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FRACTUREFRACTURE

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D EFINITIOND EFINITION

A fracture is a complete orA fracture is a complete orincomplete break in theincomplete break in thecontinuity of bone. This willcontinuity of bone. This willbe accompanied by varyingbe accompanied by varyingdegrees of injury todegrees of injury tosurrounding soft tissues.surrounding soft tissues.

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WHATWHAT CAUSES FRACTURE?CAUSES FRACTURE?

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D IRECT TRAUMAD IRECT TRAUMA

HARD HIT

FALL

ACCIDENTS

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INDIRECT TRAUMAINDIRECT TRAUMA

osteoporosis

osteomyelitis

Pathologic glands

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TWISTING FORCETWISTING FORCE

SEVERE TWISTING OVER STRETCHING

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FATIGUE AND STRESSFATIGUE AND STRESS

J OGGING

P ROLONGED MARCHING

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P OWERFUL MUSCLEP OWERFUL MUSCLE

CONTRACTIONCONTRACTION

GRAND MAL SIZURE

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GENERAL SIGNS ANDGENERAL SIGNS ANDSYM P TOMSSYM P TOMS

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A. Break in the continuity of the bonecause:

1.B LEEDING

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2 . AB NORMAL

MOB

ILITY

3 . CRE P ITUS

- abnormal sound created due to f riction o f f ractured area as the bones are moved

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B. DIS P LACEMENT OF FRAGMENTCAUSES:

1. DEFORMITY

2 . LOSS OF FUNCTION

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C. DAMAGE TO THE SOFT P ARTCAUSES:

1. SKIN WOUND

2 . HEMATOMA

3 . P AIN

4 . P ARALYSIS

3 . SWELLING

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B ROA D CLASSIFICATIONB ROA D CLASSIFICATION

A . CLOSED/SIM P LE FRACTURE

when the breakin the bone has no

communication inthe outside

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B. OPEN/COMPOUND FRACTUREB. OPEN/COMPOUND FRACTURE

when the breakin the bone comesout through theskin or there is

communication ofthe bone to theoutside

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CLASSIFICATION AS TOCLASSIFICATION AS TO

EXTENTEXTENT

COM P LETE INCOM P LETE

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CLASSIFICATION AS TOP ATTERN

TRANSVERSE O B LIQUE S P IRAL

break that runs across the bonebreak runs in slanting direction on

bone

break coils around the bone

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CLASSIFICATION AS TOCLASSIFICATION AS TO

APPEARANCEAPPEARANCE

GREENSTICK FISSURED COMMINUTED

is in incomplete, and the breaks occurs at the convex sur f ace o f the bend in the bone

involves an incomplete longitudinal break

bone splintered into f ragments

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COM P RESSION

DE P RESSION

is one in w hich bone, typically a vertebra, collapses on itsel f

AVULSION

usually occurs in the skull, w ith the broken bone driven in w ard

A f ragment o f bone, w hich is the site o f insertion o f a muscle, tendon or ligament, is detached as the result o f excessive tension

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CLASSIFICATION AS TOCLASSIFICATION AS TOLOCATIONLOCATION

P ROXIMAL

MEDIAL

DISTAL

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CLASSIFICATION INCLASSIFICATION IN

RELATION TO THE JOINTRELATION TO THE JOINT

S ynovial f luid Articular cartilage

J oint capsule

H ead

Femur J oint capsule

INTRA-CA P SULAR

EXTRA-CA P SULAR

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V ARIOUS FRACTURESV ARIOUS FRACTURES ::ITS CLINICALITS CLINICAL

MANIFESTATION ANDMANIFESTATION AND

MANAGEMENTMANAGEMENT

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MANDIBULAR FRACTURESMANDIBULAR FRACTURES

FACIALDISTORTION

MALOCCLUSIONOF THE TEETH

FACIALDISTORTION

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TREATMENTTREATMENT

IMMOBILIZATION

B ARTONSB ANDAGE

INTERDENTAL

WIRING

2 - P C LORENZSCREW

O P EN REDUCTION

INTERNAL FIXATION

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TREATMENTTREATMENT

CHEST STRAPPING ISCHEST STRAPPING IS CONTRAINDICATEDCONTRAINDICATED It reduces respiratory expansionIt reduces respiratory expansion

PULMONARY TOILETPULMONARY TOILET

STOVESTOVE--IN CHEST TRACTIONIN CHEST TRACTION Skeletal traction for multiple ribs fractureSkeletal traction for multiple ribs fracture

