PRINCIPLES OF FRACTURE MANAGEMENT

DEFINITION
Closed fractured

HOW FRACTURES HAPPEN?

Single traumatic
incident
Repetitive stress
Pathological
fracture

Mechanism of Trauma

Spiral pattern
(twisting)

Short oblique
pattern
(compression)

Triangle
butterfly
pattern
(bending)

Transverse
pattern
(tension)

Types of
Fracture
Complet
e
Fracture
Incomple
te
Fracture

Klasifikasi Fraktur Berdasarka Arah Garis

Fraktur

HOW FRACTURE DISPLACED

Fractures Displacement

HEALING PROCESS OF FRACTURE

Healing Process of Fracture

Union, Consolidation & Non union

Union
Incomplete repair
Ensheathing callus is
calcified
X- Ray:
Fracture line still clearly
visible, fluffy callus
around it
Not safe to subject the
unprotected bone to
stress

Consolidation
Complete repair
Calcified callus is ossified
X- Ray:
Fracture line to be almost
obliterated, crossed by
bone trabeculae, well
defined callus around it
Future protection is
unnecessary

Non Union

Distraction and separation of the fragme

Hypertrophy

Atrophy

Clinical Features
History

X- Ray Examination (Rules of Two)

2 occasions
views
joints
injuries
limbs

TREATMENT OF CLOSED
FRACTURES
Treatment of fractures consists of :
Manipulation to improve the position of the
fragment, followed by
Splintage to hold them together untill they unite.

Joint movement and function must be

preserved.
Fractures healing is promoted by
physiological loading of bone, so muscle
activity and early weight bearing are
encouraged

3 simple injunctions to achieve

the objectives :

The most important factor in healing of bone

Tscherne Classification of Closed Injuries

Grades
Explanation
Grade 0 Simple fracture +
Little/no soft-tissue injury
Grade 1 Fracture +
Superficial abrasion/bruising of
skin and
subcutaneous tissue
Grade 2 More severe fracture +
Deep soft tissue contusion and
swelling
Grade 3 Severe injury +
Marked soft-tissue damage +

REDUCE

The greater the contact surface area between fragment,

Condition where reduction is unnecessary :

displacement does not matter (fracture of clavicle

Closed reduction

CLOSED REDUCTION
Under anaesthesia and muscle
relaxation.
T
Fracture is reduced by THREEHOLD
MANUOVER :

OPEN REDUCTION
Is an operative reduction of the
fracture under direct vision

Indication of Open Reduction :

Closed reduction fails
When large articular fragment need
accurate positioning
For traction fractures which fragments are
held apart

HOLD REDUCTION

1- Continuous Traction
Speed

1- Continuous Traction
Traction by gravity
Skin traction
Skeletal traction

Complication of Traction :
Circulatory embarrasement
Nerve injury
Pin- site infection

2- Cast Splintage
Move

2- Cast Splintage
Plaster of Paris is still widely used as
a splint, especially for distal limb
fracture and for most childrens
fracture
Speed of union is neither greater nor
less than with traction
However, joints encased in plasters
cannot move and are liable to
stiffness.

Complication Cast Splintage :

Tight cast vascular compression
Pressure sore Localized pain
Skin abrasion or laceration due to
removing plasters
Losse cast no longer hold the
fracture due to subsided of swelling

3- Functional Bracing
One way of preventing joint stiffness
while still permitting fracture splintage
and loading
The splints are functional in that joint
movements are much less restricted
than with conventional cast

4- Internal fixation
Safety

Indication for internal fixation:

Multiple fracture
Pathological
Fractures
that
in
Patient
fractures
cannot
unstable
Unite
with
poorly
be&
nursing
reduced
and
prone
slowly
difficulty
except
to
by operation

Types of internal fixation

Types of internal fixation

Types of internal fixation

Types of internal fixation

Complication of Internal fixation

Infection

Usefu
l for :

5- External fixation

Exercise

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