General principles of

fracture management

Intended Learning Objectives

(ILO)
Etiology and types of fractures,
Diagnosis and imaging,
Indications for different types of treatment,
Complications of fractures,
Examples of common bone injuries.

Definition of a fracture?
Interruption of bone continuity
Aetiology:
Traumatic
Pathologic

high or low velocity injury

already diseased bone

Traumatic fractures

Pathological fractures

Pathological Anatomy
Shape : Transverse, short oblique, spiral
comminuted, Segemental.
Level : Metaphysis, Diaphysis , Intra-articular.
Stability : Tendency to re-displace after
reduction = Instability
Type : Simple / open

Pathological Anatomy
Specific types:
Avulsion Fracture: At sites of muscle/ligament pull.
Torus Fr. ( Buckle fracture ) : buckling of the
cortex.
Green stick Fr.: Fr. of one cortex and bending
of the other.
Fragility Fr. : Osteoporotic bones.

Pathological anatomy

Shapes of fractures

Examination
Proper history taking:
General evaluation including the vital signs:
General skeletal evaluation
Thorough local examination:
Signs of the Fracture :
:
Neurovascular testing
, thigh, leg, foot Forearm :

??? Compartment Syndrome

Imaging

Plain x ray : Basic and informative with proper

.
views: AP, lateral and oblique
Specific views: for certain Fr. e.g:
acetabulum,

shoulder
pelvis, and Calcaneus
CT: Comminuted intra-articular Fr
MRI : Occult Fr. e.g: neck of femur, scaphoid

Imaging

Treatment
Aim:

is to keep the Fr. reduced in good

position till complete union

Non operative :: POP cast or slab

Traction : Skin
Skeletal
Indications: Children Stable General or
local contraindication for surgery

Treatment
Operative :: Adults Unstable Open
Intra-articular Poly traumaNeurovascular injury Head injury
Non compliance with conservative
treatment
Open minimal invasive percutaneous
Internal Fixation:

Plates , Screws , IMN, K-wires

Staples

External Fixation: Rods, Rings, Hybrid.

Combinations

Conservative treatment

Conservative treatment
Traction

Operative Treatment
Internal fixation

External fixation

Complications of Fractures
General complications of trauma: Bleeding, shock,
ARDS, DVT, etc..
Local complications of the fracture:
Mal union
Non union
Stiffness of joints
Wasting of muscles
Atrophy of bones
Edema of the limbs
Nerve injury
Infection

Malunion

Non union

Non union

Proximal Femoral
Fractures
Fr. neck of femur : Always treatment is
surgical
Biologic factors , Mechanical factors
Healing

Stability
Union

Treatment : internal fix. , arthroplasty

Complications : Non union , avascular
necrosis

Blood Supply to
Neck of Femur

Clinical Picture

Proximal Femoral
Fractures
Trochanteric Fr. : preferred treatment is
surgical
Why?
General :problems of prolonged
recumbancy
Malunion
Treatment : Skeletal traction, Internal
Fixation

Ankle Fractures
,
Preferred to be treated Surgically
Classified according to severity of injury of
bones and soft tissues in ascending scale : A ,
B , C,
Complications : Malunion and ankle
arthritis.

Distal Radius Fractures

Colles Fracture: Distal end of radius
How ? When ?
Deformity : Dinner Fork
Treatment : Closed reduction under GA

Except?

Complications : malunion, median n. compression

Sudeks atrophy ???

Supracondylar Fractures
In Children

Types : Extension --- Flexion

c/p : Fr. ( pain, swelling, loss of function,
deformity) +
Compartment Syndrome

Treatment : Closed reduction + casting

Closed reduction +
percutaneous
K wires
Open reduction + K wires

Supracondylar fracture

K wire fixation

Supracondylar Fracture
Complications :
1- Vascular injuries : arterial spasm tear of
brachial artery
2- neural injury : Median nerve ,,,,,,, Radial &
Ulnar
3- Stiffness of elbow joint
4- Malunion : Cubitus varus

Take Home Message

Understanding anatomy and pathology of any fracture
is
essential before treatment,
Treatment of fractures should be individualized,
General patients assessment is a part of fracture
treatment,
The aim of treatment is restoration of function and ,
avoidance of complications
Proper handling of tissues , by conservative or
operative,
methods of treatment + close follow up is crucial.