Prof. Mamoun KremliAlMaarefa College
Principles of Fractures& Fracture Management
Trauma HistoryMechanism of injury
Date, time, type, method of impact, …
Consciousness
Function of injured part
Open wound / bleeding
Other injuries
Anti-Tetanus status (if skin breached)
Type of injuryMechanism of injury helps expect the
Extent and type of bone injuryExtent of soft tissue injurySuggests treatment and reduction techniqueExpected prognosis
Type of injuryFall: height, point of impact, twist
Type of injuryFall: height, point of impact, twist
Sport: type, direction of force
Type of injuryFall: height, point of impact, twist
Sport: type, direction of force
Road traffic accident (RTA)):Car (MVA) , motorcycle, pedestrian
Type of injuryFall: height, point of impact, twist
Sport: type, direction of force
Road traffic accident (RTA)):Car (MVA) , motorcycle, pedestrian
Heavy object fall: TV, wall, metal, earthquake
Type of injuryFall: height, point of impact, twist
Sport: type, direction of force
Road traffic accident (RTA)):Car (MVA) , motorcycle, pedestrian
Heavy object fall: TV, wall, metal, earthquake
Assault & firearms / blast
http://simple.wikipedia.org/wiki/Blast_injury
Mechanism of InjuryLow velocity
High velocity
Direction of force
Blunt / Sharp
Open / Closed
Mechanism of InjuryLow velocity
High velocity
Direction of force
Blunt / Sharp
Open / Closed
http://eorif.com/
Kinetic Energy = ½ MV2
If a Simple fall = 1
Skiing injury = 3-5
High-velocity gunshot = 20
Car bumper (25 km/hr) = 100
Energy dissipated during injury
What is a fracture?A fracture is a break in the structural
continuity of boneAlways associated with some soft tissue
injury
A fracture is a soft tissue injury in which bone is broken!
Fracture ClassificationAccording to site of Fracture:
DiapyhsealMetaphysealArticular
Epiphyseal (in children)
Epiphysis
Metaphysis
Diaphysis(Shaft)
Physis
Articular Surface
Fracture ClassificationAccording to fracture line:
Complete (usual)Cortex fractured on both sides
Fracture ClassificationAccording to fracture line:
Complete (usual)Cortex fractured on both sides
Incomplete (green stick) (Torus)One cortex fractured, the other intactIn children
Fracture ClassificationAccording to fracture pattern:
SimpleWedge comminutedComplex comminuted
multifragmentedA
SimpleB
WedgeC
Complex
Fracture ClassificationAccording to type of injury (force):
Ordinary fractureExpected from force of injury
Stress fractureRepetitive stress
Pathological fractureForce too weak to cause fractureBone is pathologically weak
Avulsion fractureResisted muscle action, where ligaments and
tendons pull a bone fragment off
Stress FracturesBone reacts to repeated loading, may become
fatigued & a crack develops
Fatigue fracturesAbnormal stress or torque on a bone that has normal
elastic resistanceExamples:
military recruits, athletes, ballet dancers
Insufficiency fracturesNormal muscular activity stresses a bone that is
deficient in mineral or elastic resistance
Stress FracturesFatigue fractures
2nd metatarsalTibiaFibula
Insufficiency fracturesIn osteopenia, osteomalaciaNeck of femurRibsNeck of humerusScapula
www.sanluispodiatrygroup.comwww.imaging.birjournals.org
www.studyblue.com
Pathological fracturesFractures may occur even with normal stresses if the
bone has been weakened by a change in its structure. Seen in:
Local bone diseaseOsteomyelitisBenign tumors and Bone cystsMalignant tumors and matastasis
Generalized diseaseMetabolic: osteoporosis, riketsCongenital: osteogenesis imperfectaOthers: Paget’s disease
Avulsion fracturesPart of bone separated by forceful sudden
resisted muscle actionCaused by ligament or tendon pull on bonePart of bone avulsed – bone weaker than
tendon/ligament
Type of injuryDirect
Simple contusion or severe comminutionSoft tissue more injured
IndirectPattern of fracture depends on force directionLess soft tissue injury
Penetrating Missiles
Low velocity < 300 m/s - damage along the tractComminution
High velocity: >300m/s - sever comminutionComminution with wide soft tissue damage
Force & fracture patternFracture pattern suggests mechanism of force
Spiral: (twisting)
Short oblique: (compression)
Wedge: (compression + bending)
Transverse: (angulation) (avulsion)
Force & fracture pattern
AO/OTA fracture classificationA comprehensive universal classification
system that describes the injury, guides treatment, and suggests prognosis
Based on a five-part code:
— .Bone Segment Type Group Subgroup
AO/OTA fracture classificationBone:
— .Bone Segment Type Group Subgroup
1 2 3 4
AO/OTA fracture classificationLocation:
1
2
3
1
2
3
— .Bone Segment Type Group Subgroup
AO/OTA fracture classificationType:
ASimple
BWedge
CComplex
— .Bone Segment Type Group Subgroup
AO/OTA fracture classificationGroup:
— .Bone Segment Type Group Subgroup
1 2 A 2
AO/OTA fracture classification
Humerus
Diaphysis
Simple
Oblique
Bone
Segment
Type
Group
1
2A
2Subgroup
Middle 2
2
DisplacementDescribed as: Distal in relation to proximal
Un-displaced
ShiftSidewaysShorteningDistraction
Angulation In all planes
Rotation
SHIFT ANGULATION /TILT
TWIST/ROTATION
Sideways Overlap Impaction