Fractures

By Amal

Types of fractures:

Complete fractures The bone is completely broken into two

or more fragments.

Incomplete fracturesThe bone is incompletely divided

and the periosteum remains in continuity

Mechanism of injury:

The shape of fracture depends on the direction of load.Impacted fracture:

the fragments are jammed tightly together and the fracture line is indistinct.

Spiral fracture: as a result of twisting force, most common in humerus, tibia and femur because:

•The shape of the bone is already twisted

•The muscle attachment already pulls out side in a spiral pattern.

transverse fracture: as a result of tension force.

Greenstick fracture ( type of incomplete): happens more in children coz there bones are still soft.

There are two types of complete fracture

displaced

Undisplaced: easy to heal

fractures can also be classified according to the intact of the skin to:

Open fracture: the skin is open.

Close fracture: the skin is intact.

Comminuted fracture

A comminuted fracture is one in which there are more than two fragments.

Types of comminuted:Butterfly or wedge

fracture.

Continue the type of comminuted

Segmental fracture

Longitudinal fracture

Do we need to splint in order to promote healing ?

NO—the cast has nothing to do with the healing process.

We splint to: Alleviate pain ensure good alignment

for bone union Permit early movement

and return to function.

Fracture healing: 5 stages

tissue destruction and haematoma formation– vessels around are cut & haematoma forms, the fracture surfaces is deprived of blood supply

Inflammation and cellular proliferation– happens within 8 hours/ the clotted haematoma is slowly absobed & new capillaries grow into the area

Continue: healing of fractures

Callus formation– osteoclast will mop up dead bone and osteoblast will build new bone

Consolidation– bone becomes harderRemodeling—reshaping of the bone

treatment ( reduction) of fractureClosed ( conservative)

Open ( operative)

Types of Hold reduction:1.Continues traction:

types of traction: Gravity traction: to upper limb Skin traction: no more than 4 or 5 kg Skeletal traction

2. Cast splintage ( plaster of paris)3. Functional brace: allow the movement of the

other joint

3.Internal fixation ( implants): in side the body Screw Wires Plates Intramedullary nail: usually for the shaft

4. External fixation: from out side Plates &screws

Complications of traction:

Blood supply cut off: bandages are tight Nerve injury Pin-site infection

Complication of cast Tight cast pressure sores Skin abrasion or laceration

Complication of internal fixation

InfectionNon-union: if there is a gap between

the ends of boneImplant failurerefracture

Complication of external fixation

Soft tissue damageOver distractionPin-track infectionRefractureComplication of fractures

Early complicationVisceral injury

Nerve injury InfectionPressure soresCompartment syndrome—volkmann’s

ischemic conttracture Late complications

Delay unionMalunionAvascular necrosis

Continue: late complication

Growth disturbanceBed soresNerve compression Joint stiffnessosteoarthritis

Good luck to all of you