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Complication

Muscular complication•  Traumatic myositis

ossifcans(posttraumaticossifcation)

Rapidly enlargingpainul tender mass

develop in the injuredtissues

New bone ormation inan abnormal site  

Heterotopic ossifcation

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Complication

Neurologicalcomplication

•  Tardy Nerve alsy

RemoteComplication

•

Renal !alculi• "ccident Neurosis

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Special Types ofFractures

Stress Fractures (Fatiguefractures)

• Result o repeated stresses andconse#uently may develop asmall crac$ or atigue racture

•  Treatment consist o desistingrom the responsible activityuntil the crac$ has healed%&ubse#uently' gradualresumption o activity result in

sucient wor$ hypertrophy othe bone to increase itsstrength and graduallycondition it or the stresses othe particular activity involved

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Pathological Fractures

• athological racture is one thatoccurs through abnormal bone

• one that is pathological' wea$er' andmore suspectible to racture thannormal bone%

• athological ractures can occur in

variety o disorders' some locali*ed'some disseminated' and othersgenerali*ed

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Classication of DisordersThat Predispose one to

Pathological Fracture• Congenital a!normalitiesLocali*ed+ !ongenital deect o tibia

,isseminated+ -nchondromatosis

.enerali*ed+ /steogenesis imperecta'osteoporosis

• Meta!olic !one disease+ Ric$ets' osteomalacia

• Disseminated !one disorders of un"no#n

etiology+ olyostotic fbrous dysplasia' s$letalreticuloses

• $n%ammatory disorders+ Hematogenousosteomyelitis' Tuberculous osteomyelitis' R"

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Classication of DisordersThat Predispose one to

Pathological Fracture• Neuromuscular disorders+ olymyelitis'0uscular dystrophy

• &'ascular necrosis of !one+ osttraumaticavascular necrosis' postirradiation necrosis

• Neoplasms of one

/steogenic+ /steosarcoma' surace osteosarcoma

!hondrogenic+ enign chondroblastoma'chondrosarcoma

1ibrogenic+ fbrosarcoma' /steofbrous dysplasia

"ngiogenic+ "neurysmal bone cyst' angiosarcoma

0yelogenic+ 0ultiple myeloma' Hodg$in2slymphoma

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Prognosis of Pathological Fractures

•

0ost pathological ractures willunite' because the rate o bonedeposition in racture healing isusually more rapid than the rate obone resorption o the underlyingpathological process

• 3n certain highly malignant primaryneoplasm such as osteosarcoma'the rate o bone destruction andresorption may be almost as greatas that o bone deposition

• athological ractures throughmetastatic neoplasm in the limbsusually merit internal f4ationwith 5without methylmethacrylatecombined with irradiation and' i

indicated ' hormone therapy%

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Dislocations and &ssociated$nuries

• &ynovial joints are design to permitsmooth movement through a normalrange that is specifc or each joint%

• Three structural+ Reciprocal contourso the opposing joint suraces' integrityo the fbrous capsule and ligament'

protective o muscles• Dislocation+ &tructural loss o its

stability  hysical actors

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Dislocations and &ssociated$nuries

Three degrees of ointinsta!ility

• *ccult oint insta!ility(apperent only when the

 joint is stressed)• Su!lu+ation+ 3n which the

 joint suraces have losttheir normal relationshipbut still retain considerable

contact• Dislocation+ 3n which the

 joint surace havecompletely lost contactwith each other

*ccult oint insta!ility

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Dislocations and &ssociated$nuries

Su!lu+ation Dislocation

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&ssociated $nury to the Fi!rousCapsule

• 1ibrous capsule and contiguous periosteum may bestripped up rom the bony margin o the joint andstresthed  intracapsular dislucation

• 1ibrous capsule is torn and one bone end perorate

the rent in the capsule  e4tracapsular dislocation• Large bone end becomes trapped in the dislocated

position by the small rent in the capsule  henomenon 6uttonhole dislocation7

• !losed o dislocation' a 8ap o torn capsule becomestrapped between the joint suraces' preventingperect reduction and resulting in residualsublu4ation

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Diagnosis of ,oint$nuries

• ,islocation and sublu4ation may gounrecogni*ed because o inade#uate physicale+amination and conse#uent ailure to obtainthe appropriate radiographic e+amination

• hysical e4amination must also include a diligentsearch or any associated injury to spinal cord'peripheral nerves' or major vessels%

• "t least t#o proections at right angels to eachother (" and Lateral) are essential or acuratediagnosis%

Di i f , i t

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Diagnosis of ,oint$nuries

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Normal -ealing of.igament

•  Torn ligament heal by !rous scar tissuethat is not as strong as the normal ligament

• artial tears in a ligament is protected

during the healing process%• !omplete tears o ligament' there is usually

a considerable gap between the shreddedends o ligament

•  Time re#uired or normal healing o a tornligament varies according to its si*e and theorces to which it is normally subjected%

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Complication of Dislocation and&ssociated $nuries

• 0uch the same as those o racture

• $mmediate local complication includeassociated injury to s$in' bv' peripheral

nerves' and spinal cord• /arly local complication include inection

(septic arthritis)' ater open joint injury oropen reduction9 and avascular necrosis o

one o the articulating bone end

• .ate complication include persistent jointsti:ness' persistent joint instability and

recurrent dislocation' etc%

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0eneral Principle of Treatmentfor ,oint $nuries

• 1racture treatment are e#uallyapplicable to treatment o dislocationand associated injuries%

• ,islocation and sublu4ations must !ereduces perfectly to restore normalcongruity o the joint suraces and

prevent posttraumatic arthritis%• Short1term use N&"3,s'

!orticosteroids is not indicated

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Specic Types of ,oint$nuries

• Contusion  ,irectblow' the synovialmembrane reacts to the

injury by producing ane:usion

• .igamentous Sprain &udden stretching o

the ligament with aminor' incomplete tearsand local hemorrhagebut no loss o continuity

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Specic Types of ,oint$nuries

• Dislocations and Su!lu+ations

 To restore normal congruity to joint suraces'perect reduction odislocations and sublu4ationsmust be achieved' by closed manipulation or openreduction

• Torn .igaments

!omplete tear o certain major ligament should berepaired surgically as soon as possible ater injury%

1or many other ligaments' the reduced joint needsto be immobili*ed to protect the injures ligamentand capsule

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Muscle $nuries

• ;hen severe tension issuddenly applied to analready contractedmuscle' some o the

muscle bundles mayrupture and produce thepainul local lesion

• 0ore e4tensive ruptureoccurs at themusculotendinous junction o a major muscle

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Tendon $nuries

Closed Tendon $nuries• Normal tendon seldom

ruptures even withstrenuous activity  

riction or hasdegenerated

• &udden tension on a

normal tendon mayavulse a ragment oits bony insertion

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Tendon $nuries

*pen Tendon $nuries• /pen division o

tendons in most sites

should be treated byimmediate surgicalinjury  "dhesionsbetween injured

tendons intereresignifcant