INTRODUCTION TO FRACTURES OBJECTIVES To define fractures and
INTRODUCTION TO FRACTURES
OBJECTIVES • To define fractures and understand various types of classification. • To study the salient features of open and pathological fractures. • To differentiate between fracture, dislocation and subluxation.
DEFINITION Break in the continuity of bone
Basics of Fractures • Deformation of bone is directly proportional to the nature, magnitude and direction of force. • Treatment protocols are based on these deformation patterns. • Deforming forces can be direct or indirect.
CLASSIFICATION Etiology Traumatic Pathological
Displacement Undisplaced Displaced
DISPLACED & UNDISPLACED
Relationship with external environment Open Closed
OPEN & CLOSED FRACTURES
Nature of fracture line / Basic Pattern Transverse Oblique Spiral Comminuted Segmented
OPEN FRACTURES • Communicates with the external environment • Break in overlying skin and soft tissue • Can be an Open fracture from Within or Without • Greater risk of infection
GUSTILO ANDERSON’S CLASSIFICATION OF OPEN FRACTURES • Based on extent of injury and degree of contamination • Type I • Wound < 1 cm • Little/No contamination • Non-complex fracture pattern • Type II • Wound > 1 cm • Moderate contamination • Fracture pattern may be complex or simple
• Type III • Extensive soft tissue crushing • Extensive contamination • Subdivided into: – IIIa : Soft tissue coverage by closure – IIIb : Soft tissue reconstruction needed – IIIc : Associated vascular and nerve injury; needs vascular repair
PATHOLOGICAL FRACTURE • Occurs in a bone with weakened structure due to a disease • Break occurs due to trivial trauma or even spontaneously • Causes can be localized or generalized • Commonest Cause ? • Most often affected bone ?
Localized Causes • Inflammatory – Osteomyelitis (pyogenic/tubercular) • Neoplastic – Benign : GCT – Malignant : Osteosarcoma; Ewing’s; Secondaries from Lung, Kidney, Prostate • Miscellaneous – Cysts; Dysplasia; Granulomas
Generalized Causes • Hereditary – Osteogenesis imperfecta – Osteopetrosis • Acquired – Osteoporosis – Rickets/Osteomalacia – Scurvy – Paget’s Disease
Age Wise Distribution of Pathological Fractures • At Birth : • 0 -5 years : • 5 -20 years : Osteogenesis imperfecta Osteomyelitis, Primary bone malignancies • 20 -50 years : Malignancy, Osteomalacia • > 50 years : Osteomalacia, Multiple myeloma, Secondaries
DISLOCATION Injury to a joint Articular surfaces are wholly separated Can be traumatic and pathological Traumatic dislocations - FORA Features include Pain, Swelling, Deformity, Loss of movement, Limb shortening • Treatment is based on conservative management and operative reduction • • •
SUBLUXATION • Articular surfaces are partly displaced and retain some contact
SUMMARY • Fracture is break in normal continuity of bone • It can be classified in many ways which alters the treatment protocols. Most important are Open fractures and Pathological fractures • Dislocation is COMPLETE separation of 2 articular surfaces • Subluxation is INCOMPLETE separation of 2 articular surfaces
SOURCES • Google Image Search • Essential Orthopaedics by J. Maheshwari • Essentials of Orthopaedics by RM Shenoy THANK YOU
- Slides: 24