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FRACTURES OF THEFRACTURES OF THE UPPERUPPER

EXTREMETIES AND SHOULDEREXTREMETIES AND SHOULDERGIRDLEGIRDLE

CLAVICLE

HEAD OF THEHUMERUS

SCAPULAE

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CLAVICLE FRACTURE

FALL WITHSTRETCHED ARMS

CLAVICLE FRACTURE

TRIANGULAR B ANDAGE

SHOULDER S P ICA

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FRACTURE OF THE HUMERUSFRACTURE OF THE HUMERUS

Lateral aspect

Anatomical neck

G reater tubercle

S urgical neck

sha f t

Deltoid tuberosity

G roove f or R adial nerve

Posterior vie w

H ead

Medial aspectO lecranon f ossa

Lateral epicondyle

trochlea

Medial epicondyle

G roove f or ulnar nerve

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HUMERUSHUMERUS

O P EN FRACTUREOF THE

P ROXIMALHUMERUS

FRACTURE OFTHE HUMERUS

SHAFT

SU P RACONDYLAR FRACTURE OF THE

HUMERUS

MELCH TY P E

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TREATMENTTREATMENT

CASTING

Closed F racture in the humerus

sha f t

HANGINGCAST

FUNCTIONAL CAST with callusformation

O P EN F racture in the humerus

sha f t

SUGAR TONG

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TRACTION

OVERHEAD TRACTION

-S keletal kind o f traction used f or supracondylar f racture o f the humerus

ZERO-DEGREE TRACTION

- S kin kind o f traction used f or f racture o f the neck o f the humerus

DUNLO P S TRACTION

- skin traction used f or supracondylar f racture o f

the humerus

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FRACTURES OF THEFRACTURES OF THE RADIUSRADIUS

AND ULNA AND ULNA

GALLEAZI FRACTURE COLLES FRACTURE SMITH FRACTURE

B ARTONS FRACTURE FRACTURES OF THE SHAFT

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TREATMENTTREATMENT

CASTINGCASTING

LONG ARM CIRCULAR CASTLONG ARM CIRCULAR CAST

SHORT ARM CIRCULAR CASTSHORT ARM CIRCULAR CAST

LONG ARM POSTERIOR MOLDLONG ARM POSTERIOR MOLD

SHORT ARM POSTERIOR MOLDSHORT ARM POSTERIOR MOLD

MUNSTER CASTMUNSTER CAST

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P ELVIC FRACTURESP ELVIC FRACTURES

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MALGAIGNE FRACTURE

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TREATMENTTREATMENT

CASTINGCASTING HIP SPICAHIP SPICA

DOUBLE HIP SPICADOUBLE HIP SPICA11 -- 1/2 HIP SPICA1/2 HIP SPICASINGLE HIP SPICASINGLE HIP SPICADOUBLE HIP SPICA POSTERIOR MOLDDOUBLE HIP SPICA POSTERIOR MOLD11 -- 1/2 HIP SPICA POSTERIOR MOLD1/2 HIP SPICA POSTERIOR MOLDSINGLE HIP SPICA POSTERIOR MOLDSINGLE HIP SPICA POSTERIOR MOLDFROG KCASTFROG KCAST

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TRACTIONTRACTION

SKIN TRACTIONSKIN TRACTION

B UCKS TRACTIONB UCKS TRACTION

HAMMOCK SUS P ENSIONHAMMOCK SUS P ENSIONB RYANTS TRACTIONB RYANTS TRACTION

SKELETAL TRACTIONSKELETAL TRACTIONB ALANCED SKELETALB ALANCED SKELETALTRACTIONTRACTION

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HOFFMANS EXTERNALFIXATOR

SCREWING

P LATING

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FRACTURES OF THE FEMURFRACTURES OF THE FEMUR

GREATER TROCHANTER

I ntertrochanteric Crest

G luteal Tuberosity

I ntercondylar Fossa

G luteal Tuberosity

Lateral Condyle

H ead

Lesser Trochanter

Medial condyle

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FEMORAL NECK FRACTURE

GARDENS CLASSIFICATION

incomplete

and nondisplaced

complete and nondisplaced

complete

and partially displaced

complete and totally displaced

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INTERTROCHANTERICFRACTURES

EVANS CLASSIFICATION

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SU B TROCHANTERICFRACTURES

RUSSEL-TAYLORSCLASSIFICATION

TYP E 1

FRACTURESDO NOTEXTEND INTOTHEP INFORMISFOSSA

FRACTURESEXTEND INTOTHE GREATER TROCHANTER

AND INVOLVESTHEP INFORMISFOSSA

TYP E2

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TREATMENTTREATMENT

CASTINGCASTINGHIP SPICAHIP SPICAQUADRILATERAL/QUADRILATERAL/ISCHIAL WEIGHTISCHIAL WEIGHTBEARINGBEARINGBASKET CASTBASKET CAST

