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INTRODUCTION TO FRACTURES

INTRODUCTION TO FRACTURES. OBJECTIVES. To define fractures and understand various types of classification. To study the salient features of open and pathological fractures. To differentiate between fracture, dislocation and subluxation. DEFINITION. Break in the continuity of bone.

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INTRODUCTION TO FRACTURES

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  1. INTRODUCTION TO FRACTURES

  2. OBJECTIVES • To define fractures and understand various types of classification. • To study the salient features of open and pathological fractures. • To differentiate between fracture, dislocation and subluxation.

  3. DEFINITION Break in the continuity of bone

  4. Basics of Fractures • Deformation of bone is directly proportional to the nature, magnitude and direction of force. • Treatment protocols are based on these deformation patterns. • Deforming forces can be direct or indirect.

  5. CLASSIFICATION

  6. DISPLACED & UNDISPLACED

  7. OPEN & CLOSED FRACTURES

  8. OPEN FRACTURES • Communicates with the external environment • Break in overlying skin and soft tissue • Can be an Open fracture from Within or Without • Greater risk of infection

  9. GUSTILO AND ANDERSON’S CLASSIFICATION OF OPEN FRACTURES • Based on extent of injury and degree of contamination • Type I • Wound < 1 cm • Little/No contamination • Non-complex fracture pattern • Type II • Wound > 1 cm • Moderate contamination • Fracture pattern may be complex or simple

  10. Type III • Extensive soft tissue crushing • Extensive contamination • Subdivided into: • IIIa : Soft tissue coverage by closure • IIIb : Soft tissue reconstruction needed • IIIc : Associated vascular and nerve injury; needs vascular repair

  11. PATHOLOGICAL FRACTURE • Occurs in a bone with weakened structure due to a disease • Break occurs due to trivial trauma or even spontaneously • Causes can be localized or generalized • Commonest Cause ? • Most often affected bone ?

  12. Localized Causes • Inflammatory • Osteomyelitis (pyogenic/tubercular) • Neoplastic • Benign : GCT • Malignant : Osteosarcoma; Ewing’s; Secondaries from Lung, Kidney, Prostate • Miscellaneous • Cysts; Dysplasia; Granulomas

  13. Generalized Causes • Hereditary • Osteogenesis imperfecta • Osteopetrosis • Acquired • Osteoporosis • Rickets/Osteomalacia • Scurvy • Paget’s Disease

  14. Age Wise Distribution of Pathological Fractures • At Birth : Osteogenesis imperfecta • 0-5 years : Osteomyelitis • 5-20 years : Osteomyelitis, Primary bone malignancies • 20-50 years : Malignancy, Osteomalacia • > 50 years : Osteomalacia, Multiple myeloma, Secondaries

  15. DISLOCATION • Injury to a joint • Articular surfaces are wholly separated • Can be traumatic and pathological • Traumatic dislocations - FORA • Features include Pain, Swelling, Deformity, Loss of movement, Limb shortening • Treatment is based on conservative management and operative reduction

  16. SUBLUXATION • Articular surfaces are partly displaced and retain some contact

  17. SUMMARY • Fracture is break in normal continuity of bone • It can be classified in many ways which alters the treatment protocols. Most important are Open fractures and Pathological fractures • Dislocation is COMPLETE separation of 2 articular surfaces • Subluxation is INCOMPLETE separation of 2 articular surfaces

  18. SOURCES • Google Image Search • Essential Orthopaedics by J. Maheshwari • Essentials of Orthopaedics by RM Shenoy THANK YOU

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