General principles of
fracture management
Intended Learning Objectives
(ILO)
Etiology and types of fractures,
Diagnosis and imaging,
Indications for different types of treatment,
Complications of fractures,
Examples of common bone injuries.
Definition of a fracture?
Interruption of bone continuity
Aetiology:
Traumatic
Pathologic
high or low velocity injury
already diseased bone
Traumatic fractures
Pathological fractures
Pathological Anatomy
Shape : Transverse, short oblique, spiral
comminuted, Segemental.
Level : Metaphysis, Diaphysis , Intra-articular.
Stability : Tendency to re-displace after
reduction = Instability
Type : Simple / open
Pathological Anatomy
Specific types:
Avulsion Fracture: At sites of muscle/ligament pull.
Torus Fr. ( Buckle fracture ) : buckling of the
cortex.
Green stick Fr.: Fr. of one cortex and bending
of the other.
Fragility Fr. : Osteoporotic bones.
Pathological anatomy
Shapes of fractures
Examination
Proper history taking:
General evaluation including the vital signs:
General skeletal evaluation
Thorough local examination:
Signs of the Fracture :
:
Neurovascular testing
, thigh, leg, foot Forearm :
??? Compartment Syndrome
Imaging
Plain x ray : Basic and informative with proper
.
views: AP, lateral and oblique
Specific views: for certain Fr. e.g:
acetabulum,
shoulder
pelvis, and Calcaneus
CT: Comminuted intra-articular Fr
MRI : Occult Fr. e.g: neck of femur, scaphoid
Imaging
Treatment
Aim:
is to keep the Fr. reduced in good
position till complete union
Non operative :: POP cast or slab
Traction : Skin
Skeletal
Indications: Children Stable General or
local contraindication for surgery
Treatment
Operative :: Adults Unstable Open
Intra-articular Poly traumaNeurovascular injury Head injury
Non compliance with conservative
treatment
Open minimal invasive percutaneous
Internal Fixation:
Plates , Screws , IMN, K-wires
Staples
External Fixation: Rods, Rings, Hybrid.
Combinations
Conservative treatment
Conservative treatment
Traction
Operative Treatment
Internal fixation
External fixation
Complications of Fractures
General complications of trauma: Bleeding, shock,
ARDS, DVT, etc..
Local complications of the fracture:
Mal union
Non union
Stiffness of joints
Wasting of muscles
Atrophy of bones
Edema of the limbs
Nerve injury
Infection
Malunion
Non union
Non union
Proximal Femoral
Fractures
Fr. neck of femur : Always treatment is
surgical
Biologic factors , Mechanical factors
Healing
Stability
Union
Treatment : internal fix. , arthroplasty
Complications : Non union , avascular
necrosis
Blood Supply to
Neck of Femur
Clinical Picture
Proximal Femoral
Fractures
Trochanteric Fr. : preferred treatment is
surgical
Why?
General :problems of prolonged
recumbancy
Malunion
Treatment : Skeletal traction, Internal
Fixation
Ankle Fractures
,
Preferred to be treated Surgically
Classified according to severity of injury of
bones and soft tissues in ascending scale : A ,
B , C,
Complications : Malunion and ankle
arthritis.
Distal Radius Fractures
Colles Fracture: Distal end of radius
How ? When ?
Deformity : Dinner Fork
Treatment : Closed reduction under GA
Except?
Complications : malunion, median n. compression
Sudeks atrophy ???
Supracondylar Fractures
In Children
Types : Extension --- Flexion
c/p : Fr. ( pain, swelling, loss of function,
deformity) +
Compartment Syndrome
Treatment : Closed reduction + casting
Closed reduction +
percutaneous
K wires
Open reduction + K wires
Supracondylar fracture
K wire fixation
Supracondylar Fracture
Complications :
1- Vascular injuries : arterial spasm tear of
brachial artery
2- neural injury : Median nerve ,,,,,,, Radial &
Ulnar
3- Stiffness of elbow joint
4- Malunion : Cubitus varus
Take Home Message
Understanding anatomy and pathology of any fracture
is
essential before treatment,
Treatment of fractures should be individualized,
General patients assessment is a part of fracture
treatment,
The aim of treatment is restoration of function and ,
avoidance of complications
Proper handling of tissues , by conservative or
operative,
methods of treatment + close follow up is crucial.
