Download - Fractures and dislocations
Wherever the art of medicine is loved,there is also a love of humanity.
– Hippocrates
Yahyia Khalfan Mohammed Al-Abri
90440
Junior
Definitions
Causes of fractures
fracture classification
Clinical features of fractures
Pain control in fractures
Fractures treatment
Dislocation
Clinical features of dislocations
Outline
What is fracture?
Is a break in the structural continuity of bone.
What is dislocation?
The joint surface is completely displaced and are no longer in contact.
Definitions
Sudden trauma.
Most common
Direct vs indirect
Stress and fatigue fractures.
Most in tibia , fibula , and metatarsal.
Pathological fractures
osteoporosis , osteogenesis imperfecta ,Paget's disease ,bone cyst and metastasis.
Causes of fractures
fracture classification
Displacement
Pattern
Location
Integrity of Skin and Soft Tissue
Closed (simple)
skin/soft tissue over and near fracture is intact
open (compound )
skin/soft tissue over and near fracture is lacerated or abraded, fracture exposed to outside environment
Integrity of Skin and Soft Tissue
Name of bone?
Right or left ?
Where in the bone? Epiphyseal
end of bone, forming part of the adjacent joint
Metaphyseal
the flared portion of the bone at the ends of the shaft
Diaphyseal
the shaft of a long bone (proximal, middle, distal)
Physis
growth plate
Location
Pattern
Complete
Transverse
Oblique
Butterfly
Segmental
Spiral
Comminuted
Avulsion
Compression/impacted
Incomplete
Greenstick
Torus
Stress fracture
Compression Fractures
Orientation/Fracture Pattern
Transverse ObliqueButterfly SegmentalSpiralComminuted/multi-fragmentaryAvulsion Compression/impactedGreen-stick Torus
Questions
Non-displaced
Displaced
Angulated
Rotated
Distracted
Translated
Displacement
Non-displaced : fracture fragments are in anatomic
alignment
Displaced: fracture fragments are not in anatomic alignment
Displacement
Displacement
Angulated: direction of fracture apex, e.g. varus/valgus
Rotated: fracture fragment rotated about long axis of bone
Distracted : fracture fragments are separated by a
gap
Translated percentage of overlapping bone at fracture site
Displacement
Sign andsymptoms
pain and tenderness Swelling or bruising
Deformity Loss of function bone protruding
Numbness and tingling.Crepitus
History
History of injury followed by inability to use the injured limb. Age and mechanism of injury. If fracture occurs with trivial trauma suspect pathological lesion. Pain, swelling and bruising are common symptoms but they do not
distinguish a fracture form soft tissue injury. Deformity more suggestive Symptoms of associated injury( numbness or loss of movement , skin
pallor or cyanosis, blood in the urine, difficulty with breathing or transit lose of consciousness) get distract by the main injury.
Pervious injury or musculoskeletal problems( confusion with the x-ray)
General medical history (preparation for anesthesia or operation)
Clinical features( history)
Clinical features( Examination)
look feel Move
Look:
Swelling, bruising and deformity
skin is intact?
posture of the distal extremity and the color of the skin (for tell-tale signs of nerve or vessel damage).
Feel:
Palpate for tenderness
Test for vascular and peripheral nerve abnormalities
Move:
Crepitus and abnormal movement
Examination
Crepitus and abnormal movement should be tested
for only in unconscious patient. Usually it is more important to ask if the patient can move the joint distal to the injury.
Move
X-Ray is mandatory (rule of two)
Two views
Two joints
Two limbs
Two injuries
Two occasion
Imaging
Pain control in fracturesPharmacological:
systemic analgesia (e.g morphine, NSAIDS)
Nerve block
neuraxial anesthesia (spinal and epidural anesthesia)
Non-pharmacological: Transcutaneous Electrical Nerve Stimulation (TENS)
stabilization of the fracture using traction
The general aim of early fracture management is to
control hemorrhage, provide pain relief, prevent ischemia-reperfusion injury, and remove potential sources of contamination (foreign body and nonviable tissues)
Fracture treatment
Fractures treatment
Reduce
Hold
Exercise
Reduce (Closed reduction )
1-Pull the distal of the limp2-Reposition (reverse the original direction)
3- Alignment is adjust in each plane.
Open reduction
Operative reduction
When to use it??
When closed reduction failed
When there is large articular fragment that needs accurate positioning
Avulsion fracture
When an operation needed for associated injuries Arterial damage
Reduce (open reduction )
The aim is to Splint the fracture, not necessarily
entire limp.
Hold
Sustained traction Cast splintage Functional bracing
Internal fixation external fixation
More correctly restore function not only to the
injured part but also to the patient as whole.
The objective are to
Reduce edema
Preserve joint movement
Restore muscles power
Guide patient to normal activity
Exercise
The aim is to try to prevent them from becoming infected : the four essentials are:
Open fracture
Early definitive wound coverStabilisation of the fracture
DebridementAntibiotic prophylaxis
Common site of dislocations
The most commonly dislocated is the shoulder joint.[13]
Elbow: Posterior dislocation, 90% of all elbow dislocations[14]
Wrist: Lunate and Perilunatedislocation most common[15]
Finger: Interphalangeal (IP) or metacarpophalangeal (MCP) joint dislocations[16]
Hip: Posterior and anterior dislocation of hip
Diagnosis
History:
• pain, swelling, characteristic posturing, and the inability to move
Physical examination:
Shoulder dislocation:
Arm in a characteristic position of external rotation and slight abduction
Fullness anteroinferior to the coracoid process is palpable
Elbow dislocation:
elbow held in flexion
significant amount of soft tissue swelling around the elbow
Finger dislocation:
oedema and ecchymosis (bruising)
Patellar dislocation
swollen knee held in flexion and no obvious lateral prominence
often associated with haemarthrosis (bleeding into joint spaces)
Hip dislocation:
Posterior hip dislocation is with the hip in a position of flexion, internal rotation, and adduction
Anterior hip dislocations, the hip is classically held in external rotation, with mild flexion and abduction.
Imaging
Anteroposterior x-ray view of a shoulder showing an anteroinferior dislocation
Anteroposterior x-ray view of an elbow dislocation
Comprehensive medical reference and review for the
Medical Council of Canada.
Apley's concise system of orthopaedics and fracture
Medscape
radiologymasterclass.co.uk
Pain Management Interventions for Hip Fracture(http://www.ncbi.nlm.nih.gov/books/NBK56661/)
References