FRACTURE

DEFINITION
A fracture is a complete or incomplete break in the continuity of bone. This will be accompanied by varying degrees of injury to surrounding soft tissues.
Fractures normally result from stress of short duration which is greater than normal physiological stress or is applied in a direction which is not physiological

WHAT CAUSES FRACTURE?

DIRECT TRAUMA

HARD HIT

ACCIDENTS

FALL

INDIRECT TRAUMA

Pathologic glands osteoporosis

osteomyelitis

TWISTING FORCE

SEVERE TWISTING

OVER STRETCHING

FATIGUE AND STRESS

PROLONGED MARCHING

JOGGING

POWERFUL MUSCLE CONTRACTION

GRAND MAL SIZURE

GENERAL SIGNS AND SYMPTOMS

A. Break in the continuity of the bone cause:

1.BLEEDING

2. ABNORMAL MOBILITY 3. CREPITUS

-abnormal sound created due to friction of fractured area as the bones are moved

B. DISPLACEMENT OF FRAGMENT CAUSES:

1. DEFORMITY

2. LOSS OF FUNCTION

C. DAMAGE TO THE SOFT PART CAUSES:

1. SKIN WOUND 2. HEMATOMA

3. PAIN

3. SWELLING

4. PARALYSIS

CLASSIFICATION OF FRACTURES

BROAD CLASSIFICATION
A. CLOSED/SIMPLE FRACTURE

when the break in the bone has no communication in the outside

B. OPEN/COMPOUND FRACTURE

when the break in the bone comes out through the skin or there is communication of the bone to the outside

CLASSIFICATION AS TO EXTENT

COMPLETE

INCOMPLETE

CLASSIFICATION AS TO PATTERN

TRANSVERSE

OBLIQUE

SPIRAL

break that runs the bone break coils in slanting direction on bone runs around across the bone

CLASSIFICATION AS TO APPEARANCE

GREENSTICK

FISSURED

COMMINUTED

bone splintered into fragments involves an incomplete longitudinal break is in incomplete, and the breaks occurs at the convex surface of the bend in the bone

COMPRESSION

DEPRESSION

AVULSION

A is one inof bone, which is the the of usually occurs in the skull, with site fragment which bone, typically a insertion of a collapsestendon or ligament, is broken bone muscle, on itself vertebra, driven inward detached as the result of excessive tension

CLASSIFICATION AS TO LOCATION

PROXIMAL MEDIAL

DISTAL

CLASSIFICATION IN RELATION TO THE JOINT

Synovial fluid Joint capsule Head Articular cartilage

INTRA-CAPSULAR

Femur

Joint capsule

EXTRA-CAPSULAR

VARIOUS FRACTURES:
ITS CLINICAL MANIFESTATION AND MANAGEMENT

MANDIBULAR FRACTURES
FACIAL DISTORTION

MALOCCLUSION OF THE TEETH

FACIAL DISTORTION

TREATMENT
IMMOBILIZATION

INTERDENTAL WIRING

2-PC LORENZ SCREW

BARTONS BANDAGE

OPEN REDUCTION INTERNAL FIXATION

FRACTURE IN THE THORACIC CAGE TRUE RIBS

RESPIRATION PROBLEMS

HEMO/ PNEUMOTHORAX

HEMATOMA

TENDERNESS

FALSE RIBS

TREATMENT

CHEST STRAPPING IS CONTRAINDICATED

It reduces respiratory expansion

PULMONARY TOILET STOVE-IN CHEST TRACTION

Skeletal traction for multiple ribs fracture

FRACTURES OF THE UPPER EXTREMETIES AND SHOULDER GIRDLE HEAD OF THE

HUMERUS SCAPULAE

CLAVICLE

CLAVICLE FRACTURE

TRIANGULAR BANDAGE FALL WITH STRETCHED ARMS

CLAVICLE FRACTURE SHOULDER SPICA

FRACTURE OF THE HUMERUS

Anatomical neck Head

Greater tubercle
Surgical neck

Deltoid tuberosity shaft Groove for Radial nerve Posterior view Medial aspect Medial epicondyle Lateral aspect Olecranon fossa Lateral epicondyle

Groove for ulnar nerve

trochlea

HUMERUS

OPEN FRACTURE OF THE PROXIMAL HUMERUS

FRACTURE OF THE HUMERUS SHAFT

MELCH TYPE

SUPRACONDYLAR FRACTURE OF THE HUMERUS

TREATMENT
CASTING
Closed Fracture in the humerus shaft OPEN Fracture in the humerus shaft

HANGING CAST FUNCTIONAL CAST with callus formation

SUGAR TONG

TRACTION
OVERHEAD TRACTION -Skeletal kind of traction used for supracondylar fracture of the humerus ZERO-DEGREE TRACTION

-Skin kind of traction used for fracture of the neck of the humerus DUNLOPS TRACTION
-skin traction used for supracondylar fracture of the humerus

