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Introduction

Introduction. Orthopaedic Surgery is a Specialty evolved after WW I Heritage of Orthopaedic surgery is TRAUMA. Definitions. Fracture: discontinuity of cortex Union Bone restored in terms of mechanical stability Delayed Union

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Introduction

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  1. Introduction • Orthopaedic Surgery is a Specialty evolved after WW I • Heritage of Orthopaedic surgery is TRAUMA

  2. Definitions • Fracture:discontinuity of cortex • Union • Bone restored in terms of mechanical stability • Delayed Union • Fracture is not consolidated at 3 months, but appears to be moving in that direction • Non Union • No improvement clinically or radiographically over 3 month period • Malunion

  3. How frequent? • The overall fracture incidence is 11 in 1,000 per year. • Trauma is the Leading cause of death in < 45 age group

  4. How does fracture occur ? • “High Energy" • Energy imparted into the bone disrupts the soft tissue envelope as a very destructive process • “Low Energy“ • Less energy imparted into the fracture environment, thus a less destructive process

  5. How does fracture occur ? Direct trauma

  6. How does fracture occur ? Indirect trauma

  7. How does fracture occur ? Muscle violence

  8. Types of fractures Direction of loading • Bending • Axial Loading • Tension • Compression • Torsion Bending Compression Torsion

  9. Types of fractures

  10. Types of fractures

  11. Biology of Bone Healing • Primary bone healing • RequiresAbsolute Stability (rigid internal fixation) and intimate cortical contact • Relies on Haversian remodeling with bridging of small gaps by osteocytes

  12. Biology of Bone Healing • Secondary Bone Healing = CALLUS formation (Relative Stability)

  13. Clinical features 1) Pain

  14. Clinical features 2) Swelling

  15. Clinical features 3) Deformity 4) Inability to use the fractured part

  16. Radiologic Evaluation

  17. Radiologic evaluation Plain X ray • 2 planes : AP & Lateral • 2 joints: above and below • 2 sides: in children • 2 occasions: scaphoid

  18. Radiologic evaluation How to describe? Types of displacement • Angulation • Translation • Rotation • Shortening

  19. Radiologic evaluation • CT scan

  20. Radiologic evaluation • MRI

  21. TREATMENT 1) First aid treatment 2) Definitive treatment

  22. First aid treatment 1) Assess general condition: A- Airway B- Breathing C-Circulation

  23. First aid treatment 2) Splint

  24. Definitive treatment • Reduce: closed vs open • Hold: external vs internal • Move: rehabilitation

  25. Closed Reduction • All displaced fractures should be reduced to minimize soft tissue complications, including those that require ORIF

  26. Closed Reduction • Adequate analgesia and muscle relaxation are critical for success • Correct length, rotation, and angulation • Immobilize joint above and below

  27. Closed Reduction • Reduction maneuver may be specific for fracture location and pattern • Reduction may require reversal of mechanism of injury

  28. 1) Splinting Methods of External Fixation • Non-circumferential – allows for further swelling

  29. 1) Splinting Methods of External Fixation • Types: Ulnar gutter, Volar / Dorsal hand, Thumb spica, Posterior slab (ankle), U splint

  30. 2)Casting Methods of External Fixation • More rigid immobilization • Often a poor choice in the treatment of acute fractures due to swelling and soft tissue complications

  31. 2)Casting Methods of External Fixation • Cast padding • Roll distal to proximal • 50 % overlap (2 layers minimum) • Extra padding at bony prominence

  32. Methods of External Fixation 2)Casting • Stockinette- may require two different diameters to avoid over tight or loose material • Cast padding

  33. Methods of External Fixation 2)Casting • Cast Molding • Mold applied to produce three point fixation • Avoid molding with anything but the heels of the palm to avoid pressure points

  34. Methods of External Fixation 2)Casting • Complications of Casts & Splints • Tight cast  post cast oedema & compartment syndrome • Loss of reduction • Pressure necrosis • Joint stiffness

  35. 3) Traction Methods of External Fixation • Allows constant controlled force for stabilization of bone fractures • It may aid in reduction during operative procedure

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