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Understanding Fractures: Types, Classification & Treatment

Learn about fractures, open and pathological fractures, dislocations, and subluxations. Classification and treatment protocols, with emphasis on open and pathological fractures.

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Understanding Fractures: Types, Classification & Treatment

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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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