gp lecture
TRANSCRIPT
FracturesFractures
FracturesFractures
Dr Ayman Soliman Isamail
Common Outdoor Common Outdoor Injury ManagementInjury Management
ObjectivesObjectives Review mechanisms and patterns Review mechanisms and patterns
of traumatic injuryof traumatic injury Illustrate the types of injury that Illustrate the types of injury that
occur to the skeleton, soft tissue, occur to the skeleton, soft tissue, and skeletal support structuresand skeletal support structures
Explain the general principles of Explain the general principles of wound care and the emergency wound care and the emergency care for musculoskeletal injuriescare for musculoskeletal injuries
Mechanism of InjuryMechanism of Injury
Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Penetrating TraumaPenetrating Trauma Compression (Blunt) Compression (Blunt) TraumaTrauma
Bending TraumaBending Trauma
HyperflexionHyperflexion
HyperextensionHyperextension
Nail in Index FingerNail in Index Finger
Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Penetrating TraumaPenetrating Trauma Compression (Blunt) Compression (Blunt) TraumaTrauma
Bending TraumaBending TraumaHyperflexionHyperflexionHyperextensionHyperextension
Severe Contusion of FootSevere Contusion of Foot
Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Penetrating TraumaPenetrating Trauma Compression (Blunt) Compression (Blunt) TraumaTrauma
Bending TraumaBending Trauma
HyperflexionHyperflexion
HyperextensionHyperextension
CervicalCervical(C5-C6) (C5-C6) Fracture Fracture
DislocatioDislocationn
Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Penetrating TraumaPenetrating Trauma Compression (Blunt) Compression (Blunt) TraumaTrauma
Bending TraumaBending Trauma
HyperflexionHyperflexion
HyperextensionHyperextension
Dorsal Dorsal DislocationDislocation
, Long , Long Finger Finger Middle Middle JointJoint
(PIP Joint)(PIP Joint)
Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Rotational TraumaRotational Trauma Distraction TraumaDistraction Trauma Crush TraumaCrush Trauma Deceleration TraumaDeceleration Trauma Acceleration TraumaAcceleration Trauma
Normal Normal Tibia Tibia Left Left
SpiralSpiral
FractureFracture
Tibia Tibia
RightRight
Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Rotational TraumaRotational Trauma Distraction TraumaDistraction Trauma Crush TraumaCrush Trauma Deceleration TraumaDeceleration Trauma Acceleration TraumaAcceleration Trauma
Dislocation of Right Dislocation of Right ShoulderShoulder
Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Rotational TraumaRotational Trauma Distraction TraumaDistraction Trauma Crush TraumaCrush Trauma Deceleration TraumaDeceleration Trauma Acceleration TraumaAcceleration Trauma
Train Crush Injury, LegTrain Crush Injury, Leg
Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Rotational TraumaRotational Trauma Distraction TraumaDistraction Trauma Crush TraumaCrush Trauma Deceleration TraumaDeceleration Trauma Acceleration TraumaAcceleration Trauma
Deceleration TraumaDeceleration Trauma
Mechanism of InjuryMechanism of InjuryTypes of TraumaTypes of Trauma
Rotational TraumaRotational Trauma Distraction TraumaDistraction Trauma Crush TraumaCrush Trauma Deceleration TraumaDeceleration Trauma Acceleration TraumaAcceleration Trauma
Car struck from behind Car struck from behind “accelerates” passengers, “accelerates” passengers,
producing an extension injury producing an extension injury to the neck!to the neck!
Acceleration Acceleration TraumaTrauma
Mechanism of InjuryMechanism of InjuryTypes of ForceTypes of Force
Mechanism of InjuryMechanism of InjuryTypes of ForceTypes of Force
Direct ForceDirect Force Indirect ForceIndirect Force Twisting ForceTwisting Force High Energy ForceHigh Energy Force
DirectDirectMid-Shaft Fracture, Mid-Shaft Fracture,
FemurFemur
Mechanism of InjuryMechanism of InjuryTypes of ForceTypes of Force
Direct ForceDirect Force Indirect ForceIndirect Force Twisting ForceTwisting Force High Energy ForceHigh Energy Force
IndirectIndirectPosterior Dislocation, Posterior Dislocation,
ElbowElbow
Mechanism of InjuryMechanism of InjuryTypes of ForceTypes of Force
Direct ForceDirect Force Indirect ForceIndirect Force Twisting ForceTwisting Force High Energy ForceHigh Energy Force
TwistingTwistingSubtalar Dislocation, Subtalar Dislocation,
AnkleAnkle
Mechanism of InjuryMechanism of InjuryTypes of ForceTypes of Force
Direct ForceDirect Force Indirect ForceIndirect Force Twisting ForceTwisting Force High Energy ForceHigh Energy Force
High EnergyHigh EnergyFractured PelvisFractured Pelvis
Types of InjuryTypes of Injury
Types of InjuryTypes of InjuryFractureFracture
• Any break in the Any break in the continuity of a bonecontinuity of a bone
• May vary from a simple May vary from a simple crack to a completely crack to a completely
shattered boneshattered bone
Fracture ClassificationFracture Classification
Closed/OpenClosed/Open
Incomplete/CompleteIncomplete/Complete
Non-Displaced/DisplacedNon-Displaced/Displaced
Closed Fracture,Closed Fracture,
Base of ThumbBase of Thumb ClosedClosed
Dorsally Dorsally Angulated Angulated
Forearm FractureForearm Fracture
Open Fracture, TibiaOpen Fracture, Tibia
Open Fracture, ForearmOpen Fracture, Forearm
Open Fracture, ForearmOpen Fracture, Forearm
Open Fractures Are Open Fractures Are More Serious!More Serious!
