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Principle of Fracture Management: Dr. Miawa Robert

This document discusses the principles of fracture management. It defines a fracture as an interruption in bone continuity that can be complete or incomplete. Fractures are caused by single traumatic events or repetitive stress. They are classified based on features like displacement, comminution, and soft tissue involvement. Treatment depends on if the fracture is open or closed, and may involve closed or open reduction along with immobilization methods like casting, plating, or external fixation. Physical therapy aims to reduce swelling and regain function during and after treatment.

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63 views

Principle of Fracture Management: Dr. Miawa Robert

This document discusses the principles of fracture management. It defines a fracture as an interruption in bone continuity that can be complete or incomplete. Fractures are caused by single traumatic events or repetitive stress. They are classified based on features like displacement, comminution, and soft tissue involvement. Treatment depends on if the fracture is open or closed, and may involve closed or open reduction along with immobilization methods like casting, plating, or external fixation. Physical therapy aims to reduce swelling and regain function during and after treatment.

Uploaded by

kajojo joy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Principle of Fracture Management

Dr. Miawa Robert


TOPICS COVERED
○ Definition
○ Mechanism of fractures
○ Fracture types
— Complete
— Incomplete
○ Types of displacements
○ Fracture healing
— Stages
○ Treatment of fractures
— Closed fractures
— Open fractures
DEFINITION
○ An interruption in the continuity of
the bone which may be a
complete break or an incomplete
break.
MECHANISMS
○ Single traumatic event
○ Repitive stress – Stress fractures
○ Pathological – Insufficiency fractures
HIGH-ENERGY
INJURY
○ High-energy injury
LOW ENERGY INJURY
○ Low-energy injury
PATHOLOGIC FRACTURES
○ Often need surgery
○ diagnostic workup
important
○ prognosis dependent
on biology of lesion
Polyostotic Fibrous Dysplasia
MECHANISMS OF FRACTURES
○ Direct – Bending / Crushing
○ Indirect
MECHANISMS OF FRACTURES - INDIRECT

○ Twisting causes a spiral fracture;


○ Compression causes a short oblique fracture;
○ Bending results in fracture with a
triangular 'butter-fly‘ fragment;
○ Tension tends to break the bone
transversely
CLASSIFICATION OF FRACTURES
○ Complete/ Incomplete
○ Fracture pattern
○ Soft-tissue cover
○ Displacement
○ Comminution
COMPLETE/ INCOMPLETE
GREENSTICK FRACTURES
○ Bending mechanism
○ Failure on tension side

○ Incomplete fracture,

plastic deformation on
compression side
○ May need to complete

fracture to realign
BUCKLE OR TORUS FRACTURE
○ Compression failure
○ Stable

○ Usually at
metaphyseal /
diaphyseal junction
CLASSIFICATION OF FRACTURES
○ Closed fractures
— There is no communication between the
external surface of the body and the fracture
○ Open fractures
— There is a communication between the fracture and the
skin.
— From inside-out
— From outside-in
— High risk of infection/
neurovascular injury
OPEN FRACTURES
OPEN FRACTURES
DISPLACEMENT

○ Angulation
○ Translation
○ Rotation
DISPLACEMENT

UNDISPLACED DISTAL RADIUS FRACTURE


MINIMALLY DISPLACED DISTAL RADIUS FRACTURE
DISPLACED FEMUR FRACTURE
HEALING OF FEATURES
○ Stage of haematoma
○ Stage of cellular proliferation
○ Stage of callus formation
○ Stage of consolidation
○ State of remodelling
TEMPORARY STABILISATION
DEFINITIVE TREATMENT
○ Closed reduction
○ Open reduction

○ Immobilisation
○ Internal/ External fixation
CLOSED REDUCTION
HOLD/ MAINTAIN REDUCTION
○ Traction
○ Slab/ Cast
○ Brace
MAINTAI
N
Fixation
○ Internal Fixation
— Screws
— K wires
— Plates and screws
— Nails
○ External Fixation
TENSION BAND WIRING
PLATES AND SCREWS
○ Extramedullary internal
fixation
INTERLOCKING NAIL
○ Intramedullary internal
fixation
EXTERNAL FIXATION
SKELETAL TRACTION – SKULL TONGS
SKELETAL TRACTION
– UPPER TIBIAL PIN TRACTION
SKELETAL TRACTION
– UPPER TIBIAL PIN TRACTION
SKIN TRACTION
– GALLOWS TRACTION
EXTERNAL FIXATOR
PLASTER OF PARIS
- ABOVE ELBOW CAST
EXTERNAL STABILISATION
– BUDDY STRAPPING
BOHLER BRAUN FRAME
OPEN FRACTURES
PRINCIPLES
○ IV antibiotics,
tetanus prophylaxis
○ emergent irrigation &
debridement
○ skeletal stabilization

○ soft tissue coverage


LAWNMOWER INJURIES
○ probably most common
cause of open fractures
in children
○ most children are a
rider or bystander
(70%)
○ high complication rate -
infection, growth
arrest,amputation
○ > 50% unsatisfactory
results (Loder)
LAWNMOWER INJURIES – OFTEN
RESULT IN AMPUTATIONS
PHYSIOTHERAPY DURING
IMMOBILIZATION
○ Reduce oedema – to prevent the adhesion formation
○ Assist the maintenance of the circulation – active
exercise either by static or isotonic muscle activity
○ Maintain muscle function by active or static
contraction
○ Maintain joint range where possible
○ Maintain as much function as allowed by the particular
injury and the fixation
○ Teach the patient how to use special appliances such
as crutches, sticks, frames, and how to care for
these or any other apparatus
PHYSIOTHERAPY AFTER THE
REMOVAL OF FIXATION
○ To reduce any swelling
○ To regain full range of joint movement
○ To regain full muscle power
○ To re-educate full function
THANK YOU

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