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