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Introduction to Fractures

Introduction to Fractures . Fractures - definitions, healing and management. Definitions. A Fracture is a break in the continuity of a bone A comminuted fracture is one with more than two fragments Gross comminution is usually caused by severe violence, union is often delayed or difficult.

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Introduction to Fractures

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  1. Introduction to Fractures Fractures - definitions, healing and management

  2. Definitions • A Fracture is a break in the continuity of a bone • A comminuted fracture is one with more than two fragments • Gross comminution is usually caused by severe violence, union is often delayed or difficult

  3. Types of Fractures(#) • Transverse # • Spiral # • Greenstick # • Crush # • Burst # • Avulsion # • # dislocation / subluxation

  4. Fracture definitions • Open / Compound # • some communication with the outside or an internal organ. • Infection a real possibility • Complicated # • important soft tissue damage present

  5. Fracture definitions • Impacted #’s • occurs when bone fragments are forced together • such #’s are usually stable • Unstable #’s are those that are displaced or have the potential to displace • important in spinal column #’s

  6. Definitions • Reduction • the realigning of fractures usually by manipulation under an anaesthetic - MUA or a local anaesthetic • once reduced fractures need maintaining in the correct position, usually by a plaster of Paris cast - POP • occasionally internal fixation is used - ORIF

  7. Definitions • Displacement • shortening, rotation, sideways shift or tilt. Reduction reverses the position of displacement • Dislocation • loss of joint integrity • Subluxation • partial loss of joint surface integrity

  8. Bleeding & fracture haematoma forms Inflammation 2-3 days. Phagocytosis,, Capillary budding - forms granulation tissue Osteogenic cells invade lay down osteoid 3 weeks soft callus cartilage and osteoid Callus forms, 6 - 12 weeks Clinical union 3 - 4 months Remodelling, 6 - 12 months Fracture healing

  9. Classical signs of a fracture • Pain and tenderness • Deformity • Swelling • haematoma, haemarthrosis • Local temperature increase • Abnormal mobility, occasionally crepitus • Loss of function

  10. Fractures - management • Open #’s, avoid infection risk - osteomyelitis • Reduction if necessary e.g impacted #’s or where alignment is not so important • manipulation • traction • open reduction

  11. Fractures - management • Maintain reduction • Intrinsic stability • External fixation • Splintage POP, Cast braces, Platazote etc • Traction • Internal fixation • Screws, plates, grafts, intramedullary nails, wires & pins • Frame fixators

  12. Fractures - management • How long ? Depends on method of fixation • Long bones 12 weeks • cancellous ends of long bones & in short bones 6-8 weeks • Children (& ? Elderly) 2-3 weeks • For pain relief only 2-3 weeks

  13. Fracture - Complications • At time of injury • Haemorrhage • Damage to important internal structures • Skin loss

  14. Fracture - Later Complications • Local • Tissue necrosis • Infection • Loss of alignment • General • Deep Vein Thrombosis, Pulmonary embolism & Fat embolism. • Pneumonia

  15. Late Complications • Delayed and Non Union • Late wound infection • Joint stiffness and contracture • Sudek’s atrophy • sympathetic malfunction ? • Osteoarthritis

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