Conservative and surgical management of fractures; Principles of fracture classification; Energy of injury

1. PRINCIPLES OF FRACTURE
MANAGEMENT
Dr Saseendar S, MS Ortho, DNB Ortho, MNAMS,
Dip SICOT(Belgium), FISOC(US), FASM (Sing),
Shoulder, Elbow and Knee Arthroscopy Surgeon,
Chettinad Super Speciality Hospital,
Chettinad Health City, Chennai

2. TOPICS COVERED
 Definition
 Mechanism of fractures
 Fracture types
 Complete
 Incomplete
 Types of displacements
 Fracture healing
 Stages
 Treatment of fractures
 Closed fractures
 Open fractures

3. DEFINITION
 An interruption in the continuity of
the bone which may be a
complete break or an incomplete
break.

4. MECHANISMS
 Single traumatic event
 Repitive stress – Stress fractures
 Pathological – Insufficiency fractures

5. HIGH-ENERGY
INJURY

6.  High-energy injury

7. LOW ENERGY INJURY

8. Low-energy injury

9. PATHOLOGIC FRACTURES
 Often need surgery
 diagnostic workup
important
 prognosis dependent
on biology of lesion

10. Polyostotic Fibrous Dysplasia

11. MECHANISMS OF FRACTURES
 Direct – Bending / Crushing
 Indirect

12. MECHANISMS OF FRACTURES - INDIRECT
 Twisting causes a spiral fracture;
 Compression causes a short oblique fracture;
 Bending results in fracture with a triangular
'butter-fly‘ fragment;
 Tension tends to break the bone transversely

16. CLASSIFICATION OF FRACTURES
 Complete/ Incomplete
 Fracture pattern
 Soft-tissue cover
 Displacement
 Comminution

17. COMPLETE/ INCOMPLETE

18. GREENSTICK FRACTURES
 Bending mechanism
 Failure on tension side
 Incomplete fracture,
plastic deformation on
compression side
 May need to complete
fracture to realign

19. BUCKLE OR TORUS FRACTURE
 Compression failure
 Stable
 Usually at
metaphyseal /
diaphyseal junction

21. CLASSIFICATION OF FRACTURES
 Closed fractures
 There is no communication between the external
surface of the body and the fracture

22.  Open fractures
 There is a communication between the fracture and the
skin.
 From inside-out
 From outside-in
 High risk of infection/
neurovascular injury

23. OPEN FRACTURES

24. OPEN FRACTURES

25. DISPLACEMENT
 Angulation
 Translation
 Rotation

26. DISPLACEMENT
UNDISPLACED DISTAL RADIUS FRACTURE

27. MINIMALLY DISPLACED DISTAL RADIUS FRACTURE

28. DISPLACED FEMUR FRACTURE

29. HEALING OF FEATURES
 Stage of haematoma
 Stage of cellular proliferation
 Stage of callus formation
 Stage of consolidation
 State of remodelling

34. PRINCIPLES OF MANAGEMENT
 General condition
 Temporary stabilisation
 Definitive treatment
 Reduce
 Hold
 Exercise

35. TEMPORARY STABILISATION

36. DEFINITIVE TREATMENT
 Closed reduction
 Open reduction
 Immobilisation
 Internal/ External fixation

37. CLOSED REDUCTION

38. HOLD/ MAINTAIN REDUCTION
 Traction
 Slab/ Cast
 Brace

44. MAINTAIN
Fixation
 Internal Fixation
 Screws
 K wires
 Plates and screws
 Nails
 External Fixation

45. TENSION BAND WIRING

46. PLATES AND SCREWS
 Extramedullary internal
fixation

47. INTERLOCKING NAIL
 Intramedullary internal
fixation

48. EXTERNAL FIXATION

50. SKELETAL TRACTION – SKULL TONGS

51. SKELETAL TRACTION
– UPPER TIBIAL PIN TRACTION

52. SKELETAL TRACTION
– UPPER TIBIAL PIN TRACTION

53. SKIN TRACTION
– GALLOWS TRACTION

54. EXTERNAL FIXATOR

55. PLASTER OF PARIS
- ABOVE ELBOW CAST

56. EXTERNAL STABILISATION
– BUDDY STRAPPING

57. BOHLER BRAUN FRAME

59. OPEN FRACTURES
PRINCIPLES
 IV antibiotics,
tetanus prophylaxis
 emergent irrigation &
debridement
 skeletal stabilization
 soft tissue coverage

60. LAWNMOWER INJURIES
 probably most common
cause of open fractures
in children
 most children are a
rider or bystander
(70%)
 high complication rate -
infection, growth
arrest,amputation
 > 50% unsatisfactory
results (Loder)

61. LAWNMOWER INJURIES – OFTEN
RESULT IN AMPUTATIONS

62. PHYSIOTHERAPY DURING
IMMOBILIZATION
 Reduce oedema – to prevent the adhesion formation
 Assist the maintenance of the circulation – active
exercise either by static or isotonic muscle activity
 Maintain muscle function by active or static
contraction
 Maintain joint range where possible
 Maintain as much function as allowed by the particular
injury and the fixation
 Teach the patient how to use special appliances such
as crutches, sticks, frames, and how to care for these
or any other apparatus

63. PHYSIOTHERAPY AFTER THE
REMOVAL OF FIXATION
 To reduce any swelling
 To regain full range of joint movement
 To regain full muscle power
 To re-educate full function

64. THANK YOU

65.  Information contained in this presentation are intended for
academic purpose only for the students of orthopaedic
surgery.
 The guidelines mentioned cannot be used absolutely for
management of patients.
 I am not responsible for any controversies that arise out of
this presentation.
 For clarifications/ suggestions please contact
ssaseendar@yahoo.co.in or call at 91-9500366970.