Sure signs of fracture

• Deformity
• Shortening
• Abnormal Mov’t
• Crepitus
• Visiual fracture
 Classification of fractures
• Simple
– Transverse(less than 300
– Oblique
– spiral
• Wedge
• Complex
– Segmental
– Communited
– Fracture with bone loss
 Orthopedics
• Principles of Fracture Management
– Resuscitation
– Reduction
• Open
• Closed
– Manipulation
– Traction
– Gravity
– Retention
• Traction /Gravity
• External splints
• Internal fixation
• External fixation
– Rehabilitation 5
 Skin traction
• hip dislocation
• Trochanteric fra
• Proximal femoral fracture
 Common sites for skeletal traction
• Calcaneus
• Proximal tibia
• Distal femur
• Distal tibia
• Olecranon
• Skull
 Cast Indications
• Short Arm Cast
– Colle’s and Smith’s Fracture
– Fracture of Metacarpals
• Long Arm Cast
– Mid shaft radioulnar fracture
– Lower third radioulnar fracture
– Distal humeral fracture
– Olecranon fracture
– Supracondylar fracture
• Short Leg Cast
– Malleolar fracture
• Uni malleolar bimalleolar trimalleolar
– Metatarsal fracture
– Talus Fracture
– Calcaneous fracture
• Long Leg Cast
– Lower third of tibiofibular fracture
– Mid shaft tibiofibilar fracture
– Distal femoral fracture
10
 Complications of Plaster Casts
• The Tight Cast
– Pain
– Pressure sore
– Compartmental syndrome
– The Cast Syndrome.
– Peripheral nerve injury
• loose cast
• Thermal Effects of Plaster
• Allergic Reactions
• Joint stiffness
11
 Closed reduction
Indications
• Minimally displaced fracture
• For most fractures in children

12
 Open reduction
indications
• When closed reduction fails
• When there is large articular fragment
that needs accurate positioning
• For traction fractures in which the fragments are
held apart

• Open fractures
• Avulsion fractures
• Displaced intraarticular fracture
13
• Hw long shud ext fix be kept? 6wks followed
by cast.
8.Avulsion
fracture
• Average time for internal fixator-one and half
yrs
 Monteggia and Galleazzi
– Fracture of One Bone w. Ligament Rupture
• Ulna w. Radial Head Dislocation = Monteggia
• Radius w. DRUJ Dislocation = Galleazzi
• Monteggia Galleazzi
u R U R

These are called fracture dislocations(fracture of

necesitans )bec internal fixation is necessary.
18
 Hip Dislocation
• Posterior (common)80%
– presents with shortening,
– flexion
– adduction
– internal rotation
• Anterior (rare)
– patient presents with hip in flexed
– abducted
– externally rotated position
• Central
• Complications of Hip Dislocation
– Sciatic nerve injury
– Avascular necrosis of head of femur
– Recurrence of dislocation
– Osteoarthritis
– Myositis ossificans

19
 Amputation
• Indications
•Complications
– Dead limb
• Peripheral vascular ds(90%)
Infection
• Severe trauma,burns,frost Hemorhage
bite Skin brkdown
Phantom limb
– Deadly-
• severe infection or
sensation
• Malignancy Phantom limb pain
• Crush injury Stump neuroma
– Dead loss Joint contracture
• major nerve injury
• Pain
• Gross malformation
• Recurrent sepsis
• Severe loss of function
Complications of
fracture
 Systemic complications
• Shock
• Fat embolism syndrome/ ARDS
• Infections
• Crush syndrome
• Cxs of prolonged recumbency
– DVT and PE
– Bed sores
– Osteoporosis
– Nephrolithiasis
– Constipation
 LOCAL

EARLY complications
Affect mainly the soft tissues

LATE complications
Months after injury , affect mainly bones and
joints
 LOCAL COMPLICATIONS
EARLY LATE

• Visceral injury • Delayed union

• Vascular injury • Non-union
• Compartment syndrome • Malunion
• Nerve injury • Joint stiffness
• Haemarthrosis • Myositis ossificans
• Infection • AVN
• Osteoarthritis
 VISCERAL INJURY
Rib fractures can penetrate the lung
PNEUMO / HAEMO THORAX
VISCERAL INJURY
Pelvic fractures can penetrate:
Bladder , urethra ,rectum
 VASCULAR INJURY

Paraesthesia
Cold and pale or cyanosed
Pulse weak or absent

Radiology can reveal high risk fracture

Angiogram
 SWELLING
ALMOST WITH EVERY

INURY / FRACTURE

IMMOBILIZE
ELEVATE
 COMPARTMENT SYNDROME
Classical signs of impending compartment
syndrome are:
pain
pallor
paraesthesia
Paralysis
pulselessness
(The 5 p’s).
 NERVE INJURIES
Neurapraxia :
Damage is minimal, transient lesion with
spontaneous recovery: Few days- weeks
Axonotmesis:
Axons damaged, but nerve sheath intact.
Recovery is delayed but likely
Neurotmesis:
Nerve is completely severed, needs surgical
repair