8/14/2019 All About Fractures

1/29

(Medical Student Education Series-Core

Orthopaedics)

(Medical Student Education Series:Core Orthopaedics)

ALL ABOUT FRACTURES

(Fxs).Part One

Open Fx tibia from suicide

The 10-15 minute FractureTalk for all Medical Studentscopyright 2008 eugene [sic]

8/14/2019 All About Fractures

2/29

there are > 500 differenttypes of Fxs and softtissue injuries; it took me

30 years to know them;here you can learn themin just 10-15 minutes.

(You can learn orthopaedics fromreading books or from:

Youtube or simply building your

8/14/2019 All About Fractures

3/29

What is aFracture (Fx)?A break in the

bone

8/14/2019 All About Fractures

4/29

Why treat a

Fx?

To revent mal-

8/14/2019 All About Fractures

5/29

How to describe aFx.

(stand one meter from the XRbox,

name the patient and the date ofthe XR)Which bone, which end of thebone, fracture

line configuration

8/14/2019 All About Fractures

6/29

How to treat a Fx?

(save the patient, ABC,and save the limb).

REDUCE the Fx(Externally-traction &manipulate orINTERNALLY- operate) and

HOLD the Fx(Externally-POP, external

REDUCE-MANIPULATE

HOLD

REDUCE-TRACTION

Skier dead fromhead injury

8/14/2019 All About Fractures

7/29

How does a Fx heal?Haematoma (minutes),granulation tissue (hours),(forget days),immature callus (weeks, =clinicalunion),

mature callus (months, =XR union),

8/14/2019 All About Fractures

8/29

How can you tell a Fx ishealed?

No pain when loaded in

Healed Fx tibia

8/14/2019 All About Fractures

9/29

Open and

Open Fxcommunicates

with the skin.Wash-out within

8/14/2019 All About Fractures

10/29

Open Fx (need to stop

Soft tissues-Debride/clean,close,reconstruct (skin grafts/flap)

Open subtalar Fx/dislocation

The Bone-Debride,reduce, hold,reconstruct(bone graft).ie wash-out,ext fix to bone,close skin 2 to 3 days, maybe skin graft,bone graft at 6 to 8 wks.

8/14/2019 All About Fractures

11/29

Complications ofFxs.

Nerves-

neuropraxia/axonotmesi

s/neurotmesis

Non unionhumerus

Heel pressurearea

EPL rupture

8/14/2019 All About Fractures

12/29

and late(Osteo-

OA ankle

OA kneeOA wrist

8/14/2019 All About Fractures

13/29

Dont forget INFECTION

Never get in closed

management

8/14/2019 All About Fractures

14/29

Compartment syndrome(EMERGENCY-easilymissed; can become

disaster).

Extreme pain at rest,extreme pain with movement,

ins-and- needles.Release tight POP,

fascioto

8/14/2019 All About Fractures

15/29

Stress Fx

where XR is normal,

8/14/2019 All About Fractures

16/29

(Medical Student Education Series-Core

Orthopaedics)

(Medical Student Education Series:Core Orthopaedics)

ALL ABOUT FRACTURES

(Fxs).Part Two

Open Fx tibia from suicide

The 10-15 minute FractureTalk for all Medical Studentscopyright 2008 eugene [sic]

8/14/2019 All About Fractures

17/29

Which Fxs you shouldust about

always operate on?

Multi-trauma,

athological,nursing difficulties,forearm,displaced into joints,

Pathological Fx

Ankle Fx

Fx femurFx left femur,Fx right tibia

Pelvic Fx

8/14/2019 All About Fractures

18/29

Which Fxs you just

aboutnever operate on?

Children (with

Pelvic Fx, 8 yo, re models. Fx wrist.8 yo.Closed reduction.

Fx forearm.Closed

reduction. 11 yo.

8/14/2019 All About Fractures

19/29

Who NOT to operateon?

Patients who haveroblems

8/14/2019 All About Fractures

20/29

NEVER-

pplyPOPto new

8/14/2019 All About Fractures

21/29

FOLLOW-UP ALL Fxs.Esp childrens.

Lat condylar Fx in a 8 yo, complicationsmay appear at age 20.20 yrs.

Fx lower femur, 11 yo,growtharrest may appear 12 to 24 mths later.

Physealbridge

ankle 11 yo.Apparent

Growth arrestLower femur apparentat 18 mths post injury

8/14/2019 All About Fractures

22/29

Difficult to treat Fxs

-Impossible Fx(comminuted, pathological,

unstable)-Impossible facilities( you need the right

knowledge& equipment)

8/14/2019 All About Fractures

23/29

Childrens Fxs.

Involves growth plateinjuries ,bone may stop growing,

which can later causeshortening andangulation of leg/limbs.

Lat condylar Fx in a 8 yo, complicationsmay appear at age 20.20 yrs.

Fx lower femur, 11 yo,see below:

Physeal bridge.Ankle Fx. 11 yo,.

Growth arrest

at 18 mths.

8/14/2019 All About Fractures

24/29

Here we

ALL

8/14/2019 All About Fractures

25/29

Common Fxs:

Shoulder-proximalhumerus,

clavicle.Elbow-lateralcondylar,

supra-condylarColles/wristScaphoid5th metacarpal neck

Supra condylarFx humerus

Colles Fx

Fx 5thmetacarpal

Fx clavicle

Fx proxhumerus

Fx lateralcondyle

Scaphoid Fx

8/14/2019 All About Fractures

26/29

Hip and femurKnee

Tibiankle

TalusCalcaneusBase 2nd

metatarsalBase 5thmetatarsal

Both legs broken. 8 yo.

Plateau Fx

Upp tibial Fx

ommon so t t ssue

8/14/2019 All About Fractures

27/29

ommon so t t ssueinjuries:

Skiers thumb-brace/splint

Dislocated shoulder-sling/investigate/follow/often needsurgery

Knee sprain-examine/image/often surgery

Dislocated

Torn meniscus

Sprain

Skiers thumb

8/14/2019 All About Fractures

28/29

And dont forget:

-Important signs (eg blood at tipof

penis post injury? = Pelvic Fx.)

-In multi trauma,young doctorssometimes forget about footfractures, these later becomethe main concern of the patient(

Blood at tip

penis

8/14/2019 All About Fractures

29/29

Enjoy treating Fxs; try hard;these are often young and

active patients, you canmake a big difference totheir life.

MVA nearly killed Beforesurgery

Put nail infemur You saved

herBeforesurgery

Before surgery

You saved her