FRACTURES

SURGERY DEPARTMENTMEDICAL FACULTY YARSI UNIVERSITY

JAKARTA2008

Loss of bony continuity

Bony disruption

Compound fractures

Simple fractures

Direct violence

Indirect violence

Pathological fracture

Osteoporosis

Secondary metastases

Hair line fracture

Greenstick fracture

Greenstick fracture

March fracture

Fracture type

Depends on Anatomic location Region (diaphysis , metaphysis,

epiphysis, intra/extra articular) Fracture lines (transverse, oblique,

spiral) Condition of bone (comminuting,

pathologic, incomplete, segmental)

Bone loss Butterfly fragment Stress fracture Avulsion and impacted fracture Deformities (length discrepancy,

angulations, rotation, translation) Alignment

Diagnosis

1. AnamnesisMechanism of injury, history

A fracture is suspected from history and clinical examination, and confirmed by radiography

2. Physical examination

Look Asymmetry of contour

Comparing one side with the otherDisplaced, angledLocal bruising, swelling, laceration

Asymmetry of postureFemoral neck fracture with external rotationAngulations, shortening

FeelCrepitus, tenderness

Movementfalse moving/ pseudoarthrosis

Assess NVD and compartment syndrome!

Neurovascular disturbance

Neurologic Sensor and motor fx distal to fracture

site

Vascular Pulse palpation Capillary refill Warm or cold skin Color of skin

Compartment syndrome Pain Pale Parestesia Paralysis Pulseless

Pain on passive stretching of the muscle intracompartment

3. Radiological examination Two projection

Standard projections AP and lateral Two articulation

Above and below , dislocation? Two extremity

Comparison, especially in child Two times

Hair line, callus formation

FRACTURE complications

Delayed union Non union

Atrophic nonunion Hypertrophic nonunion

Med malleolar nonunion

Diabetic nonunion

Diabetic nonunion

Pseudoarthrosis nonunion

Mal union

Colles malunion

Bone infection, osteomyelitis

Bone infection, osteomyelitis

Debridement / guttering

Joint contracture, stiffness Limb shortening Compartment syndrome NVD Avascular necrosis Heterotrophic ossification

Management

Closed reduction

Splinting Casting Traction technique

Skin traction Skeletal traction

Steinmann’s pin

Open reduction

Splintage Allows sliding between implant and bone

Bridging To bridge an area of comminution

Kirschner wire Lag screw

Kirschner wire

Kirschner wire

Kuntcher nail Screw

Plate and screw

External fixator

Rehabilitation

Extremely important Part of fracture management Regain optimal function asap Arrangements

Restoring ROM Stretching Strengthening

decrease pain and swelling

Lower extremity Cane Crutch walker

Fracture healing

Inflammation stageBleeding at fracture site Source of hemopoetic cells

ProliferationFibrovascular tissue developedOsteoblast, fibroblast proliferate

Repair stage Primary callus or bridging callus occur 2wks Fibrocartilage developed Soft callus to hard callus (woven bone) by ossification Medullary callus can supplements the bridging callus

Remodeling stage From midpoint repair until the fractures

heal clinically (up 7 yrs) Woven bone replaced by lamellar bone Bone assume its normal configuration

If there is anomaly in biological bone formation in healing process, there will be disturbance in the union of fractures, ex delayed or nonunion.

Factors affecting fracture healing

Type of bonecancellous bonecortical bone

Patient’s ageMobility fracture siteSeparation bone endsInfectionJoint involvementBone pathologyDisturbance of blood supply

Thank you