pricple of closed fracture mngement

8/19/2019 Pricple of Closed Fracture Mngement

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PRINCIPLES OF FRACTURE MANAGEMENT


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DEFINITIONClosed fractured


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HOW FRACTURES HAPPEN?

Single traumaticincident

Repetitive tre

Pat!"l"gical#racture


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$ec!anim "# Trauma

Spiral pattern(twisting)

Short obliquepattern

(compression)

Triangle‘butterfy’pattern

(bending)

Transversepattern

(tension)


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Types o

Fractureomplet

eFracture

!ncomple

teFracture


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"lasi#$asi Fra$tur %erdasar$a &rah 'arisFra$tur


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HOW FRACTURE DISPLACED


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Fractures Displacement


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HEALING PROCESS OF FRACTURE


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Healing Process of Fracture


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Union Consoli!ation " Non union

nion onsolidation

!ncomplete repair omplete repair

nsheathing callus is

calci#ed

alci#ed callus is ossi#ed

*+ ,ay-Fracture line still clearly

visible. fu/y callusaround it

*+ ,ay-Fracture line to be almost

obliterated. crossed bybone trabeculae. well

de#ned callus around it

0ot sae to sub1ect theunprotected bone to

stress

Future protection isunnecessary


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Non Union

Ditracti"n and eparati"n "# t!e #ragm


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H%pertr"p!% Atr"p!%


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Clinical Features

2istory


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#$ Ra% E&a'ination (Rules of T)o*

& vie'& ("int& in(urie& lim)& "ccai"n


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TREAT+ENT OF CLOSED

FRACTURES

• Treatment o ractures consists o -Manipulation to improve the position o the

ragment. ollowed by

Splintage to hold them together untill they unite3• Joint movement and unction must be

preserved3

• Fractures healing is promoted by

physiological loading o bone. so muscleactivity and early weight bearing areencouraged


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* imple in(uncti"n t" ac!ievet!e ")(ective +

&


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The most important factor in healing of bone


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Tsc,erne Classification of Close! In-uries

,rade E-planati"n'rade 4 • Simple racture 5

• 6ittle7no sot+tissue in1ury

'rade 8 • Fracture 5• Super#cial abrasion7bruising os$in and subcutaneous tissue

'rade 9 •

:ore severe racture 5• ;eep sot tissue contusion andswelling

'rade < • Severe in1ury 5

• :ar$ed sot+tissue damage 5


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REDUCE

T,e greater t,e contact surface area .et)een frag'ent


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ondition where reduction is unnecessary -

diplacement d"e n"t matter .#racture "# clavicl


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Cl"ed reducti"n


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CLOSED REDUCTION

• nder anaesthesia and musclerela=ation3

• Fracture is reduced by THREEHO0D

$ANUO1ER +

T


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OPEN REDUCTION

• !s an operative reduction o theracture under direct vision

In!ication of O/en Re!uction :• losed reduction ails

• >hen large articular ragment needaccurate positioning

• For traction ractures which ragments areheld apart


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HO0D REDUCTION


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0$ Continuous Traction

Speed


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0$ Continuous Traction

•

Traction by gravity• S$in traction

• S$eletal traction


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Co'/lication of Traction 1

• irculatory embarrasement

• 0erve in1ury

•

?in+ site inection


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2$ Cast S/lintage

$"ve


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2$ Cast S/lintage

• ?laster o ?aris is still widely used asa splint. especially or distal limbracture and or most children’s

racture• Speed o union is neither greater nor

less than with traction

• 2owever. 1oints encased in plasterscannot move and are liable tosti/ness3


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Co'/lication Cast S/lintage 1

• Tight cast vascular compression• ?ressure sore 6ocali@ed pain

• S$in abrasion or laceration due to

removing plasters• 6osse cast no longer hold the

racture due to subsided o swelling


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3$ Functional 4racing

•

Ane way o preventing 1oint sti/nesswhile still permitting racture splintageand loading

• The splints are unctional in that 1ointmovements are much less restrictedthan with conventional cast


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5$ Internal fi&ation

Sa#et%


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Indicati"n #"r internal 2-ati"n+

Fracture t!at cann"t )e reduced e-cept )% "perati"nFracture t!at unta)le 3 pr"ne t"Fracture t!at Unite p""rl% and l"'l%$ultiple #racturePat!"l"gical #ractureFracture in Patient 'it! nuring di4cult%


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T%pe "# internal 2-ati"n


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Co'/lication of Internal fi&ation

!nection


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56 E-ternal 2-ati"nseul or -


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i


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E-ercie


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THAN7 8OU

pricple of closed fracture mngement

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