Principles of Fractures

1. Principles of Fractures Dr. AbdulrahmanAlgarni, MD, SSC (Ortho), ABOS Assist. Professor consultant orthopedic and arthroplasty surgeon

2. Defintions. Mechanisms. Diagnosis. Classification. Fracture healing. Introduction.

3. Introduction • Fractures in children. • Pathological fractures. • Management techniques. • Open fractures. • Complications of injury.

4. Fracture:- Break in the continuity of bone

5. Defintions. Complete Incomplete

6. Defintions. • Closed fracture (simple). • Open fracture (compound). • Complicated fracture.

7. Defintions. • Closed Fracture (simple ):- Does NOT communicate with external environment

8. Defintions. • Open Fracture (compound ):- Communicate with external environment Infection !!

9. Defintions. • Complicated Fracture:- Associated with damage to nerves, vessels or internal organs

10. Defintions. • Dislocation. • Subluxation. • Fracture disloction.

11. Defintions. • Dislocation:- Complete separation of the articular surface. Distal to proximal fragment Anterior, Posterior, Inferior, Superior

12. Defintions. • Subluxation:- Incomplete separation Joint Function in Anatomical position Only

13. Defintions. • Fracture Dislocation:- Association! Always X-Ray Joint Above and Below

14. Defintions. • Pathological Fracture:- Fracture abnormal bone Cyst, Tumour, Infection

15. Defintions. • Pathological fracture.

16. Mechanisms • Amount of Force:- * Trivial force = Pathological * Magnitude = Non-pathological • Direction of Force:- * Direct Force * Indirect Force

17. Mechanisms Indirect Force On Long Bones:- • Twisting Force Spiral Line

18. Mechanisms Indirect Force On Long Bones:- 2) Angulating Force Transverse pattern

19. Mechanisms Indirect Force on Long Bones 3) Angulating + Axial compression Transverse line + Triangular “Butterfly”

20. Mechanisms Indirect Force on Long Bones 4) Angulating + Axial compression + Twisting forces (short oblique pattern)

21. Mechanisms Indirect Force On Long Bones:- 5) Vertical compression comminuted

22. Mechanisms Direction of Force On Cancellous Bones:- Direct OR Indirect Comminuted Pattern Burst

23. Mechanisms Force due to Resisted Muscle Action:- “Avulsion” Transverse pattern

24. Diagnosis I- HISTORY II- EXAMINAION A- General B- Local III- INVESTIGATIONS

25. Diagnosis I- HISTORY • Trauma * Pathological (trivial) * Non-pathological ( magnitude) 2) Mechanism * Fall from height, * RTA, pedestrian, Driver….?

26. Diagnosis I- HISTORY 3) Complaint: a) Pain sharp, increase by movement, Not radiating b) Loss of Function c) Deformity d) Symptoms of complications e) Other organs: head, chest, abdomen

27. Diagnosis II- EXAMINATION A- General examination B- Local examination

28. Diagnosis A- General examination : 1) Signs resulting from fracture or trauma: a) Vital signs, Shock A,B,C b) Associated Head, Chest, Abdomen 2) Signs related to cause of fracture: Pathological # …CA Lung, Prostate..

29. Diagnosis B- Local Examination • LOOK : Skin damage, deformity, swelling • FEEL : Localized tenderness • MOVE : Abnormal movement, crepitus • DO : a) Special tests : Circulation & Nerves b) Measurements : shortening [Always compare]

30. Diagnosis INVESTIGATIONS X-RAY:- A- Essential requirements: 1) Two views AP & Lateral. 2) Two joints Above & below #.

33. Diagnosis INVESTIGATIONS X-RAY:- B- Occasional Requirements * Two Limbs “ Compare “ * Two Occasions “Scaphiod” * Special X-rays Stress, CT..

34. Diagnosis

35. Diagnosis C- Description of X-ray : 1) Situation : side, site, localization 2) Pattern : line of fracture 3) Displacement : a) Shift : lateral,medial,anterior,posterior b) Tilt : angulations c) Twist : rotation , internal, external d) Shortening: overriding, impaction

37. Repair of Fracture A - Primary repair • With Rigid Internal Fixation • No Callus formation • Active Haversian remolding • Long time

38. Repair of Fracture B - Secondary Repair • Without rigid fixation • Commonest type even with I.F. • Stages :

39. Repair of Fracture

40. Time Factor- Perkin’s formula Children Half this time isneeded

41. Fracture in children • Different from those in adults. • Children's bones are more malleable, allowing a plastic type of "bowing" injury.

42. Fracture in children • The periosteum is thicker than in adults and usually remains intact on one side of the fracture which helps to: 1. stabilize any reduction, 2. decreases the amount of displacement, and 3. lower incidence of open fractures in children than in adults.

43. Fracture in children • Healing is more rapid. • Open reduction is rarely indicated. • High remolding rate. • Growth disturbance. • Often missed (poor communication). • X-rays of both limbs for comparison.

44. Fracture in children Physeal Injuries • 30% of the fractures • twice as often in the upper extremities as in the lower extremities. • Salter-Harris classification: based on the radiographic appearance of the fracture

45. Fracture in children

46. Fracture in children Birth Fractures • most commonly in the clavicle, humerus, hip, and femur. • They rarely require surgery but frequently are diagnosed as pseudopalsy, infection, or dislocation.

47. Fracture in children Fractures Caused by Child Abuse • Between birth and 2 years of age. • Multiple fractures in different stages of healing are almost always indicative of child abuse. • Multiple areas of large ecchymoses in different stages of resolution (from black and blue to brown and green) also are pathognomonic of child abuse.

48. Fracture in children • The most common sites of fractures caused by child abuse are the humerus, tibia, and femur • bone scan or a skeletal survey generally is indicated

49. Pathological Fractures • Fracture within an abnormal bone structure due to: 1- congenital diseases (O.I). 2- Infection (osteomyelitis). 3- Fracture through a cyst . 4- Metabolic diseases ( Osteoporosis, Osteomalacia, Pagets disease). 5- Primary bone tumours. 6- Metastatic bone tumours.

50. Pathological Fractures Diagnosis: History: 1- insignificant amount of trauma. 2- constitutional symptoms. 3- history of malignancy.