Dr. Pathrose Parathuvayalil, Chairman & Managing Director of Parathuvayalil Hospital & Orthopedic Center mentions the basics of fracture management.

1. Basic Principles of
FRACTURE MANAGEMENT
Parathuvayalil Hospital & Orthopedic Center

2. WHAT IS A FRACTURE?
Fracture is a break in the continuity of a bone.

3. Types of Fracture
 Fractures can be classified on the basis of its
pathology as Traumatic fracture & Pathological
fracture.
 Traumatic Fracture can be transverse, oblique, spiral,
displaced, angulated, impacted, rotated, distracted
or comminuted

4. Traumatic Vs. Pathological Fractures
 A fracture sustained due to trauma is called
traumatic fracture.
 A fracture through a bone which has been made
weak by some underlying disease is called a
pathological fracture.

6. Healing of fracture
A fracture begins to heal as soon as the bone is broken
provided the conditions are favorable; healing proceeds
through several stages until the bone is consolidated.

7. Treatment Principle in Fracture
The three fundamental principles of treatment of
fracture are
 Reduction
 Immobilization &
 Rehabilitation.

8. Reduction, Immobilization & Rehabilitation
 Reduction is the technique of setting a displaced
fracture to proper alignment.
 Immobilization is to prevent the displacement of the
fracture that might interfere with the reunion.
 Rehabilitation essentially consists of muscle
reeducation exercises and gait training.

9. REDUCTION OF FRACTURES
 This is the technique of setting a displaced fracture
to proper alignment.
 Reduction can be done in three ways: Closed
Manipulation, Continuous Traction & Open
Reduction

10. Closed Manipulation
Re-aligning a displaced fracture by feeling it
through the soft tissues

11. Continuous Traction
Re-aligning a displaced fracture by feeling it
through the soft tissues

12. Open Reduction
Fragments are reduced under direct vision during
operation

13. IMMOBILIZATION OF FRACTURES:
Conservative methods
The conservative methods for the immobilization of
fractures include:
 Strapping
 Immobilization by using a sling, cast etc.
 Functional bracing
 Applying traction

14. Strapping
The fractured part is strapped to an adjacent part
of the body

15. Immobilization by using a sling

16. Immobilization by using a cast
Using plaster of paris, fiber glass casting tapes etc.

17. Functional bracing
Continuous use of the affected limb while the
fracture is kept adequately supported

18. Applying traction

19. IMMOBILIZATION OF FRACTURES:
Operative Methods
 Operative method for immobilization include internal
or external fixation.
 In internal fixation, fracture once reduced is fixed
internally with the help of some metallic or non-
metallic device such as steel wire, screw, plates etc.
 In external fixation, the fracture is held in a steel
frame outside the limb.

20. Internal Fixation

21. External Fixation

22. Conservative OR Operative Method?
 Conservative methods for immobilization are used in
CLOSED FRACTURES (Fractures not communicating
with external environment) and operative methods
in OPEN FRACTURES (Fracture with break in the
overlying skin and soft tissues leading to the fracture
communicating with the external environment),
usually.

23. REHABILITATION OF FRACTURES
 Rehabilitation of fractured limb begins at the time of
injury and goes on until the maximum possible
functions have been regained.
 It essentially consists of muscle reeducation exercises
and instructions regarding immobilization of the limb
and gait training.

24. Immobilizing the limb
 For immobilization, one may
need to support the limb with
braces, calipers, casts etc.
Walking aids such as walker,
crutches, sticks etc. may be
necessary

25. Exercises
 Suitable exercises are
observed during
immobilization and after
immobilization Rehab-
exercises are adviced.
Rehabilitation exercises
differ from fracture to
fracture and need to be
observed under the
guidance of a clinician.

26. Reach Us:
Dr. Pathrose Parathuvayalil Group
Post Box no: 9, Keezhillam PO
Perumbavoor, Ernakulam, Kerala, India. Pin-683 541
Ph: 91-484-2653041, 2653875, 2653876, 2653042
Email: pathroseparathuvayalilgroup@gmail.com
URL: www.parathuvayalilhospital.com
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Image courtesy: AO Foundation