Long

bones

UPPER END

SHAFT

LOWER END
 SITE OF A LESION OR FRACTURE
UPPER END

SHAFT
T
METAPHYSIS H AF
D-S
EPIPHYSIS MI

LOWER END
Long
bones
• Trauma
• Diseases: Cong,
Inflammatory
- infective (specific or non
spicific)
- non-infective
Neoplastic,
Degenerative,
Developmental,
Metabolic, nutritional, …
etc
What do we need to
know
• Diagnosis of common problems
• Investigations
• Reading X ray
• 1st aid management
• When to refer a pt to Orthopaedic Surgeon
• Common questions asked by Pt
• Methods of treatment in Orthopaedics
 Diagnosis of common
problems
FRACTURES
• PROBABLE(SUSPICIOUS) SIGNS
OF FRACTURE
Swelling
Local pain
Tenderness
Ecchymosis,abrasions
Limited joint
movement
 SURE (DEFINITIVE) SIGNS
OF FRACTURE
Deformity

Shortening(length discrepancy)
Abnormal movement at the bone
Crepitus
LONG BONE INJURIES
CLOSED FRACTURES

PATHOLOGICAL FR
OPEN FRACTURES
OPEN AND CLOSED
FRACTURES - Definition
- Precautions
X-RAYS

Transverse Oblique Spiral

X-RAYS

Comminuted -
Segmental -
X-RAYS

Single bone -
Two bones -
 X-RAYS

:Special Types
.COLLES FR
 X-RAYS

.PATHOLOGICAL FR
TREATMENT OF OPEN
FRACTURES
• Radical debridment
• Stabilization
• Limb reconstruction
TREATMENT OF CLOCED FRACTURES
UNDISPLACED
REDUCIBLE
 CONSERVATIVE TREATMENT
1-TRACTION
GALLOW,s TRACTION

SKIN TRACTION
CLOSED, UNDISPLACED
CLOSED, REDUCIBLE
 CONSERVATIVE
TREATMENT

2- CAST

Above Knee
Below Knee
POP) )Plaster Of Paris
POP Cast for simple
nondisplaced fractures with no
skin nor neurovascular
compromise
POP Slab or Splint
CONSERVATIVE TREATMENT
POP (CAST)

Below Knee
Above Knee

FRACTURE PLETHORA

COMPLICATIONS:
* Malunion
* Delayed union
* Non-union
* Joint Stiffness
* Muscle Atrophy
*Skin Complications
Malunion, Cross-
union
Fracture remodeling
Nonunion
 * CLOSED,UNSTABLE
* OPEN FRACTURES
* PATOLOGICAL FRACTURE
 OPERATIVE
TREATMENT

Intra-medullary Nail
(IMN) Plate and Screws
External Fixator
Internal & external fixation
Internal fixation for early
movement, & better
chance of union
Inter-locking Nail
TYPES OF
PLATES
Shape & density of bone
Ch osteomylitis, bone soft.dis.,
dysplasea, tumours ...etc
OSTEOMYELITIS
- dead bone )Sequestrum )
- new bone formation
) )Involucrum
Chronic
osteomyelitis
Osteogenesis
imperfecta
Fibrous
dysplasea
Rickets )cupping,
broadening, & fraying &
shaft deformity)
Malunion
.Malunion, paget dis
Fracture callus
TUMOURS
Osteosarcom
a
Pathological fracture
 Causes of limb length
discrepanccy
) ) LLD
• cong. • Growth retardation
• Infect. OR stimulation
• Trauma
• Neoplasm
• Paralytic
• Mechanical
• developmental
N,Vs,or bone
• idiopathic
hemihyper./atroph
Clinical assessment

• LLD
• pain
• function
• deformity & apparent vs true
LLD
• joint movement and stability
• Vs & N exam.
Genu varum &
valgum
Cubitus varus &
valgum
Clinical assessment
Normal mechanical axis to see
deformity, or limb length

LOWER LIMB LENGTH

-TRUE
-APPARENT
Apparent shortening, & true
shortening
X ray
Rotation & femoral
antiversion
effects of LLD