Presentation on theme: "CONSERVATIVE TREATMENT OF FRACTURES"— Presentation transcript:
1 CONSERVATIVE TREATMENT OF FRACTURES Dr. Muhammad ASIFOrthopedic SurgeonDepartment of OrthopaedicsCollege of MedicineKing Khalid University Hospital
2 Fracture management Either The ideal goal of fracture management is anatomical reduction and function restoration compatible with the severity of injury, age, occupation and activity of daily living of injured patient.EitherOperativeNon operative (Conservative)TractionSplint (Cast / Slab)
3 TractionTraction is the application of a pulling force to a part of the bodyPurpose:to reduce, align, and immobilize fractures;Unstable and unfixableWhen reduction and/or proper length cannot be maintained by static immobilizationto minimize muscle spasmto prevent or reduce skeletal deformities or muscle contractures.
4 Classification of Traction Skin Traction : is maintained by direct application of a pulling force on the patient’s skin . Generally temporary measure.To reduce muscle spasmsTo maintain immobilization before surgeryIn childrenSkeletal Traction : applied to bone by means of a pin or wire surgically inserted into the bone,providing a strong steady, continuous pull, andcan be used for prolonged periods .
6 Complications of traction Neurovascular compromise.Inadequate fracture alignment..Skin breakdown .Soft tissue injuryPin tract infection .Osteomyelitis can occur with skeletal traction.
7 Complications of traction complications from immobility especially with long term traction and in elder pt.Pressure ulcerPneumoniaConstipationAnorexiaUrinary stasis and infectionVenous stasis with DVT
8 General Indications for CAST 1. Most fractures in children: a. Tremendous capacity of remodeling. b. Non union and stiffness is unlikely. 2. Undisplaced fracture 3. Poor bone Quality: Osteoporosis. 4. Unfixable fracture e.g. severe comminuted. 5. Systemic contraindication. 6. Local contraindication. 7. Psychosocial problem.
9 Splint / Cast Principle: Objectives: To stabilize joint above and joint below the site of injury whenever and wherever is possibleObjectives:To hold broken bone anatomically to prevent malunion.To reduce excessive movements to prevent non union.To get early function
10 How to Preserve Function? Immobilize only joint necessary,Range of motion of uninvolved joints.Isometric exercise.Physiotherapy after cast removal.Weight bearing whenever possible in case of lower limb fracture.
11 What are casts made of ? The outside, or hard part of the cast, two different kinds of casting materials.Plaster (POP) - white in color.hemihydrated calcium sulphate.On adding water it solidifies by an exothermic reaction into hydrated calcium sulphatefiberglass - variety of colors, patterns, and designs.inside of the castCotton and other synthetic materials are used to line the inside of the cast to make it soft and to provide padding around bony areas.
12 Plaster is usually used in the early stages of treatment, Displaced Fracture that need manipulationcan be molded more precisely.heavymust remain dry, water will distort the cast FiberglassCan be used in Undisplaced Fx if swelling not expectedhealing process has already started.lighter weight, durable, require less maintenance.
13 Different types of casts Type of Cast/SlabLocationUsesShort armApplied below the elbow to the hand.Distal Forearm or wrist Fx. Also used to hold the forearm or wrist muscles and tendons in place after surgery.Long armApplied from the upper arm to the hand.Distal humerus, elbow, or proximal forearm fractures. Also used to hold the arm or elbow muscles and tendons in place after surgery.Scaphoid cast/ thumb spicaBelow elbow to hand including thumbScaphoid Fx, thumb FXU slabFrom shoulder to elbow and then to armpitHumerus shaft fx
15 Type of Cast / SlabLocationUsesShort leg cast:Applied to the area below the knee to the foot.Distal T/F Fx,ankle Fx,severe ankle sprains/strains.Long leg castFrom above knee to footProximal T/F Fx,trauma around kneeHip spicaFrom lower chest to one or both feetFemur fracture in childrenPTB castFrom knee to footFor weight bearing in healing Fx T/F
18 Closed Reduction Method Adequate analgesia / anaesthesiaTraction – countertractionIncrease the deformity if needed, to reduce / lock on fragmentsCorrect rotational deformity as well.Remove any rings from fingers or affected limbsAll acute injuries (<48 hours post injury)fully padded well molded plaster,full casts may be splittted.
19 After Closed Reduction and Casting must have circulation checkPlaster takes 48 hours to become fully dry and harden so take care.Weekly radiographs for 3 weeks to confirm acceptable reduction.Can re-manipulate within 3 weeks after injury if displaced.
21 Colles’ Fracture Displaced dorsolaterrally Treatment: Cast +/- surgery, depending on shortening and displacement
22 Scaphoid Bone FX Retrograde blood supply Total healing time of weeks or more
23 Boxer’s Fracture Classically neck of the fifth metacarpal bump over the back of palm just below the small finger knuckleTreatment: casting or surgery (pins)
24 Patellar Fracture Fall onto kneecap or when quadriceps is contracting Attempt “straight leg raise”If Extensor mechanism intact / undisplaced Fx Cast / Slab
25 Fracture of 5th Metatarsal Avulsion Fracturebase of 5th metatarsal from pull of attached tendon;heal well in castJones FractureTransverse fracture through base of 5th metatarsal, about 1-2 cm from tip;cast for 6-8 wks if undisplaced
37 Post Cast instructions Keep your limb elevated to prevent swelling.Apply an ice bag to injured area.Keep the cast clean and dry.Check for cracks or breaks in the cast.Rough edges should be padded to protect the skin from scratches.Do not scratch the skin under the cast by inserting sticks.Encourage patient to move his/her fingers or toes to promote circulation
38 Contd Prevent small toys or objects from being put inside the cast. Do not put powders or lotion inside the cast.Cover the cast while your child is eating to prevent food spills and crumbs from entering the cast.Do not use the abduction bar on the cast to lift or carry the child.Use a diaper or sanitary napkin around the genital area to prevent leakage or splashing of urine.
39 How To Know if Something Is Wrong With Your Cast Pain that is not adequately controlled with medication prescribed by your doctor.Increasing swellingNumbness or tingling in the extremity (hand or foot).Inability to move your fingers or toes beyond the cast.Circulation problems in your hand or foot.Loosening, splitting or breaking of the cast.Unusual odors, sensations, or wounds beneath the cast.If you develop a fever or generalized illness
40 Complications of castCompartment syndrome, tight cast that restricts swelling.Impaired distal neurovascular.most serious is deep venous thrombosis leading to pulmonary embolism----calf pain.Re displacement of fracture.stiff joints, muscle wasting.Plaster Sores.Malunion, Nonunion, Delayed union
41 Cast Burns- can occur during cast removal if blade dull or improper technique used.