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1. Introduction to Fractures Nan-Ying Yu
2005 12 12
2. Definition An interruption in the continuity of the bone which may be a complete break or an incomplete break or an incomplete break (crack).
3. Classification There are two main types of fracture and various subdivisions which are named according to the position of the fractured parts of the bone
4. Closed fracture This type indicates that there is no communication between the external surface of the body and the fracture.
5. Open fracture There is a communication between the fracture and the skin. This could occur because the displacement of the bone ends has caused one or both to pierce the skin, or because an external force has pierced the skin, soft tissues, and fractured the bone. This type of fracture is an additional cause for concern because of the possibility of infection.
6. Types of fracture Simple fracture
Spiral fracture
Transverse fracture
Oblique fracture
Comminuted fracture
Greenstick fracture
7. Causes Trauma
Might be a direct blow
*indirect violence such as falling on a hand or foot
*caused by repeated minor trauma (stress or fatigue fractures)
Pathological fractures
*Occur as a result of disease such as carcinoma, osteogenesis imperfecta, Pager’s disease and infection.
8. Clinical features
9. Immediately after fracture Shock
Pain
Deformity
Oedema
Marked local tenderness
Muscle spasm
Abnormal movement and crepitus
Loss of function
10. Following reduction and fixation Pain
Oedema
Loss of functions
11. After removal of the fixation Pain
Oedema
Limitation of joint movement
Weak muscles
Loss of functions
12. Healing of features Stage of haematoma
Stage of sub-periosteal and endosteal cellular proliferation
Stage of callus formation
Stage of consolidation
State of remodelling
13. Healing of cancellous bone Union of fractures
It depends on the following factors
Type of bone
Classification of fracture
Blood supply
Fixation
Age
Delay union – This indicates that healing is taking longer than would normally be expected.
14. Complications Infection
Avascular necrosis
Mal-union (deformity of shortening)
Joint disruption
Adhesion
Injury to large vessels
Injury to muscle
Injury to nerves
Sudeck’s atrophy
Injury to viscera
Contracture
15. Principles of management First aid
The patient should not be moved
Possible further fractures should be prevented
16. Principles of management Principles of treatment by surgeon
In the case of severe injury, there may be other problems that take priority over treatment of the fracture: shock, bleeding, maintenance of airway and ventilation, and possibly other injury.
The surgeon will aim to obtain good reduction and alignment of the fracture, followed by immobilization that is sufficient to promote good healing and restoration of function.
17. Principles of management Reduction
Closed reduction
Reduction by traction
Open reduction
Immobilization
External splinting
Internal fixation
18. Physiotherapy during immobilization Reduce oedema – to prevent the adhesion formation
Assist the maintenance of the circulation – active exercise 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 particular injury and the fixation
Teach the patient how to use special appliances such as crutches, sticks, frames, and how to care for these or any other apparatus
19. 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