1. TRAUMA Fractures, Dislocations & other injuries By Barbara Peacock Cumberland County College 2009

2. Definition of trauma: Injuries which are caused by external force or violence. They may range from minor to major, obvious to not apparent, single injury to multiple.

3. When a bone fractures, there is usually damage to the surrounding area which may include: Damage to muscles Tearing of blood & lymph vessels Severing of nerves Damage to nearby organs Laceration of the skin

4. Signs of fracture: limited or no movement of a limb swelling at the site of injury pain at, or distal to, the injury bruising at injury site deformity of a limb no pulse distal to the injury loss of feeling at, and distal to, the injury

5. Clinical indication of dislocation Deformity of a limb

6. Fracture Healing Healing begins when swelling occurs. Blood, lymph, & tissue fluids form a fibrin clot around the fracture. Soon fibroblasts appear & begin granulation. Granulation process helps stabilize the fracture…….. (continued)

7. Healing (continued) Calcium is deposited around the fracture forming a callus. *The callus is the first phase of healing which can be demonstrated radiographically. Calcified area may be large at first, but will reduce with use. Fracture site may be stronger than before!

8. Factors affecting healing: Patient age general health nutrition circulation at site of injury

9. Terminology A/A or MVA abrasion amputation concussion crepitus dislocation Fracture hematoma sprain luxation subluxation

10. Examples of dislocation

11. Example of subluxation

12. General types of fractures Complete vs. Incomplete Entire cross section of the bone fractures vs. not broken into separate pieces.

13. General fracture types (cont.) Closed (simple) vs. compound Bone does not pierce through the skin vs. bone is through the skin

14. Closed vs compound fractures

15. General types of fractures (cont.) Direct vs Indirect fracture occurs at the site of trauma vs away from the impact point

16. Fracture Alignment Displacement or apposition = misalignment of a fracture Other terms denoting misalignment: Varus Valgus Bayonet (see note)

17. OUCH!

18. Varus or Valgus?

19. ANOTHER OUCH !

20. Overlapping fx.

21. Specific types of fractures LINEAR - straight lines

22. Transverse fx

23. Transverse fx.

24. Longitudinal (cleft)

25. Oblique fx (also an oblique fx because of the direction of the fracture line)

26. Spiral fx Fracture line rotates around the bone, usually from a twisting force

27. Spiral fx.

28. Comminuted fx 2 or more fracture lines = 3 or more fragments

29. Crush fx Severe communited !

30. Impacted fx Typical of a front seat passenger in a car crash ! Fractured ends get pushed into one another

31. Impacted fx.

32. Splinter fx Fracture ends are thin shards or splinters like wood. (gunshot wounds)

33. Stellate fx Specific to the patella- fracture lines radiate out from a center point in a star-like pattern.

34. Compression fx Specific to the vertebrae - vertebral body collapses, anterior aspect is reduced in height. From trauma or demineralization of bone (old age).

35. Burst fx C - 1 (atlas)C1 ring is broken, fragments move outward. Football injuries, heavy object dropped on head.

36. Blowout fx Orbital floor collapses from direct blow to eyeball (fist, baseball)

37. Depressed fx Section of bone pushed into center of an area (skull, sternum)

38. Complicated fx Fractured bone causes damage to an internal organ. Ex. - rib pierces lung

39. Avulsion fx (chip fx) Caused by stress to a joint, ligament, or tendon. Small piece of bone is torn away. Often seen with dislocations. (see note)

40. NON-TRAUMA FRACTURES 1. Pathologic - bone is weakened by disease, spontaneous fx’s (cancer, osteomalacia, osteomyelitis, Pagets) 2. Stress - caused by prolonged running or marching - metatarsals fracture. Difficult to visualize.

41. Pediatric fractures 1. Greenstick (torus) - incomplete fx, bones more flexible, bends & fractures only outer edge. 2. Epiphyseal - fractures located at the site of an epiphysis. Sometimes with associated dislocation (slipped epiphysis)

42. Don’t forget to review the specific fracture types listed on the last pages of your handout! (eg: Colles, nursemaid, Potts)

43. THE END !!