Fractures By Amal

Types of fractures: Complete fractures The bone is completely broken into two or more fragments.

Incomplete fractures The bone is incompletely divided and the periosteum remains in continuity

Mechanism of injury: The shape of fracture depends on the direction of load. Impacted fracture: the fragments are jammed tightly together and the fracture line is indistinct.

Spiral fracture: as a result of twisting force, most common in humerus, tibia and femur because: The shape of the bone is already twisted The muscle attachment already pulls out side in a spiral pattern.

transverse fracture: as a result of tension force.

Greenstick fracture ( type of incomplete): happens more in children coz there bones are still soft.

There are two types of complete fracture displaced Undisplaced: easy to heal

fractures can also be classified according to the intact of the skin to: Open fracture: the skin is open. Close fracture: the skin is intact.

Comminuted fracture Types of comminuted: A comminuted fracture is one in which there are more than two fragments. Types of comminuted: Butterfly or wedge fracture.

Continue the type of comminuted Segmental fracture Longitudinal fracture

Do we need to splint in order to promote healing? NO—the cast has nothing to do with the healing process. We splint to: Alleviate pain ensure good alignment for bone union Permit early movement and return to function.

Fracture healing: 5 stages tissue destruction and haematoma formation– vessels around are cut & haematoma forms, the fracture surfaces is deprived of blood supply Inflammation and cellular proliferation– happens within 8 hours/ the clotted haematoma is slowly absobed & new capillaries grow into the area

Continue: healing of fractures Callus formation– osteoclast will mop up dead bone and osteoblast will build new bone Consolidation– bone becomes harder Remodeling—reshaping of the bone

treatment ( reduction) of fracture Closed ( conservative) Open ( operative)

Types of Hold reduction: 1.Continues traction: types of traction: Gravity traction: to upper limb Skin traction: no more than 4 or 5 kg Skeletal traction 2. Cast splintage ( plaster of paris) 3. Functional brace: allow the movement of the other joint

3.Internal fixation ( implants): in side the body Screw Wires Plates Intramedullary nail: usually for the shaft 4. External fixation: from out side Plates &screws

Complications of traction: Blood supply cut off: bandages are tight Nerve injury Pin-site infection Complication of cast Tight cast pressure sores Skin abrasion or laceration

Complication of internal fixation Infection Non-union: if there is a gap between the ends of bone Implant failure refracture

Complication of external fixation Soft tissue damage Over distraction Pin-track infection Refracture Complication of fractures Early complication Visceral injury

Late complications Nerve injury Infection Pressure sores Compartment syndrome—volkmann’s ischemic conttracture Late complications Delay union Malunion Avascular necrosis

Continue: late complication Growth disturbance Bed sores Nerve compression Joint stiffness osteoarthritis

Good luck to all of you