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F R A C T U R E S

Learn about fractures, their diagnosis, and treatment options in orthopaedics. Understand the different types of fractures and their classifications, as well as imaging techniques and management strategies. Explore specific fractures of the upper limb, such as Colle's fracture, Smith's fracture, Barton's fracture, and Chauffeur's fracture.

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F R A C T U R E S

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  1. FR A C TUR E S DR.IMTHIAZ, DEPT.OF ORTHOPAEDICS,Y.M.C

  2. SKELETAL SYSTEM • AXIAL SKELETON - 80 • APPENDICULAR SKELETON - 126 FUNCTION PROTECTIVE SUPPORT OF BODY HAEMOPOESIS LOCOMOTIVE MINERAL STORAGE

  3. COMPOSITION : MATRIX - TYPE 1 COLLEGEN IN MUCOPOLYSACHRIDE GROUND SUBSTANCE - OSTEOID MINERAL - Ca , Phosphate , IN THE FORM OF HYRDOXY APPATITE BONE CELL - OSTEOCYTE OSTEOBLAST OSTEOCLAST HARVESIAN SYSTEM - LAMELLI CONNECTED WITH CANALICULI

  4. DEVELOPMENT • CONDENSATION OF MESENCHYMA – FORMS CARTILAGENOUS MODELS - SMALL CLEFTS FORMS [FUTURE JOINTS ] - 5th WEEK - PRIMARY CENTERS APPEAR - TRANSFORMS BONE BY ENDCHONDRAL OSSIFICATION. • SECONDARY CENTER - LATER • GROWTH PLATE - LONGITUDINAL GROWTH • PERIOSTEUM - WIDTH

  5. ANATOMY : MEDULLA - STORAGE - MARROW CORTEX - STRENGTH - REMODELING - ATTACHMENTS EPIPHYSIS GROWTH PLATE METAPHYSIS DIAPHYSIS

  6. TYPES: LONG BONES SHORT BONES FLAT BONES IRREGULAR BONES SESAMOID BONES

  7. DIAGNOSIS IN ORTHOPEADICS • HISTORY • SYMPTOMS • PAIN - • GRADE • RADIATION OF PAIN • AUTONOMIC PAIN • STIFFNESS - • TIMING • LOCKING

  8. SWELLING DEFORMITY WEAKNESS INSTABILITY ALTERED SENSATION LOSS OF FUNCTION FAMILY HISTORY SOCIAL HISTORY

  9. EXAMINATION GAIT INSPECTION - SKIN SHAPE ATTITUDE DEFORMITY PALPATION - SKIN SOFT TISSUES BONE & JOINTS

  10. TENDERNESS SWELLING SIZE SHAPE SITE MARGIN CONSISTANCY TENDERNESS MULTIPLICITY MOBILITY

  11. MOVEMENTS NORMAL ABNORMAL JOINT STIFFNESS JOINT LAXITY

  12. NEUROLOGICAL APPEARANCE TONE POWER REFLEXES SENSATION

  13. IMAGING PLAIN X RAY - SOFT TISSUE BONES JOINTS CONTRAST X RAY - SINOGRAPHY ARTHROGRAPHY MYELOGRAPHY

  14. C.T. SCAN MRI SCAN ULTRASONOGRAPHY RADIONUCLIDE IMAGING BLOOD - ROUTINE ,C-REACTIVE PROTEIN , R.A FACTOR ,ELECTROPHORESIS SYNOVIAL FLUID ANALYSIS.

  15. BIOPSY ARTHROSCOPY ELECTRO DIAGNOSIS

  16. FRACTURES HISTORY Egyptians Hippocrates Splintage; 460 B C Al-Zabra Casting Chinese Willon Board Arabians Immobilization Mathysen POP in 1876 H.O.ThomasRest,Rest& Rest

  17. FRACTURES contd……. • Robert Jones Father of Orthopaedics • Sarmiento FCB • Kuntscher IM Nailing • AO Group 1958,Muller, • Primary intention • Illizarov • Dr.M.G.Kini

  18. FRACTURES DEFINITION Break in surface of bone(Cortex or Articular surface) FORCE REQUIRED Direct Indirect -Sudden & Severe -Repetitive -Trivial(Pathological)

  19. TYPES I 1.Simple 2.Compound II 1.Complete Displaced - Shift, Tilt, Rotation Un Displaced 2.Incomplete III 1.Linear - Transverse - Oblique - Spiral - Butter Fly 2.Comminuted 3.Segmental 4.Bone Loss <50% >50%

