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FRACTURES. And other Orthopaedic Disorders Jill Cavaiuolo. Fracture Definition.
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FRACTURES And other Orthopaedic Disorders Jill Cavaiuolo
Fracture Definition • Description: A fracture is a medical condition in which a bone is cracked or broken. While many fractures are the result of high force impact or stress, bone fracture can also occur as a result of certain medical conditions that weaken the bones.
CLASSIFICATION OF # • Open fracture (Also called compound fracture.) - the bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin. • Closed fracture (Also called simple fracture.) - the bone is broken, but the skin is intact. • Complete- the bone is completely broken in two or more pieces • Incomplete-the bone is not broken all the way through • Direction of FractureLine • Transverse • Oblique • Spiral • Comminuted • Compression
Categories of Fractures • In a compound fracture, also called an open fracture, the bone breaks through the skin; it may then recede back into the wound and not be visible through the skin.
Categories of Fractures • In a simple fracture, also called a closed fracture, the bone breaks but there is no open wound in the skin.
Complete fractures refer to the way the bone breaks: In a complete fracture, the bone snaps into two or more parts..(i.e. # ulna) Incomplete fractures have a bone that breaks, but does not go all the way through. Categories of Fractures
Fracture Categories http://www.hughston.com/hha/b_14_2_1a.jpg
Common Fractures Greenstick - incomplete fracture. The broken bone is not completely separated.
Common Fractures • Transverse - the break is in a straight line across the bone.
Common Fractures • Spiral - the break spirals around the bone; common in a twisting injury.
Common Fractures • Oblique - diagonal break across the bone. http://brighamandwomens.staywellsolutionsonline.com
Common Fractures • Compression - the bone is crushed, causing the broken bone to be wider or flatter in appearance http://brighamandwomens.staywellsolutionsonline.com
Other types of Fractures • An impacted fracture is one whose ends are driven into each other. This is commonly seen in arm fractures in children and is sometimes known as a buckle fracture. • Other types of fractures are pathologic fracture, caused by a disease that weakens the bones, and stress fracture, a hairline crack.
Xray Example • This xray indicates a lateral view of an oblique fracture to the mid humerus.
Closed Oblique Fracture • This fracture is considered to be mildly displaced.
Types of Fractures • Mildly displaced spiral fractures of the Tibia and Fibula.
Types of Fractures • Comminuted and mildly displaced fractures of the distal Tibia and Fibula.
EXAMPLE: A 57 year old 350 lbs. man who puts significant pressure on his ankle as he walks. Diagnosis PILON FRACTUREThis is a comminuted fracture of the distal tibia due to axial compression of the ankle joint. It is frequently associated with a fracture of the distal shaft of the fibula as well.
WARNING GRAPHIC TRAUMA PICTURE
Open Fractures • A break in the skin and underlying soft tissue leading into, or communicating with the fracture and its hematoma
WARNING THE NEXT TRAUMA SLIDE IS VERY GRAPHIC
REVISION Define Fracture • Define Open and Closed # • Define Complete or Incomplete # • Give examples of classification based on the direction of # line. • Define the following types of fractures.
Did you answer that it is a closed comminuted fracture of the femur?
Compound(open) # of Tibia and Fibula. The tibial break looks oblique, and the fibula appears to be comminuted.
Fractures—Signs and Symptoms • Some clearly present (compound fracture) or obvious deformity • Swelling, tenderness, altered sensation • Inability to move limb • Crepitus • Grating sound heard if ends of bone fragments move over e/other • Pain immediately after injury • Can be delayed if nerve damage in area • Diagnostic Tests • X-rays
Fractures- Complications • Muscle spasm • Due to local pain and irritation • Pulls bone fragments further out of position • Causes angulation (deformity) and rotation of bone which can cause more soft tissue damage, bleeding, and inflammation. • Infections • Tetanus, osteomyelitis • In Compound fractures or when surgery needed precautions taken (antimicrobials, tetanus booster shot)
# Wrist: Note Swelling in top and bottom picture and deformity in the compound (open) fracture below.
Complications • Ischaemia • Develops in limb following treatment • Occurs as oedema increases in 1st 48 hrs after trauma and casting. • Can be due to cast becoming too tight. • The affected part becomes pale, pulseless, painful, paralysed, paraesthetic and 'perishing with cold' ('the 6 Ps'). • Fixed mottling of the skin implies irreversible changes. • The limb may be red when dependent, leading to a misdiagnosis of inflammation, e.g. gout or cellulitis.
Complications Cont. Compartment syndrome: • Develops shortly after fracture when more extensive inflammation (crush fractures) • Increased pressure of fluid w/in fascia causes severe pain and ischemia or necrosis of muscle • Pressure effects can be aggravated by cast
Compartment Syndrome Pressure Release
Compartment Syndrome • www.residentandstaff.com/issues/articles/2007-03_01.asp
Complications Cont. • Nerve damage • w/ severe trauma or tearing of periosteum • Failure to heal (nonunion) or healing of bone w/ deformity (malunion) • Results if bone is not stabilized with ends closely approximated and aligned • Fractures at or near joint may havelong-term effects • Osteoarthritis or stunted growth
Complications Cont. • Fat emboli • Risk when fatty marrow escapes from bone marrow into vein w/in 1st week after injury • More common in fracture of pelvis or long bones, especially if not well immobilized after injury • Can travel to lungs and cause obstruction, extensive inflammation, and respiratory distress
Fat Embolism • Fat Embolism Syndrome • Globules of fat, released from fractured bone • Fat mixes with platelets • Emboli travel to lungs, brain, or other areas. • Clotting cascade activated = petechiae
Fat Embolism Syndrome • Signs and Symptoms • Dyspnoea • Confusion • Pulmonary complications • Pulmonary Oedema • ARDS(Acute Respiratory distress syndrome) • Petechiae-small spots on the skin
Closed Fracture Considerations • The energy of the injury • Degree of contamination • Patient factors • Additional injuries
Fractures—Treatment • Management of Pain,nausea etc. • Cleaning the wound if open-may be done in theatre • Immediate splinting and immobilization • Reduction of bones to restore normal position Closed reduction: exerting pressure and traction Open reduction: requires surgery • Pins, rods, plates, screws
Splinting and Immobilization • Casting with plaster or fiberglass, and splints .
Closed ReductionTraction • Application of force or weight pulling on limb that is opposed by body weight • Force maintains alignment of bones, prevents muscle spasms, and immobilizes the limb
Open Reduction • Internal fixation of Radius
External Fixation • This is a patient treated with an external fixator, which is used to treat fractures that are too unstable for a cast. You can shower and use your hand gently with the external fixator in place.
