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1 Classifications of Fractures

This document provides an overview of fracture classifications and types. It begins by defining a fracture and describing closed versus open fractures. It then covers the following: 1. Common types of fractures including complete, incomplete, physeal and compression fractures. 2. Gustillo and Salter-Harris classification systems for open and physeal fractures respectively. 3. Factors that influence fracture healing times including fracture location and stability based on the Perkins rule. 4. Clinical features involved in examining a fracture including history, symptoms, imaging and risks of different immobilization techniques.

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رغد شاكر محمود أحمد
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81 views

1 Classifications of Fractures

This document provides an overview of fracture classifications and types. It begins by defining a fracture and describing closed versus open fractures. It then covers the following: 1. Common types of fractures including complete, incomplete, physeal and compression fractures. 2. Gustillo and Salter-Harris classification systems for open and physeal fractures respectively. 3. Factors that influence fracture healing times including fracture location and stability based on the Perkins rule. 4. Clinical features involved in examining a fracture including history, symptoms, imaging and risks of different immobilization techniques.

Uploaded by

رغد شاكر محمود أحمد
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Classifications of fractures

By : Mustafa Munther Alhassany


A fracture is a break in the structural continuity of bone.

It may be no more than a crack, a crumpling or a splintering of the


cortex; more often the break is complete and the bone fragments
are displaced.
If the overlying skin remains intact it is a closed
(or simple) racture;

if the skin or one of the body cavities is


breached
it is an open (or compound) fracture, liable to
contamination and infection.
How fracture happen?
1- From single traumatic incident.
2- Repetitive stress ( tibial fracture).
3- Abnormal weakening of the bone (pathological
fracture).
TYPES OF FRACTURE

1- Complete fractures: - The bone is completely broken


into two or more fragments. It may be:
Transverse.
Oblique.
Spiral.
Impacted (the fragments are jammed tightly together)
Comminuted (there are more than two fragments)
2- Incomplete fractures: -The bone is incompletely
divided and the periosteum remains in continuity.
- Greenstick fracture the bone is buckled or bend, this seen
in children.
- Compression fracture the bone is compressed or
crumpled

3- Physeal fractures
Fractures through the growing physis are a specialcase. Damage to the
cartilaginous growth plate may give rise to progressive deformity out of
allproportion to the apparent severity of the injury.
Common types of fracture

(a) Incomplete (‘greenstick’) fracture of the ulna (b) displaced transverse fracture (c)
oblique fracture (d) spiral fracture (e) segmental fracture (f) compression fracture (g)
avulsion fracture
What is the classification system of open fracture?

Gustillo classification: -
Type I: - wound < 1 cm.
Type II: - wound 1-10cm.
Type III A: - wound > 10 cm, high energy, adequate
tissue for coverage includes segmental / comminuted
fractures even if wound <10cm (farm injuries are
automatically Gustillo III).
Type III B: - Extensive periosteal stripping and requires
free soft tissue transfer.
Type III C: - Vascular injury requiring vascular repair.
Gustillo classification
What is the classification system of closed fracture?
What is the classification system of physeal fracture?
salter Harris classification:
FRACTURE DISPLACEMENT
Translation (shift): the fragments may be shifted sideways, backwards or forwards in
relation to each other

Alignment (angulation): the fragments may be tilted or angulated in relation to each


other

Rotation (twist): long-bone fragments may be rotated in relation to each other

Length: the fragments may be distracted and separated, or they may overlap, due to
muscle spasm, causing shortening of the bone.
SOFT-TISSUE DAMAGE

Low-energy (low-velocity) fractures cause only moderate soft-


tissue damage; the classic example is a closed spiral fracture.

High-energy (highvelocity) fractures cause severe damage;


examples are segmental and comminuted fractures

The state of the enveloping soft tissues has a significant effect on


fracture healing.
What are types of fracture healing?
1- Primary bone healing
• Rigid fixation (e.g. internal fixation).
• No callus.
• aka contact/gap healing.

2- Secondary bone healing


• Non-rigid fixation (plaster of Paris cast)
• Callus formation.
• aka endochondral ossification.
What are the steps of secondary healing (healing by callus)?