Blood lossBlood loss
Potential contamination Potential contamination with risk of infectionwith risk of infection
Fracture ClassificationFracture Classification
Closed/OpenClosed/Open
Incomplete/CompleteIncomplete/Complete
Displaced/DisplacedDisplaced/Displaced
Incomplete Fracture, Incomplete Fracture, Distal RadiusDistal Radius
Complete Fracture, Complete Fracture, FemurFemur
Fracture ClassificationFracture Classification
Closed/OpenClosed/Open
Incomplete/CompleteIncomplete/Complete
Non-Displaced/DisplacedNon-Displaced/Displaced
Non-Displaced Fracture, Non-Displaced Fracture, Distal Tibia and FibulaDistal Tibia and Fibula
Displaced Forearm Displaced Forearm FracturesFractures
Other Types of FractureOther Types of FractureComminuted – fractured into Comminuted – fractured into more than two segmentsmore than two segments
Pathologic – fracture Pathologic – fracture through diseased bonethrough diseased bone
Epiphyseal – fracture passes Epiphyseal – fracture passes through the growth platethrough the growth plate
Comminuted Femur Comminuted Femur FractureFracture
Other Types of Fracture
Comminuted – fractured into more than two segments
Pathologic – fracture through diseased bone
Epiphyseal – fracture passes through the growth plate
PathologicPathologicLytic lesion (darker = Lytic lesion (darker =
tumor) in proximal phalanx tumor) in proximal phalanx of finger, with associated of finger, with associated
transverse fracturetransverse fracture
Other Types of Fracture
Comminuted – fractured into many pieces
Pathologic – fracture through diseased bone
Epiphyseal – fracture through the growth plate
Epiphyseal (growth-line) Epiphyseal (growth-line) Fracture, Fracture,
Distal Femur Distal Femur
Signs of a FractureSigns of a Fracture
TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
Seven Seven Signs of FractureSigns of Fracture TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
Fractured PatellaFractured Patella
Seven Seven Signs of FractureSigns of Fracture TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
AngulatedAngulated Fracture, Fracture, Radius and UlnaRadius and Ulna
Seven Seven Signs of FractureSigns of Fracture
TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
CrepitusCrepitus
In a complete fracture, In a complete fracture, the the sounds of bone ends clicking sounds of bone ends clicking
or rubbing against each other;or rubbing against each other; denotes an unstable fracture!denotes an unstable fracture!
Seven Seven Signs of FractureSigns of Fracture
TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
Open Ankle FractureOpen Ankle Fracture
Seven Seven Signs of FractureSigns of Fracture TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
False MotionFalse MotionThe unusual visual The unusual visual
sensation of observing sensation of observing motion at a long bone motion at a long bone fracture site wherefracture site where
““there is no joint!” there is no joint!”
Seven Seven Signs of FractureSigns of Fracture TendernessTenderness Swelling and EcchymosisSwelling and Ecchymosis DeformityDeformity CrepitusCrepitus Exposed FragmentsExposed Fragments False MotionFalse Motion Inability to Use the LimbInability to Use the Limb
Fracture, Right Clavicle Fracture, Right Clavicle Right Arm ProtectedRight Arm Protected
Seven Signs of Seven Signs of FractureFracture
The presence of The presence of
any oneany one
of the of the
seven fracture signs just listed seven fracture signs just listed
is sufficient to assess this injury!is sufficient to assess this injury!
