FRACTURE AND ITS MANAGEMENT DR UJJWAL SINHA DEPARTMENT

FRACTURE AND ITS MANAGEMENT DR. UJJWAL SINHA DEPARTMENT OF ORTHOPAEDICS

SKELETAL SYSTEM � AXIAL SKELETON - 80 � APPENDICULAR SKELETON - 126 FUNCTION PROTECTIVE SUPPORT OF BODY HAEMOPOESIS LOCOMOTIVE MINERAL STORAGE

COMPOSITION : MATRIX - TYPE 1 COLLEGEN IN MUCOPOLYSACHRIDE GROUND SUBSTANCE - OSTEOID MINERAL - Ca , Phosphate , IN THE FORM OF HYRDOXY APPATITE BONE CELL - OSTEOCYTE OSTEOBLAST OSTEOCLAST HARVESIAN SYSTEM - LAMELLI CONNECTED WITH CANALICULI

ANATOMY : MEDULLA - STORAGE - MARROW CORTEX - STRENGTH - REMODELING - ATTACHMENTS EPIPHYSIS GROWTH PLATE METAPHYSIS DIAPHYSIS

TYPES: LONG BONES SHORT BONES FLAT BONES IRREGULAR BONES SESAMOID BONES

FRACTURES HISTORY l. Egyptians l. Hippocrates l. Al-Zabra l. Chinese l. Arabians l. Mathysen l. H. O. Thomas Splintage; 460 B C Casting Willon Board Immobilization POP in 1876 Rest, Rest & Rest

FRACTURES contd……. � Robert Jones Orthopaedics � Sarmiento � Kuntscher � AO Group � Illizarov � Dr. M. G. Kini Father of FCB IM Nailing 1958, Muller, Primary intention

FRACTURES DEFINITION Break in surface of bone(Cortex or Articular surface) FORCE REQUIRED -Sudden & Severe -Repetitive -Trivial(Pathological) Direct Indirect

Sign and symptoms � Definite � Pain history � Swelling � Tenderness � Deformity � Crepitus � Inability to use the involved limb � Loss of transmitted movements

I TYPES 1. Simple 2. Compound II 1. Complete Displaced -Shift, Tilt, Rotation Un Displaced 2. Incomplete III 1. Linear Transverse Oblique Spiral - Butter Fly 2. Comminuted 3. Segmental 4. Bone Loss <50% >50%

IV. ATYPICAL FRACTURES 1) 2) 3) 4) 5) 6) Green stick Impacted Stress Pathological Hairline Torus

A. O. Classification: � Ø Each long bone is numbered. First digit Bone Ø Second digit Ø Third letter AO/ASIF Segment 1– 4 Type A – C Proximal & distal A - C

Common Types of Fractures

Common Types of Fractures

Transverse fracture � Usually caused by directly applied force to fracture site

Spiral (Oblique) � Caused by violence transmitted through limb from a distance (twisting movements)

Greenstick � Occurs in children: bones soft and bend without fracturing completely

Compression (Crush) fractures � Fracture in cancellous bone: result of compression (osteoporosis)

Comminuated fracture � Two or more bone pieces - high energy trauma

Impacted fracture � Bone fragments are impacted into each other.

Stress Fracture � Abnormal stress on normal bone (fatigue fracture) or normal stress on abnormal bone (insufficiency fracture).

Casts Fig. 619

OPEN FRACTURES : EMERGENCY GUSTILLO ANDERSON: I Less than 1 cm II 1 -10 cm ; No devitalization III > 10 cm ; Devitalized, Contaminated III a. Extensive, but soft tissue coverage present III b. Bone exposed, periosteum III c. Neuro. Vascular injury