How To Deal With Fractures.www.1aim.net

HOW TO DEAL WITH A FRACTURE

:SYMPTOMS

FRACTURES

,History of trauma ,Pain ,Swelling Limited movements.

SIGNS :LOCAL

,Swelling ,Ecchymosis ,Tenderness Limited movements ,Deformity Length ,discrepancy

SYSTEMIC: SHOCKHYPOVOLAEMIC NEUROGENIC SPINAL

DISTAL: NEURO-VASCULAR

TRAUMA Direct Indirect    

Vehicular accidents Fall from height Crushing accidents Avulsion fractures Fall

FRACTURE

DISLOCATION

on out-stretched arm FRACTURE-DISLOCATION

FRACTURES PROBABLE(SUSPICIOUS) SIGNS OF FRACTURE

Swelling Local pain Tenderness Ecchymosis, abrasions Limited joint movement

:Sure Signs Deformity, Length discrepancy, Abnormal movements,

DINNER FORK

Crepitus VARUS S-SHAPE ,Length discrepancy Abnormal M

Crepitus

OPEN AND CLOSED FRACTURES

- Definition - Precautions

FRACTURE PLETHORA (BULLAE)

MULTIPLE INJURIES RISK

Investigations 

Plain Xray

Transverse

Oblique Spiral

GREENSTICK

X-RAYS

Comminuted Segmental -

Special Types COLLES .FR

SMITH FR

SUPRACONDYLAR FRACTURE :Two types 

ₒExtension type

Flexion type  Caused by fall on caused by fall on (outstretched hand(85%tip of elbow(15%) 

FLEX

 EXT

MONTEGGIA FRACTURE-DISLOCATION

GALEAZZI FRACTURE-DISLOCATION

Hip Fractures 

Femoral neck 45%  



intracapsular, disruption of blood supply to femoral head, high incidence of healing complications (nonunion, osteonecrosis)

Intertrochanteric 45%  

 

extracapsular, no interference with the blood supply of the femoral head, less complications Malunion

Subtrochanteric  

extracapsular Malunion

DISLOCATIONS

SHOULDER RECURRENCE

ELBOW POSTERIOR

HIP POSTERIOR SCIATIC N. INJ MYOSITIS OSSIFICANS

FRACTURE PELVIS FR. ACETABULUM CENTRAL HIP DISLOCATION

.PATHOLOGICAL FR

Osteogenesis imperfecta

OTHER INVESTIGATIONS

CT

CT

& 3D-CT

MRI

BONE SCAN

US examination

LAB INVESTIGATIONS

METHODS OF TREATMENT

TREATMENT OF CLOCED FRACTURES UNDISPLACED REDUCIBLE  CONSERVATIVE TREATMENT

TRACTION-1

BALANCED SKIN TRACTION GALLOW,s TRACTION

SKELETAL TRACTION

CAST (POP).2 FOR SIMPLE NONDISPLACED FRACTURES WITH NO SKIN

NOR NEUROVASCULAR COMPROMISE

OPEN FRACTURES DEBRIDEMENT EXTERNAL FIXATOR

EXTERNAL FIXATOR



percutaneous pinning.

ORIF K-WIRES

METHODS OF INTERNAL FIXATION

INTER TROCHANTERIC FRACTURE DHS

Displaced Femoral neck Fracture esp. in elderly pt. HEMIARTHROPLASTY TOTAL ARTHROPLASTY

Prosthetic

COMPLICATIONS

Malunion

Cross union

Nonunion

ULNAR N PALSY

Axillary nerve injury Deltoid wasting



VOLKMANN,s ISCHAEMIC CONTRACTURE

MYOSITIS OSSIFICANS

Recurrence of dislocation of the shoulder This is the most common complication.  Causes of recurrence: 1- Patient age: High incidence below the age of 40 years. 2- Inadequate immobilization: less than 3 weeks. 3- associated head fractures: (Hill-Sachs lesion) increase the incidence of recurrence. 

INFECTIONS

CHRONIC OSTEOMYELITIS Pathology: Affected bone is destroyed or devitalized with cavities containing pus and pieces of dead bone (sequestrum), surrounded by vascular tissue, and beyond that by areas of sclerosis. Sequestra act as substrates for bacterial adhesion causing persistence of the infection until removed or discharged through draining sinuses. Sinuses may close spontaneously then reopen when tissue tension rises. Pathological fracture may develop.

•New bone formation  Involucrum •Bone necrosis  Sequestrum •Cavity,dischargin g sinus  Cloaca

Imaging : X-ray shows bone resorption with thickening and sclerosis of the surrounding bone. Sequestra seen as unnaturally dense fragments in contrast with the surrounding vascularized bone. Sometimes the bone is crudely thickened and misshapen resembling a bone

Deformitie s

Genu varum & valgum

Cubitus varus ”Carrying angle “

Cubitus varus ”Carrying angle “

Cubitus valgum ”Carrying angle “

Coxa vara Neck shaft angle