  20. IV. ATYPICAL FRACTURES 1) Green stick 2) Impacted 3) Stress 4) Pathological 5) Hairline 6) Torus

  21. A.O.Classification: • Each long bone is numbered. First digit Bone • Second digit Segment 1 – 4 • Third letter Type A – C Proximal & distal A - C

  22. OPEN FRACTURES: EMERGENCY GUSTILLO ANDERSON: I Less than 1cm II 1-10 cm ; No devitalization III > 10cm ; Devitalized, Contaminated III a. Extensive, but soft tissue coverage present III b. Bone exposed, periosteum III c. NeuroVascular injury

  23. MANAGEMENT • Stabilization of patient – A B C • Exploration of wound – Dilution • Expression of non viable tissue • Evacuation of Foreign Body • Stabilization of fracture • Convert to closed fracture • Appropriate antibiotics • Definitive fixation later

  24. FRACTURE HEALING Hunter’s stages • Stage of haematoma • Stage of induction • Stage of inflammation • Stage of soft callus • Stage of hard callus • Stage of remodeling

  25. INJURIES OF UPPER LIMB COLLE’S FRACTURE DEFINITION: -Within 2.5cm -With or without dislocation of RADIOULNAR joint -With or without styloid fracture Classically 6 displacements MECHANISM INCIDENCE CL. FRACTURES: -Dinner Fork -Styloid process test

  26. RADIOLOGY: A P & LATERAL VIEW • Displacements • MetaphysealCommunition • RC , RU Joint involvement • Fracture of Styloid Process & level • R- C angle

  27. CLASSIFICATION:FRYKMAN’S • STYLOID FRACTURE • Absent Present • Extra Articular I II • RC Joint III IV • R.U Joint V VI • RC + RU VII VIII

  28. TREATMENT Fully functional hand without deformity Conservative – Closed reduction , shake hand. Operative – ORIF Ext. Fixation

  29. COMPLICATIONS Early1. Unstable reduction 2. Median and ulnar nerve injury 3. Compartment Syndrome 4. Anaesthetic problems

  30. LATE 1. Malunion - Improper reduction - Improper immobilization - Comminuted dorsal surface - Oesteoporosis - Radioulnar Ligament injury TREATMENT Deformity - Fernandes - Campbell Function - Darrach’s

  31. 2. Sudeck’s Osteodystrophy – Abnormal Sympathetic Response 3. Shoulder hand syndrome 4. Carpal tunnel syndrome 5. Extensor Pollicis rupture 6. Non union

  32. SMITH’S FRACTURE • Opposite displacement • Garden spade deformity • Treatement - immobilization

  33. BARTONS FRACTURE • Intra articular • Dorsal –Fall on extended wrist • Volar – Fall on flexed wrist Treatment - Closed reduction - Surgical

  34. CHAUFFEUR’S FRACTURE • Radial styloid with avulsion of radio carpal ligament • Backfire of crank of engine TREATMENT - Conservative - K.wire

  35. SCAPHOID FRACTURE • Lies obliquely at 45degree to long axis • Crosses 2 rows of carpus • Articulates with radius and 4 carpus • B. supply: 33% have no foramina in proximal third • 66% have throughout body

  36. MECHANISM: Outstretched hand with radial deviation • CLASSIFICATION: Proximal Poli (20%) • Waist (70%) • Distal body (10%) • Tuberosity

  37. CLINICAL FEATURES RADIOLOGY - Repeat X-ray - Multiple views TREATEMENT: Over treatment Undisplaced – conservative Displaced - Reduction K. wire Screws

  38. COMPLICATIONS • – Non union – ORIF with Bone Graft • AVN – Bone Graft • Arthritic changes - Arthodesis • - Silastic implants • - Excision of fragment

  39. BENNETT’S FRACTURE Edward Bennett (1882) • Fracture Dislocation of Base of first MC • Mech : Axial Blow, Fist fight • C . F : Avulsion of ANT. Oblique Ligament • Pull of Add. Pollicis TREATMENT: -Closed Reduction and K Wire - ORIF & K. Wire

  40. MALLET FINGER • Base ball finger • Forced flexion of distal phalanx, with extended finger • Pathology – Tendon injury Stretching • Bony Avulsion Rupture • Untreated – Secondary Hyper extension of • PIP – Swan Neck

  41. TREATMENT • Immobilization of DIP • Volar Splint • Mallet finger splint • POP Cast • K – Wire fixation – bony injury

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