1 / 32

Displacement

Displacement. Described as: Distal in relation to proximal Un-displaced Shift Sideways Shortening Distraction Angulation In all planes Rotation. Fracture Diagnosis. Clinical features Imaging: Radiology (x-Ray). Clinical Features. History of Trauma Symptoms and signs: Pain Swelling

eliana-mckee
Download Presentation

Displacement

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Displacement • Described as: Distal in relation to proximal • Un-displaced • Shift • Sideways • Shortening • Distraction • Angulation • In all planes • Rotation

  2. Fracture Diagnosis • Clinical features • Imaging: Radiology (x-Ray)

  3. Clinical Features • History of Trauma • Symptoms and signs: • Pain • Swelling • Deformity • Bony tenderness • Abnormal movement • Crepitus • Loss of function

  4. Approach - history • Details of injury • Mechanism, force, bleeding, consciousness, … • Details of facture • Deformity, pain, loss of function, .. • Other medical problems • Anti-tetanus status if open injuries • Careful: • Fractures are not always at the site of impact • Some fractures do not need severe force

  5. Approach – clinical exam • General medical condition • should be evaluated to exclude • shock • brain injury • other problems • Vital signs • should be observed and followed up

  6. Approach – clinical exam • Look: • Adequate exposure • General on patient • Local: • Swelling, deformity, bruises, color, … • Special attention is to be paid to wounds

  7. Approach – clinical exam • Feel: • Tenderness, distal pulses, temperature and crepitus on movement • Sensory and motor deficits • Pulse distal to injury • Compartment syndrome • Move: • With care • make sure not to cause more pain or injury • Crepitus &abnormal movement indicates a fracture • Joints distal to the affected area

  8. Approach – clinical exam • Examination of the viscera • Liver and spleen in rib fractures • Urinary bladder and urethra in pelvic fractures • Neurological examination in head and spinal injury

  9. Investigations - Imaging • X-rays: • Low of 2s • Two views: AP and Lateral • Two joints: Above and Below • Two sides: Right and Left • Two occasions • Two Doctors ! • Special views: • Obliques, Tunnel view, skyline, functional flexion / extension • Arthrography: • Shows intra-articular structures • Functional in hip

  10. Imaging • Plain x-ray:(law of twos) • Two views:AP and Lateral AP Lat AP Lat Apley’s System of Orthopedics & Fractures

  11. Imaging • Plain x-ray:(law of twos) • Two views: AP and Lateral • Two joints: joint above and joint below Apley’s System of Orthopedics & Fractures

  12. Imaging • Plain x-ray:(law of twos) • Two views: AP and Lateral • Two joints: joint above and joint below • Two limbs: for comparison • more in children to compare epiphysis Apley’s System of Orthopedics & Fractures

  13. Imaging • Plain x-ray:(law of twos) • Two views: AP and Lateral • Two joints: joint above and joint below • Two limbs: for comparison • more in children to compare epiphysis • Two occasions • e.g. stress fractures • e.g. scaphoid fracture Apley’s System of Orthopedics & Fractures

  14. Imaging • Plain x-ray:(law of twos) • Two views: AP and Lateral • Two joints: joint above and joint below • Two limbs: for comparison • more in children to compare epiphysis • Two occasions • e.g. stress fractures • e.g. scaphoid fracture • Two injuries • e.g. patellar fracture and hip injury • e.g. calcaneal fractures & spine injuries www.jumpintheair.com

  15. Imaging • Plain x-ray:(law of twos) • Two views: AP and Lateral • Two joints: joint above and joint below • Two limbs: for comparison • more in children to compare epiphysis • Two occasions • e.g. stress fractures • e.g. scaphoid fracture • Two injuries • e.g. calcaneal fractures & spine injuries • .....and two Doctors! www.123rf.com/

  16. Imaging • Plain x-ray: (law of twos) • Special views: • Calcaneal view • Shoulder dislocation: axial view • Scaphoid views • Acetabular fractures: 45o tilt views http://osuemed.wordpress.com/

  17. Imaging • CT Scan: • In complex and ntra-articular fractures • In spine • In pelvic and acetabular fractures • In calcaneal fractures www.learningradiology.com

  18. Imaging • MRI • Show associated injuries in spinal fractures • Associated soft tissue injuries – e.g. knee • Hidden fractures: • Subtrochanteric (ST) disruption • Stress (fatigue) fractures • Scaphoid fracture • Suspected avascular necrosis www.highperformancesports.blogspot.com www.bjj.boneandjoint.org.uk

  19. Fracture healing • A broken bone heels because …..it is broken ! Alan Apley

  20. Natural bone healing • Movement at the fracture site initiates a healing process—callus formation • Vascular and cellular response leads to tissue differentiation and mineralization resulting in restoration of mechanical integrity

  21. Natural bone healing http://classes.midlandstech.edu/

  22. Cascade of tissue differentiation Following a Fracture: • Hematoma • Granulation tissue • Connectivetissue • Fibrocartilage • Mineral deposition • Bone

  23. bony bridging Fracture healing • Inflammation • Hematoma • Mesenchymal cells • Soft callus • Granualation tissue • Hard callus • Intramembranous bone formation • Enchondral ossification • Remodeling

  24. Cellular and Vascular Reaction cells haematoma granulation tissue

  25. Tissue Differentiation connective tissue granulation tissue Giemsa

  26. Tissue Differentiation Cascade Masson-Goldner Cartilage formation Mineral deposition Bone

  27. Healing time & strength

  28. Fracture Healing • Conditions necessary for bone healing: • Good blood supply • Controlled motion • No infection

  29. Fracture Healing • Unfavorable factors • Impairment of blood supply • Infection • Excessive movement • Presence of tumor • Interposition of soft tissue • Any form of Nicotine (smoking) • Bad nutrition

  30. Average healing time • Children: • Upper limb: 3-4 weeks • Lower limb: 2X upper limb (6-8 weeks) • Adults: • Upper limb: 2X children (6-8 weeks) • Lower limb: 2X upper limb (12-16 weeks)

  31. Fracture Treatment • Aim of fracture treatment • aid healing, • in normal position, • avoiding complications

  32. Fracture treatment • Treat the patient, not only the fracture • Reduce the fracture • Immobilize the fracture • Prevents displacement • Alleviates pain • Promotes soft tissue healing • Mobilize the patient • Avoid complications

More Related