1. Tissue destruction & hematoma formation.


2. Inflammation & cellular proliferation.
3. Callus formation
4. Consolidation
5. Remodeling
X-rays
showing
fracture
healing by
callus
How to estimate the time of healing?

by Perkins role :

A spiral fracture in the upper limb unites in 3 weeks; for consolidation


multiplyby 2;

for the lower limb multiply by 2 again; for transverse fractures multiply
again by 2.
CLINICAL FEATURES

History
-There is usually a history of injury, followed by inability to use the
injured limb

-Pain, bruising and swelling are common symptoms

-symptoms of associated injuries: numbness or loss of movement, skin


pallor or cyanosis, blood in the urine, abdominal pain, difficulty with
breathing or transient loss of consciousness.
Examination

Examine the most obviously injured part.


Check for arterial damage.


Test for nerve injury.


Look for injuries of local soft tissues and viscera.


Look for injuries in distant parts.
Imaging
X-ray examination is mandatory.

the role of Two in x-ray imaging:

Two views — at least two views AP & Lateral.

Two limbs

Two injuries

Two occasions

Two joints
Computed tomography (CT) and magnetic resonance imaging (MRI)
are useful for displaying fracture patterns in ‘difficult’ sites such as the
vertebral olumn, the acetabulum and the calcaneum.

Radio-isotope scanning is helpful in diagnosing a suspected stress


fracture.
Management of fractures
- Closed reduction (manipulation under anesthesia or traction).
- Open (operative) reduction.

indications of operative reduction


1- Failure of closed reduction.
2- Intra-articular fracture.
3- Some avulsion fractures.
What are the methods of immobilization?

1) Continuous traction : For long bone like humerus and femur and
some shoulder and hip fractures.

2) Cast splintage (plaster).


3) Functional bracing.
4) Internal fixation.
5) External fixation.
Methods of continuous traction

1- Gravity (arm sling).


2. Skin traction: traction is by cord, this
traction produces a pull of up to 5 kg.
3. Skeletal traction: - A wire or pin is inserted through
the bone distal to the fracture & traction is applied via
hook or a stirrup

risks of continuous traction

vascular problem, nerve injury, compartment syndrome & pin tract infection.
cast splintage

1- Plaster of Paris (POP): - is hemi hydrated calcium


sulphate, it reacts with water to form hydrated calcium
sulphate & the reaction is exothermic.
2- fiberglass: - replaced POP recently (light).

What are the risks of cast splintage?

1- Tight cast: -this may cause vascular compression


2- Pressure sores: - the cast may press the skin & causing the ulcer.
3- Skin laceration or abrasion: - may be seen on
removing the plasters.
4- loose cast.
Functional bracing
Segments of a cast are applied only over the shafts of the
bones, leaving the joints free. Used if union occurs but
still not complete in tibial or femoral fractures.

Benefits:
-allow mobility of joint
-prevent stiffness.
-light weight
Internal fixation
This is an operative fixation of bone fragments by screws, pins, plate, wire,
intramedullary nail.

Indications:

1- Fractures that cannot be reduced except by operation.


2- Unstable fractures (like forearm fracture & displaced ankle fracture
& traction injury like patella & olecranon fracture).
3- Fractures that prone to non-union (Femoral neck fracture).
4- Pathological fracture in which bone disease may
prevent healing.
5- Poly trauma
complications of internal fixation:

1- Infection.
2- Non-union.
3- Implant failure: - implant may be break if subjected to
stress (e.g. early walking).
4- Refracture
External fixation
Transfixing pins, which pass through the bone above &
below the fracture site & are attached to an external frame

Indications:

1- Fractures associated with sever soft tissue damage.


2- Fractures associated with nerve or vessel damage.
3- Severely comminuted & unstable fracture.
4- Fracture of the pelvis.
5- Infected fracture.
complications of external fixation
1- Pin tract infection: - this needs regular cleaning of the pin entry sites.
2- Delayed union: - because:
- The fragments are held apart by the rigid fixator.
- There is reduced load transmission through the bone.
Any open fracture should be initially managed as following :

1- Antibiotic prophylaxis (Third Gen. cephalosporin).


2- Wound (soft tissue) debridement.
3- Stabilization of the fracture (the bone).
4- Early wound cover.

Stabilization as following:

- Grade I&II gustillo treated as closed.


- Grade III gustillo treated with external fixation.
- Open intra-articular left open for 5 days until become clean then internal
fixation.
THANK YOU

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