FRACTURES OF THE RADIUS AND ULNA

GALLEAZI FRACTURE

COLLES FRACTURE

SMITH FRACTURE

BARTONS FRACTURE

FRACTURES OF THE SHAFT

TREATMENT

CASTING

LONG ARM CIRCULAR CAST SHORT ARM CIRCULAR CAST LONG ARM POSTERIOR MOLD SHORT ARM POSTERIOR MOLD MUNSTER CAST

PELVIC FRACTURES

MALGAIGNE FRACTURE

TREATMENT

CASTING
HIP SPICA

DOUBLE HIP SPICA 1-1/2 HIP SPICA SINGLE HIP SPICA DOUBLE HIP SPICA POSTERIOR MOLD 1-1/2 HIP SPICA POSTERIOR MOLD SINGLE HIP SPICA POSTERIOR MOLD FROG CAST

TRACTION
SKIN TRACTION

BUCKS TRACTION HAMMOCK SUSPENSION BRYANTS TRACTION

SKELETAL TRACTION

BALANCED SKELETAL TRACTION

HOFFMANS EXTERNAL FIXATOR

SCREWING

PLATING

FRACTURES OF THE FEMUR

GREATER TROCHANTER Head Lesser Trochanter

Intertrochanteric Crest
Gluteal Tuberosity

Intercondylar Fossa

Medial condyle

Lateral Condyle

FEMORAL NECK FRACTURE

GARDENS CLASSIFICATION

incomplete and nondisplaced

complete and partially displaced

complete and nondisplaced

complete and totally displaced

INTERTROCHANTERIC FRACTURES
EVANS CLASSIFICATION

SUBTROCHANTERIC FRACTURES
RUSSEL-TAYLORS CLASSIFICATION

FRACTURES DO NOT EXTEND INTO THE PINFORMIS FOSSA

FRACTURES EXTEND INTO THE GREATER TROCHANTER AND INVOLVES THE PINFORMIS FOSSA
TYPE 2

TYPE 1

TREATMENT

CASTING

HIP SPICA QUADRILATERAL/ ISCHIAL WEIGHT BEARING BASKET CAST CAST BRACE

TRACTION

BALANCE SKELETAL TRACTION BRYANTS TRACTION BUCKS TRACTION 90-90 DEGREE TRACTION BOOT LEG TRACTION RUSSEL TRACTION

FRACTURES OF THE LOWER LEG

POTTS FRACTURE

SHATZNERS FRACTURE

TREATMENT
CASTING
LONG LEG CIRCULAR CAST SHORT LEG CIRCULAR CAST LONG LEG POSTERIOR MOLD SHORT LEG POSTERIOR MOLD PATELLAR-TENDON BEARING WALKING CAST DELVIT CAST CYLINDRICAL CAST

STAGES OF BONE HEALING

1. HEMATOMA FORMATION the clot begins 24 hours after the fracture occurs. This clot serves as fibrin network
when a bone is fractured, blood extravagates into the area between and around the fragments and the bone marrow

CELLULAR PROLIFERATION

The combination of takes place and periosteal elevationafterthe granulation tissue containing several days. blood vessel, fibroblast and osteoblasts produce a substance called osteoids

CALLUS FORMATION

After the following weeks, minerals are being deposited in the osteoid forming a large mass of differentiated tissue bridging the fractured called callus

OSSIFICATION

Final laying down of bone, is the stage in which fracture ends knit together

CONSOLIDATION

The primary cancellous bone is remodelled, compact bone being formed according to the consolidation is Whenstress patterns completed the excess cells are absorbed

COMPLICATIONS

Interruptions in the sequence of healing are caused by:

DEBRIDEMENT LACK OF VITAMIN D INFECTION LOSS OF CIRCULATION IMPROPER IMMOBILIZATION INADEQUATE FIXATION NECROSIS DUE TO FIXATION DEVICES METABOLIC DISTURBANCE

AVASCULAR NECROSIS
When

a joint is injured, as in a fracture or dislocation, the blood vessels may be damaged. This can interfere with the blood circulation to the bone and lead to trauma-related avascular necrosis.

SIGNS AND SYMPTOMS

PAIN ON BEARING WEIGHT PAIN CREPITUS ON ROTATION

TREATMENT

SURGICAL TREATMENT CONSERVATIVE TREATMENT

CORE DECOMPRESSION acids Medicines to reduced fatty This surgical procedure removes the inner layer of bone, Reduced weight pressure within the bone, increases blood which reduces bearing Range ofto the bone,exercise more blood vessels to form flow motion and allows Electrical stimulation to induced bone growth OSTEOTOMY

This surgical procedure reshapes the bone to reduce

stress on the affected area

BONE GRAFT

OTHER COMPLICATIONS

PNEUMONIA BED SORES INFECTION CONTRACTURES COMPRESSION SYNDROME