HOW TO DEAL

WITH A FRACTURE
 :SYMPTOMS
,History of trauma
,Pain
,Swelling
FRACTURES Limited movements.

SIGNS

:LOCAL SYSTEMIC:
,Swelling SHOCKHYPOVOLAEMIC
,Ecchymosis NEUROGENIC
,Tenderness SPINAL
Limited
movements
,Deformity DISTAL:
Length NEURO-VASCULAR
,discrepancy
 TRAUMA
Direct
Indirect
 Vehicular accidents
 Fall from height
 Crushing accidents
 Avulsion fractures
Fall on out-stretched
arm
FRACTURE DISLOCATION FRACTURE-DISLOCATION
FRACTURES
PROBABLE(SUSPICIOUS)
SIGNS OF FRACTURE
Swelling
Local pain
Tenderness
Ecchymosis,
abrasions
Limited joint
movement
:Sure Signs
Deformity,
Length discrepancy,
DINNER FORK
Abnormal
movements,
Crepitus

VARUS
S-SHAPE
,Length discrepancy

Abnormal M

Crepitus
OPEN AND CLOSED
FRACTURES
- Definition
- Precautions
FRACTURE PLETHORA
(BULLAE)
MULTIPLE INJURIES
RISK
Investigations
 Plain X-
ray
Transverse Oblique
Spiral

GREENSTICK
X-RAYS

Comminuted -
Segmental -
 Special
Types

COLLES
.FR

SMITH FR
 SUPRACONDYLAR FRACTURE
:Two types 

ₒExtension type Flexion type 

Caused by fall on caused by fall on
(outstretched hand(85%tip of elbow(15%)

  EXT

FLEX
MONTEGGIA FRACTURE-DISLOCATION
GALEAZZI FRACTURE-DISLOCATION
 Hip Fractures
 Femoral neck 45%
 intracapsular,
 disruption of blood supply to
femoral head,
 high incidence of healing
complications (nonunion,
osteonecrosis)
Intertrochanteric 45%
 extracapsular,
 no interference with the
blood supply of the femoral
head,
 less complications
 Malunion
Subtrochanteric
 extracapsular
 Malunion
DISLOCATIONS
SHOULDER
RECURRENCE
 ELBOW
POSTERIOR
HIP
POSTERIOR
SCIATIC N. INJ
MYOSITIS OSSIFICANS
 FRACTURE PELVIS
FR. ACETABULUM
CENTRAL HIP DISLOCATION
.PATHOLOGICAL FR
Osteogenesis
imperfecta
OTHER INVESTIGATIONS
CT
CT & 3D-CT
MRI
BONE SCAN
US examination
LAB INVESTIGATIONS
METHODS OF
TREATMENT
TREATMENT OF CLOCED
FRACTURES
UNDISPLACED
REDUCIBLE
 CONSERVATIVE TREATMENT

TRACTION-1

BALANCED SKIN TRACTION

SKELETAL TRACTION
GALLOW,s TRACTION
CAST (POP).2
FOR SIMPLE NONDISPLACED FRACTURES WITH NO

SKIN NOR NEUROVASCULAR COMPROMISE

OPEN FRACTURES
DEBRIDEMENT
EXTERNAL FIXATOR
EXTERNAL FIXATOR
 percutaneous
pinning.
ORIF

K-WIRES
METHODS OF INTERNAL FIXATION
INTER TROCHANTERIC FRACTURE
DHS
Displaced Femoral neck
Fracture esp. in elderly
pt.
HEMIARTHROPLASTY

TOTAL ARTHROPLASTY

Prosthetic
COMPLICATIONS
Malunion Cross union
Nonunion
ULNAR N PALSY
Axillary nerve
injury
Deltoid wasting
VOLKMANN,s ISCHAEMIC
CONTRACTURE
MYOSITIS OSSIFICANS
 Recurrence of dislocation
of the shoulder
 This is the most common complication.
 Causes of recurrence:

1- Patient age: High incidence below the

age of 40 years.
2- Inadequate immobilization: less than 3
weeks.
3- associated head fractures: (Hill-Sachs
lesion)
increase the incidence of recurrence.
INFECTIONS
 CHRONIC OSTEOMYELITIS

Pathology:
Affected bone is
destroyed or devitalized with
cavities
containing pus and pieces of
dead bone (sequestrum),
surrounded by vascular tissue,
and beyond that by areas of
sclerosis.
Sequestra act as •New bone
substrates for bacterial formation
adhesion causing persistence 
of the infection until removed Involucrum
or discharged through •Bone necrosis
draining sinuses. 
Sinuses may close Sequestrum
spontaneously then reopen •Cavity,dischargin
when tissue tension rises. g sinus
Pathological fracture  Cloaca
may develop.
Imaging :
X-ray
shows bone
resorption with
thickening and
sclerosis of the
surrounding bone.
Sequestra seen
as unnaturally dense
fragments in contrast
with the surrounding
vascularized bone.
Sometimes the
bone is crudely
thickened and
misshapen
resembling a bone
Deformitie
s

Genu varum & valgum

Cubitus varus
”Carrying angle “
Cubitus varus
”Carrying angle “
Cubitus valgum
”Carrying angle “
Coxa vara
Neck shaft angle