Textbook reading

PRINCIPLES IN FRACTURE


Oleh :
George A. Sitanaya
Made A. Dwi Winarka
Nik Nor Aini

Pembimbing:
dr. Ganda Purba
dr. Faisal Fachsan
dr. Erick Gamaliel

Dibawakan Dalam Rangka Tugas Kepaniteraan Klinik
Bagian Ortopedi dan Traumatologi
Fakultas Kedokteran Universitas Hasanuddin
Makassar
2011
Fracture break in structural continuity of
bone, it may be no more than a crack, a
crumpling or a splintering of the cortex; more
often the break is complete and the bone
fragments are displaced.

If overlying skin remains intact closed
fractured

If skin not intact or one of the body cavities is
breached open fractured
Traumatic incident direct force , ex : traffic
accident
Stress fractures repetitive stress , ex : in
athlete or soldier
Pathological fractures normal force in
weakened bone , ex : osteoporosis
Complete fractures the bone is completely
broken into two or more fragments. Ex :
transverse, oblique, spiral, comminutive,
impacted
Incomplete fractures the bone incompletely
divided and the periosteum remains in
continuity, ex : greenstick fractures
Tissue destruction and haematoma formation
Inflamattion and cellular proliferation
Callus formation
Consolidation
Remodelling

General sign
A : Airway obstruction and Cervical spine injury
B : Breathing problem
C : Circulating problem and bleeding control
D : Disability
E : Exposure

Local sign
Look : bruishing, swelling, deformity, and skin contact
Feel : tenderness, vascular and nerve abnormalities
Move : active and passive movement
Rules of two:
Two view: a fracture or dislocation may not be seen
on a single x-ray film, and least two views
(anteroposterior and lateral) must be taken
Two joint : The joints above and below the fracture
must be both be included on the x-ray films
Two limbs : make comparison between fracture or
non fracture (in children)
Two injuries : severe force often causes injuries at
more than one level
Two occasion : some fractures are difficult to detect
soon after injury, but another x-ray examination a
week or two later may show the lession

Computed tomography (CT) vertebra and
joint
magnetic resonance imaging (MRI) may be the
only way of showing whether a fractured
vertebra is threatening to compress the spinal
cord
Under appropriate anaesthesia and muscle
relaxation
Three fold manoeuvre:
Distal part of the limb is pulled in the line of the
bone
As the fragment disengage, they are repositioned
(by reversing the original direction of force if this can
be deduced)
Alignment is adjusted in each plane

Closed reduction is used for non displaced or
all minimally displaced fractures
Most fracture in children
Fractures that are stable
Traction by gravity
Skin traction
Skeletal traction
Balance traction
Circulatory embarrasement
Nerve injury
Pin- site infection
Plaster of Paris is still widely used as a splint,
especially for distal limb fracture and for most
childrens fracture

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

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
Is an operative reduction of the fracture under
direct vision
Closed reduction fails
When large articular fragment need accurate
positioning
For traction fractures which fragments are held
apart

Indications:
Cannot be reduced except by operation
Unstable and prone to displacement
Unite poorly and slowly
Pathological fractures
Multiple fracture
Patient with nursing difficulty
Interfragmentary screws
Wires
Plate and screws
Intermedullary nails

Infection
Implant failure


Severe soft tissue damage
Nerve or vessel damage
Severe comminuted and unstable fractures
Ununited fractures
Fractures of the pelvis
Infected fractures
Severe multiple injuries
Damage to soft tissue structures
Overdistraction
Pin-track infection
Early complications:
Vascular injury
Nerve injury
Compartment syndrome
Infection
Late complications:
Delayed union
Non-union
Malunion
Avascular necrosis
Nerve compression
Muscle contracture
Joint stiffness
Osteoarthritis