1. Fractures
By Amal

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

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

4. 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.

5. 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.

6. transverse fracture: as a result of tension force.

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

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

9. 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.

10. 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.

11. Continue the type of comminuted
Segmental fracture
Longitudinal fracture

12. 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.

13. 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

14. 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

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

16. 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

17. 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

18. 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

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

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

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

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

23. Good luck to all of you