CAST BRACECAST BRACE

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FRACTURES OF THEFRACTURES OF THE

LOWER LEGLOWER LEG

P OTTS FRACTURE SHATZNERSFRACTURE

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TREATMENTTREATMENT

CASTINGCASTINGLONG LEG CIRCULAR CASTLONG LEG CIRCULAR CASTSHORT LEG CIRCULARSHORT LEG CIRCULARCASTCAST

LONG LEGP

OSTERIORLONG LEGP

OSTERIORMOLDMOLDSHORT LEG P OSTERIORSHORT LEG P OSTERIORMOLDMOLDP ATELLARP ATELLAR- -TENDONTENDONBEARINGBEARING

WALKING CASTWALKING CASTDELVIT CASTDELVIT CASTCYLINDRICAL CASTCYLINDRICAL CAST

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CELLULAR P ROLIFERATION

takes place a f ter several days .

The combination o f periosteal elevation and the

granulation tissue containing blood vessel, f ibroblast and

osteoblasts produce a substance called osteoids

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CALLUS FORMATION

Af ter the f ollo w ing w eeks, minerals are being deposited in the osteoid f orming a large mass o f di ff erentiated tissue bridging the f ractured called

callus

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OSSIFICATION

F inal laying do w n o f bone,

is the stage in w hich f racture ends knit together

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CONSOLIDATION

W hen the consolidation is

completed the excess cells are absorbed

The primary cancellous bone is remodelled, compact

bone being f ormed according to stress patterns

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COMPLICATIONS

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Interruptions in the sequenceInterruptions in the sequence

of healing are caused by:of healing are caused by:D EB RI D EMENTD EB RI D EMENTLACK OF VITAMIN DLACK OF VITAMIN D

INFECTIONINFECTIONLOSS OF CIRCULATIONLOSS OF CIRCULATIONIMPROPER IMMO B ILIZATIONIMPROPER IMMO B ILIZATION

INA D EQUATE FIXATIONINA D EQUATE FIXATIONNECROSIS D UE TO FIXATION D EVICESNECROSIS D UE TO FIXATION D EVICESMETA B OLIC D ISTUR B ANCEMETA B OLIC D ISTUR B ANCE

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AVASCULAR NECROSIS AVASCULAR NECROSIS

W hen a j oint is W hen a j oint is in j ured, as in a in j ured, as in a f racture or f racture or dislocation, the dislocation, the blood vessels may blood vessels may be damaged . This be damaged . This can inter f ere w ith can inter f ere w ith the blood the blood circulation to the circulation to the bone and lead to bone and lead to traumatrauma -- related related avascular necrosis . avascular necrosis .

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SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

P AIN

P AIN ON B EARINGWEIGHT

CRE P ITUS ONROTATION

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TREATMENTTREATMENT

CONSERVATIVE TREATMENTCONSERVATIVE TREATMENTMedicines to reduced fatty acidsMedicines to reduced fatty acidsReduced weight bearingReduced weight bearingRange of motion exerciseRange of motion exerciseElectrical stimulation to induced bone growthElectrical stimulation to induced bone growth

SURGICAL TREATMENTSURGICAL TREATMENTCORE DECOMPRESSIONCORE DECOMPRESSION

This surgical procedure removes the inner layer of bone,This surgical procedure removes the inner layer of bone,which reduces pressure within the bone, increases bloodwhich reduces pressure within the bone, increases blood

flow to the bone, and allows more blood vessels to formflow to the bone, and allows more blood vessels to form

OSTEOTOMY OSTEOTOMY This surgical procedure reshapes the bone to reduceThis surgical procedure reshapes the bone to reducestress on the affected areastress on the affected area

BONE GRAFTBONE GRAFT

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OTHER COMPLICATIONSOTHER COMPLICATIONS

PNEUMONIAPNEUMONIABED SORESBED SORESINFECTIONINFECTIONCONTRACTURESCONTRACTURESCOMPRESSION SYNDROMECOMPRESSION SYNDROME