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Fractures: Benjamin Farah

This document provides an overview of fractures, including definitions, classifications, clinical examination, investigations, natural bone healing, and management. It defines types of fractures such as subluxation, dislocation, incomplete, complete, comminuted, and impacted fractures. It describes examining a fracture through inspection, palpation, and neurological and vascular assessment. Investigations include x-rays, CT, and ultrasound. Natural bone healing occurs in five stages over weeks to months. Management options are discussed, including splinting, casting, pain control, and surgical options like plates, nails and wires for indications such as unstable, open, or intra-articular fractures. Complications are also reviewed.

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117 views

Fractures: Benjamin Farah

This document provides an overview of fractures, including definitions, classifications, clinical examination, investigations, natural bone healing, and management. It defines types of fractures such as subluxation, dislocation, incomplete, complete, comminuted, and impacted fractures. It describes examining a fracture through inspection, palpation, and neurological and vascular assessment. Investigations include x-rays, CT, and ultrasound. Natural bone healing occurs in five stages over weeks to months. Management options are discussed, including splinting, casting, pain control, and surgical options like plates, nails and wires for indications such as unstable, open, or intra-articular fractures. Complications are also reviewed.

Uploaded by

bennator
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Fractures

Benjamin Farah
Definitions
• Subluxation  = partial loss of
congruity between articular surfaces
• Dislocation  = total loss of congruity
between articular surfaces
• Fracture = a break in continuity of a
bone
Classification of Fractures
• Skin breakage
– Open (compound): Skin is broken
– Closed (simple): Skin is intact
• Degree of breakage
– Incomplete: Fragments still partially joined
– Complete: Fragments completely separated
– Comminuted: Bone broken into a number of pieces
– Impacted: Fragments driven into one another
• Angle
– Linear
– Transverse
– Spiral
• Cause
– Impact
– Stress
– Pathological
A picture is worth 1000 words
A picture is worth 1000 words
Clinical Examination
• ATLS survey first (history + examination)
• Inspect for soft tissue damage, or breaks in the skin
• Palpate pulses and examine capillary refill distal to the
fracture site
• Examine the nervous system distal to the fracture site
• Palpate the fracture site, and look for adjacent injuries in
nearby bones and joints. Always look at least one joint
proximal and one joint distal
• In a child, when presented with a suspicious fracture,
evaluate for child abuse
• If a pathological fracture is present, examine for signs of
the underlying disease
• Do not asses motion until radiological surveys are done
Investigations
• X-Ray is the modality of choice
– Must always have at least two views “one view = no
view”
– Must include entire bone or joint in suspicion
– If the anatomy is not clear, repeat until you can prove
that the structure is normal
• CT and MRI may be necessary when fractures
are clinically present, but x-ray is negative.
Especially useful for stress and pathological
fractures
• Musculoskeletal ultrasound is portable and may
be more useful in field/acute settings
Natural Bone Healing
• Affected by many factors • Stage one
– Haematoma formation
– Age – Bone ends bleed
– T4/T3/GH levels – Periosteum is stripped for variable length
– Surrounding soft tissues may be damaged
– Calcitonin • Stage two
– Glucocorticoids – Acute inflammation
– Cell division begins within 8 hours
– Nutrition – Cell proliferation seen within periosteum
– Diabetes • Stage three
– Callus formation
– Blood supply – Dead bone is resorbed
– Alcohol/Tobacco use – Immature woven bone is laid down
– Medications (NSAIDS, Abx) • Stage four
– Woven bone is replaced by lamellar bone
– Fracture becomes united
• Stage five
• Can be divided into five stages – Phase of remodelling
(time span highly variable) – Medullary cavity is restored
• Upper limbs heal in 6 weeks, – Bone returns to normal shape

lower limbs x2, compound x2


Simple Management (Assuming
fracture is the only problem)
• Splinting – Used to immobilize the bone
during the acute phase.
• Casting – 5-7 days post injury, after
swelling has reduced
– Casting too early can lead to tissue
ischemia, pressure injury, and compartment
syndrome
• Pain Management
– NSAIDs usually sufficient
– Pain that persists more than a week is
suspicious of other complications
• Cast Removal
– Balance between too short (unstable) and
too long (LOM)
– Usual follow up is between 4-6 weeks
– Highly Variable
Surgical Management
• Indications • Management of Open
– Intra-articular fractures - to stabilise
anatomical reduction Fracture
– Repair of blood vessels and nerves - – Early Operation (<6 hours)
to protect vascular and nerve repair –
– Multiple injuries
Clean Wound
– Elderly patients - to allow early – Debridement
mobilisation – Stabilize the Fracture
– Long bone fractures - tibia, femur and
humerus
– Give Abx, immunize
– Failure of conservative management against tetanus
– Pathological fractures • Complications
– Fractures that require open reduction
– Infection
– Unstable fractures
– Open Fractures – Non-Union
• Types of Internal Fixation – Implant Failure
– Plates – Refracture
– Nails
– K-Wires
Complications
• Fat Embolism
– Confusion
– Dsypnea
– Petechiae on chest
• Infection
• Muscle/Tendon Injury
• Nerve Injury
• Vascular Injury
• Visceral Injury
• Compartment Syndrome
• Non-Union
• Malunion
• Avascular Necrosis
Enjoy the Weekend and
Urology
Good Luck on Shelf!

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