Types of Injury Types of Injury DislocationDislocation
Disruption of a joint such Disruption of a joint such that the bone ends are no that the bone ends are no longer in normal contactlonger in normal contact
Must have torn ligaments Must have torn ligaments and joint capsuleand joint capsule
Signs of DislocationSigns of Dislocation
TendernessTenderness Deformity (usually Deformity (usually
marked)marked) Swelling and EcchymosisSwelling and Ecchymosis Loss of normal joint Loss of normal joint
motionmotion
Common DislocationsCommon Dislocations
ShoulderShoulder FingerFinger HipHip ElbowElbow
Anterior Dislocation, Right Anterior Dislocation, Right ShoulderShoulder
Common DislocationsCommon Dislocations
ShoulderShoulder FingerFinger HipHip ElbowElbow
Dislocation, Middle Joint Dislocation, Middle Joint (PIP Joint), Ring Finger(PIP Joint), Ring Finger
Common DislocationsCommon Dislocations
ShoulderShoulder FingerFinger HipHip ElbowElbow
Posterior Hip DislocationPosterior Hip Dislocation
Common DislocationsCommon Dislocations
ShoulderShoulder FingerFinger HipHip ElbowElbow
Posterior Elbow DislocationPosterior Elbow Dislocation
Types of InjuryTypes of Injury Fracture-DislocationFracture-Dislocation
A combined injury with A combined injury with joint dislocation and an joint dislocation and an adjacent bone fractureadjacent bone fracture
Fracture–Dislocation, AnkleFracture–Dislocation, Ankle
Types of Injury Types of Injury SprainSprain
Partial or completePartial or completetemporarytemporary joint dislocationjoint dislocation
Ligaments are torn Ligaments are torn partially or completelypartially or completely
May produce as much May produce as much structural damage as a structural damage as a
dislocationdislocation
Sprain, Left AnkleSprain, Left Ankle
Assessing Assessing Musculoskeletal Musculoskeletal
InjuriesInjuries ABC’sABC’s Injury History (“What Injury History (“What
happened?”)happened?”) Palpation of injury site --Palpation of injury site --
“ “Take one finger and Take one finger and show me where it show me where it hurts!”hurts!”
DCAP-BTLSDCAP-BTLS DDeformitieseformities CContusionsontusions AAbrasionsbrasions PPuncture Woundsuncture Wounds BBurnsurns TTendernessenderness LLacerationsacerations SSwellingwelling
Evaluation of Distal Evaluation of Distal Neurovascular FunctionNeurovascular Function
(CMS)(CMS)
Pulse (circulation)Pulse (circulation) Motor FunctionMotor Function SensationSensation
Radial Pulse Posterior Radial Pulse Posterior Tibial Tibial PulsePulse
Evaluation of Distal Evaluation of Distal Neurovascular FunctionNeurovascular Function
(CMS)(CMS)
Pulse (circulation)Pulse (circulation) Motor FunctionMotor Function SensationSensation
Extension Extension FlexionFlexion
Ankle Dorsiflexion Ankle Plantar Ankle Dorsiflexion Ankle Plantar FlexionFlexion
Evaluation of Distal Evaluation of Distal Neurovascular FunctionNeurovascular Function
(CMS)(CMS)
Pulse (circulation)Pulse (circulation) Motor FunctionMotor Function SensationSensation
Medial and Medial Foot Medial and Medial Foot Lateral FootLateral FootLateral HandLateral Hand
Principles of Principles of Musculoskeletal Injury Musculoskeletal Injury
ManagementManagement ABC’sABC’s Evaluate distal neurovascularEvaluate distal neurovascular
functionfunction Dress all woundsDress all wounds Splint all suspected injuriesSplint all suspected injuries Prepare patient for transportPrepare patient for transport
Injury ManagementInjury Management
All All
open woundsopen wounds
should be covered with a should be covered with a
dry sterile compression dry sterile compression dressingdressing
Injury ManagementInjury ManagementSplinting Immobilizes Splinting Immobilizes
the Injury and:the Injury and: Reduces PainReduces Pain Facilitates TransportFacilitates Transport Prevents further damage Prevents further damage
totoblood vessels, nerves andblood vessels, nerves andskin adjacent to the injuryskin adjacent to the injury
Decreases BleedingDecreases Bleeding
Principles of SplintingPrinciples of Splinting Check and record CMS Check and record CMS DressDress all wounds all wounds Immobilize the joints Immobilize the joints above above
and belowand below a suspected a suspected fracturefracture
With injuries at or near joints, With injuries at or near joints, immobilize the bones above immobilize the bones above and below the injuryand below the injury
Stabilize the injury site during Stabilize the injury site during splint application splint application
Principles of SplintingPrinciples of Splinting
Use gentle in-line Use gentle in-line manual tractionmanual traction to realign displaced long bone to realign displaced long bone fracturesfractures
Expect to encounter Expect to encounter increased increased painpain and some resistance when and some resistance when attempting to realign a deformed attempting to realign a deformed limblimb
Immobilize all suspected spinal Immobilize all suspected spinal injuries injuries in a neutral in-line in a neutral in-line positionposition on a on a spineboardspineboard
Total Body Total Body ImmobilizationImmobilization
When in doubt:When in doubt:
SPLINT!SPLINT!
Soft SplintsSoft Splints Air Splint Vacuum Air Splint Vacuum SplintSplint
Sling and Swathe Blanket Sling and Swathe Blanket RollRoll
Traction SplintTraction Splint
When standard splints When standard splints are unavailable, are unavailable, improvisation improvisation
is better than doing is better than doing nothing!nothing!
UPPER UPPER EXTREMITYEXTREMITY
All fractures All fractures can be can be
immobilized immobilized by securing by securing
the extremity the extremity to the chest!to the chest!
LOWER EXTREMITYLOWER EXTREMITYAll fractures can be immobilized by All fractures can be immobilized by
securing the injured extremity to securing the injured extremity to the opposite lower extremity!the opposite lower extremity!