerus Cause: direct trauma Cl.F: pain, swelling, deformity, bruise, wrist drop (radial nerve injury)? Treatment: surgery Supracondylar Fracture of Distal Humerus Cause: indirect trauma due to fall on the hand Clinical significance: Brachial artery injury Treatment: surgery  Colles’ Fracture Cause: fall on the hand Cl.F.: pain, swelling Deformity (dinner-fork) Risk of Median nerve compression Treatment: manipulation + cast splint  Scaphoid Fracture Cause: fall on the hand Cl.F.: pain, swelling and tenderness at the anatomical snuffbox. Complication: risk of avascular necrosis of the proximal fragment of the bone. Common Fractures of the Lower Limb  Fracture Neck of Femur Cause: indirect Cl.F.: pain, (inability to stand and walk (loss of function) Complication: risk of avascular necrosis of the femoral head. Treatment: surgery  Fracture Shaft of Femur Cause: direct or indirect Cl.F.: pain, swelling, loss of function Risk of bleeding Treatment: surgery  Supracondylar Fracture of the Distal Femur Cause: indirect Clinical significance: risk of popliteal artery injury  Fracture Proximal End of Fibula Risk of common peroneal nerve injury that may cause foot drop + loss of the sensory perception at the lateral aspect of the leg and dorsum of the foot.  Fracture Shaft of the Tibia Risk of break of the overlying skin with contamination and become an open Loading… (compound) fracture  Fracture calcaneum Cause: fall from height on the foot. May be associated with fracture pelvis and spine. May cause chronic pain in the heel due to joint distortion. Thank You