introduction to fractures (1)

8/2/2019 Introduction to Fractures (1)

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Introduction to Fractures

Nan-Ying Yu

2005 12 12


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Definition

An interruption in the continuityof the bone which may be acomplete break or an incomplete

break or an incomplete break(crack).


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Classification

There are two main types of fracture andvarious subdivisions which are namedaccording to the position of the fractured

parts of the bone


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Closed fracture

This type indicates that there is nocommunication between the externalsurface of the body and the fracture.


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Open fracture

There is a communication between thefracture and the skin. This could occurbecause the displacement of the bone

ends has caused one or both to pierce theskin, or because an external force haspierced the skin, soft tissues, and

fractured the bone. This type of fracture isan additional cause for concern becauseof the possibility of infection.


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Types of fracture

Simple fracture

Spiral fracture

Transverse fracture Oblique fracture

Comminuted fracture

Greenstick fracture


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Causes

Trauma

Might be a direct blow

*indirect violence such as falling on a hand or foot

*caused by repeated minor trauma (stress orfatigue fractures)

Pathological fractures

*Occur as a result of disease such as carcinoma,osteogenesis imperfecta, Pagers disease and

infection.


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Clinical features


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Immediately after fracture

Shock

Pain

Deformity

Oedema

Marked local tenderness

Muscle spasm

Abnormal movement and crepitus

Loss of function


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Following reduction and fixation

Pain

Oedema

Loss of functions


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After removal of the fixation

Pain

Oedema

Limitation of joint movement Weak muscles

Loss of functions


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Healing of features

Stage ofhaematoma

Stage ofsub-periosteal and endostealcellular proliferation

Stage ofcallus formation

Stage ofconsolidation

State ofremodelling


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Healing of cancellous bone

Union of fractures

It depends on the following factors

Type of bone

Classification of fracture Blood supply

Fixation

AgeDelay union This indicates that healing is takinglonger than would normally be expected.


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Complications

Infection

Avascular necrosis

Mal-union (deformity of shortening)

Joint disruption

Adhesion

Injury to large vessels

Injury to muscle

Injury to nerves

Sudecks atrophy

Injury to viscera

Contracture


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Principles of management

First aid

The patient should not be moved

Possible further fractures should beprevented


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Principles of treatment by surgeon

In the case of severe injury, there may be otherproblems that take priority over treatment of the

fracture: shock, bleeding, maintenance of airwayand ventilation, and possibly other injury.

The surgeon will aim to obtain good reductionand alignment of the fracture, followed byimmobilization that is sufficient to promote goodhealing and restoration of function.


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Reduction

Closed reduction

Reduction by traction Open reduction

Immobilization

External splinting Internal fixation


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Physiotherapy during

immobilization Reduce oedema to prevent the adhesion formation

Assist the maintenance of the circulation activeexercise either by static or isotonic muscle activity

Maintain muscle function by active or static

contraction Maintain joint range where possible

Maintain as much function as allowed by the particularinjury and the fixation

Teach the patient how to use special appliances suchas crutches, sticks, frames, and how to care for theseor any other apparatus


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Physiotherapy after the removal

of fixation

To reduce any swelling

To regain full range of joint movement

To regain full muscle power To re-educate full function


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introduction to fractures (1)

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