7. • Mechanism:
• High energy vs. low energy
• Multiple injuries vs. isolated injury.
• Pathological fracture: normal load in presences of weakened bone (tumor,
osteoporosis, infection)
• Stress fracture: normal bone subjected to repeated load (military recruits).
20. Why pediatric fractures are unique?
• Thicker periosteum
• Presence of growth plate
• Anatomic reduction is not necessary
• Time to heal is shorter
• Think of child abuse
21.
22.
23.
24. Classifications
• Why we use classifications?
• Ease of communication
• Occasionally helps in treatment
• Research uses
29. Diagnosis: History
Patients complain of pain and inability to
use the limb (if they are conscious and
able to communicate)
What information can help you make the
diagnosis?
30. Diagnosis: History
Onset:
When and how did the symptoms begin?
Specific traumatic incident vs. gradual onset?
If there was a specific trauma, the details of the event are essential
information:
Mechanism of injury?
Circumstances of the event? Work-related?
Severity of symptoms at the time of injury and
progression after?
33. Diagnosis: Physical exam
If a fracture is suspected what should we rule
out?
Neurovascular injury (N/V exam)
Compartment syndrome
Associated MSK injuries (examine
joint above and below at
minimum)
34. How to describe a
fracture
Clinical parameters
Radiographic parameters
35. Clinical Parameters
Open vs. closed
ANY break in the skin in proximity to the fracture site is OPEN
until proven otherwise
Neurovascular status
Presence of clinical deformity
36. Location
Which bone?
Which part of the bone?
Epiphysis -intraarticular?
Metaphysis
Diaphysis -divide into 1/3s
Use anatomic landmarks when possible
e.g. medial malleolus, ulnar styloid, etc
53. General scheme for fracture management
• Follow trauma protocols
• Immobilize the limb
• X-Ray the injured bone
• Determine the fracture pattern
• Plan treatment accordingly
• Reduce if needed (closed)
• X-Ray after reduction
• Immobilize and follow
• Rehabilitate early
54.
55. How to maintain the reduction after closed
reduction (CR)?
• Splints
• Cast
• External fixators (Ex. Fix.) [for specific indications]
58. What if closed reduction failed?
• May need re-reduction
• Other options?
• Open reduction
• aka needs Surgery
59. How to maintain reduction after open reduction
(OR)?
• Internal fixation = ORIF
• The first surgery we learned is ORIF
• Options
• Intramedullary device, e.g. IM rod, wires
• Extramedullary devices, e.g. plates and screws
• Sometimes can be treated by external fixator
60.
61. Summary of fracture treatment
• Immobilization
• Closed reduction and immobilization (stabilizationfixation)
• Open reduction and external or internal fixation
63. Non-union and delayed union
• Non-union when fracture never heals
• Causes are diverse
• Types
• Treatment
• Treatment is to optimize local and systemic factors
• Almost always needs surgery
• Delayed union when the fracture passes the typical time of healing of
such fracture
64. Bone grafts
• Adjuncts used to stimulate bone healing
• Variety of types
• Autografts
• Allograft
• Synthetic