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Introduction to fractures

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Introduction to Fractures for medical students.
Prepared in collaboration with Dr. Mohammed Alharbi.

Publicado en: Salud y medicina
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Introduction to fractures

  1. 1. Introduction to Fractures Dr. Yasser Alwabli
  2. 2. Contents • Definitions • Mechanisms • Classifications • Fracture description • Management – conservative or surgical • Fracture healing • Complications • Non-union and delayed union • Bone grafts
  3. 3. Axial skeleton vs Appenicular skeleton Long bone vs flat bone
  4. 4. What is a fracture? • Discontinuation in the bone cortex • A broken bone Normal Fractured
  5. 5. • fracture extends 360° of bone circumference (all around) Complete fracture
  6. 6. • Incomplete: seen almost in children: • Greensick Incomplete fracture
  7. 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).
  8. 8. Fracture patterns (descriptive classification) • Transverse • Oblique • Comminuted • Spiral • Segmental • Impacted • Avulsed
  9. 9. • Transverse: loading mode is bending
  10. 10. • Oblique: loading mode is compression.
  11. 11. • Spiral: loading mode is torsion.
  12. 12. • Fracture with Butterfly fragment: loading mode is bending and compression
  13. 13. • Comminuted fracture: 3 or more fragments • Segmental fracture
  14. 14. Fracture description Name of injured bone Integrity of skin Skeletal maturity Location Fracture pattern Alignment
  15. 15. Integrity of skin Closed fracture Open fracture
  16. 16. Integrity of skin • Closed fracture • Skinsoft tissues intact • Open fracture • Fracture exposed to the outside environment
  17. 17. Skeletal maturity • Pediatric • Adult • ? Geriatric
  18. 18. 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
  19. 19. Classifications • Why we use classifications? • Ease of communication • Occasionally helps in treatment • Research uses
  20. 20. Classifications • Every fracture has a unique classification system • Unified classification system, e.g. AO classification
  21. 21. Example: Garden classification for femoral neck fractures Type 1 Type 2 Type 3 Type 4
  22. 22. AO Classification
  23. 23. PRINCIPLES OF EVALUATION
  24. 24. 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?
  25. 25. 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?
  26. 26. Diagnosis: Physical exam Inspection Swelling Ecchymosis Deformity If fracture is open: Bleeding Protruding bone
  27. 27. Diagnosis: Physical exam Palpation Bony tenderness
  28. 28. 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)
  29. 29. How to describe a fracture Clinical parameters Radiographic parameters
  30. 30. 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
  31. 31. 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
  32. 32. Location • Epiphyseal • Metaphyseal • Diaphyseal • Physeal (growth plate) • Articular
  33. 33. Pattern Simple vs. comminuted Complete vs. incomplete Orientation of fracture line Transverse Oblique Spiral
  34. 34. Displacement Displacement is the opposite of apposition Position of distal fragment relative to proximal Expressed as a percentage
  35. 35. Angulation Deviation from normal alignment Direction of angulation defined by apex of Expressed in degrees
  36. 36. Fracture description: Summary Clinical parameters Open vs. Closed Neurovascular status Clinical deformity Radiographic parameters Location Pattern Displacement Angulation Shortening
  37. 37. Exercises
  38. 38. Bone healing
  39. 39. Fracture healing
  40. 40. • Primary bone healing : 1. Absolute fixation 2. No callus formation 3. Plate • Secondary bone healing : 1. Relative fixation 2. callus formation 3. Cast + Nail + EX- fix
  41. 41. Management • Reduction (if needed) • Maintain reduction • Rehabilitation
  42. 42. 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
  43. 43. How to maintain the reduction after closed reduction (CR)? • Splints • Cast • External fixators (Ex. Fix.) [for specific indications]
  44. 44. Initial (Immobilization)
  45. 45. What if closed reduction failed? • May need re-reduction • Other options? • Open reduction • aka needs Surgery
  46. 46. 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
  47. 47. Summary of fracture treatment • Immobilization • Closed reduction and immobilization (stabilizationfixation) • Open reduction and external or internal fixation
  48. 48. Complications
  49. 49. 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
  50. 50. Bone grafts • Adjuncts used to stimulate bone healing • Variety of types • Autografts • Allograft • Synthetic

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