Fractures

Dr. Pradeep Fernando MS, FRCS

Definition
Types
Description
Diagnosis
Initial management
Complications
Management of open fractures
Definition


A break or breach in the normal continuity
of a bone
Types of fracture
Traumatic fractures

Pathological fractures

Stress fractures
Pathological fractures
Fracture through a
diseased bone





Osteoporotic fractures
are they pathological?
Stress fractures
March fractures,
fatigue fractures

Repeated trauma

Metatarsals, others
Traumatic fractures- Epidemiology
Falls, RTA, assault, work injury, military

In the elderly

Mostly affect the young. Economically
important
Traumatic fractures- types
Closed


Open
Traumatic fractures- types
Comminuted
Segmental
Transverse
Oblique
Spiral
Impacted
Greenstick
Traumatic fractures- types
Traumatic fractures- types
comminuted
transverse
Traumatic fractures- types
segmental
open
Traumatic fractures- types
impacted
greenstick
Traumatic fractures- history
History of trauma
Pain
Loss of movement / abnormal movement
Swelling

Traumatic fractures- signs
Visible bone
Abnormal position
Oedema
Bruising
Blisters
Abnormal movement,
crepitus
Traumatic fractures- assessment

ABC of trauma pt as a whole

Distal circulation, distal sensation

Fracture itself describe (photograph)
Traumatic fractures- treatment
Initial resus. Remember spine.

Stop bleeding

Stabilize the fracture splint

Toxoid, gangrene,
Traumatic fractures- Investigations


X-rays two planes. Two joints

CT, MRI, bone scan.
Traumatic fractures- treatment
Reduce

Hold

Move (Rehabilitation)
Treatment - Reduction
Not always necessary impacted
fractures, metatarsals, scapula, iliac crest
Methods
Manipulation
Traction
Using EF or distracting device
Open reduction
Treatment - Immobilisation
Not always necessary ribs, skull,
impacted, distal phalanx
Methods
Cast
Traction
External fixators
Internal fixation
Treatment - rehabilitation
Always needed

Movement is life, life is movement

Physiotherapy for the affected part,
for patient as a whole (occupational
therapy)
Complications of fractures
Immediate
Bleeding
Injury to other structures vessels, nerves,
abdominal and pelvic organs, cord, brain
Open fracture

Early
Fat embolism



Complications of fractures
Intermediate
Infection
Fat embolism
DVT

Complications of fractures
Late
Infection
Malunion
Non-union
Delayed union
AVN
Fracture disease (Sudeck, Reflex sympathetic
dystrophy)
Osteoarthritis
Damage to structures tendons, cord

Management of open fractures
Initial management
Toxoid, ?serum, ?gangrene prophylaxis
Blood for DT, other Ix
Broad-spectrum IV (pen-gent metro)
Nil by mouth
Arrange for wound debridement ASAP
Management of open fractures
In OT
Irrigate
Remove dead and devitalised tissue, FB
Reduce
Stabilize IF, cast, EF
Management of open fractures
Management of open fractures
Summary
Definition
Types
Description
Diagnosis
Initial management
Complications
Management of open fractures