1. PRINCIPLE OF FRACTURE MANAGEMENT DR S SOMBILI 2012

2. DEFINITION
Fracture is an open or close soft tissue injury of varying severity with a break in the continuity of the underlying bone
The soft tissue component is important

3. DIAGNOSIS HYSTORY Minor trauma- Falling - Assault Major trauma- MVA
- PVA
- Motorcycle accident
- Industrial accident
- Air tarffic accident

4. PHYSICAL EXAMINATION Swelling Abrasion Ecchymosis Deformity Wound
Tenderness
Abnormal movement
Crepitus
N/V examination

5. INVESTIGATION X-Ray CT- Scan Anteriorposterior view Lateral view
Two sides
Joint above and below
Before and after reduction
CT- Scan
For complex fractures

6. FRACTURE TYPE FRACTURE PATTERNS Transverse Oblique Spiral Impaction
Simple
Segemental
Comminuted

7. PRINCIPLE OF TREATMENT
Think
Patient,Limb,Fracture
Resucitation:ABC

8. Splintage- Temporary
- Plaster slab
Well padded cramers wire
Traction

9. Displaced fractures - Close reduction
Splintage:cast,joint above and below,traction.
Reduction must be done within 72hrs.

10. Undisplaced fractures
Splintage: cast,traction,collar and cuff sling

11. Post- Reduction Check:N/V status,swelling Compartment syndrome
Control X-ray
Rehabilitation
Discharge patient
Review after 10 days to check pop
Reapply pop
Patient may be reviewed after every 4 weeks from now until
fracture union.

12. Indication for open reduction and internal fixation of fractures
Failure of close reduction (C/R)
Failure to maintain C/R
Intra-articular fractures
Floating knee,elbow,shoulder
Multiple fractures
Pathological fractures
Neck of femur fractures in young patients
Galeazzi fractures
Monteggia fractures
devices:
plate and screws
Intramedullary nails
Kirschner wires

13. Fracture healing Upper limb Children: about 3 to 4 weeks
Adults: about 6 to 8 weeks
Lower limb
Children: about 6to 8 weeks
Adults : about 12 to 16 weeks

14. OPEN FRACTURES Orthopaedic emergency
Definition:a fracture that communicates with an epithelial surface
Principle of treatment :
-Resuscitation –ABC
Dress the wound with a saline dressing
Splint the fracture
Tetanus toxoid
Analgesia
- Opiod
- No NSAIDS
Antibiotics:
First generation
Cephalosporins e.g. kefzol
IV. Augmention
Cloxacillin

15. Triple regime:
Cloxacillin
Flagyl
Gatamycin
for farm yard or train injuries
Investigations
-X-Rays
CT Scan
Admit patient in the ward
Book patient for theatre

16. In theatre General anaesthesial \ regional Wound - Irrigation
- Debridement
Fracture reduction
Maintanance of reduction – exfix
No internal fixation of open fractures
Leave wound open

17. In the ward
Wound inspection in 24 hours, if no sign of sepsis by 72hours –wound closure
External fixator is removed after 6 weeks
A cast is applied for the remainder of treatment
The pin tracts must be cleaned with hibitane in 70% alcohol daily

18. THE END