LECTURE 1 : FRACTURE

A fracture is a broken bone, the same as a crack or a

break.

Open fracture (compound fracture) – bone pokes

through the skin and can be seen, or a
deep wound exposes the bone through the
skin.
• Closed fracture (simple fracture) - bone is broken, but
the skin is intact.

Etiology

Managing Fracture RIP Principles

Reduction

Clinical and Radiological Features

Immobilization

Immobilisation

Preservation of Function (Rehabilitation)

How?
 Active use
 Active Exercise
 Continuous
passive motion
Complications Related To The Fracture Itself
1. Infection
Wound is contaminated by organisms carried from OUTSIDE
the body. Treatment include creating drainage so that pus or
abscess can exit, antibacterial medication and in chronic
cases, operation to remove bone)
2. Delayed Union
Fracture is still mobile in 3 – 4 months and may progress to
non union. Treatment is bone grafting (putting healthy tissue
of bone from other site to the affected bone)
3. Non Union
Fragments are not united for many months (passes delayed
union). Radiographically, formation of callus bridge is not
seen, gap of fracture filled with fibrous tissues. Bone end
becomes dense (tebal) and rounded. Treatment include bone
grafting.
4. Mal Union
Imperfect position of fragments’ union. May unite with either
angulation, rotation, loss of end-to-end apposition, overlap or
consequent shortening. Surgical treatment is done to fix the
alignment.
5. Avascular Necrosis
Death of bone due to insufficient blood supply. Treatment
include revascularizing by drilling the site affected. If not
possible, the avascularized site will be removed, and
reconstruction of joint done using arthroplasty or atherodesis
6. Shortening
Shortening due to mal union, crushed or loss of bone
and disturbance of growth plate in children.
Complications Because of Associated Injury
1. Injury to Blood Vessel
Caused by any agent (eg bullet), causing them to tear across,
contused or occluded by thrombosis. Symptoms include severe
pain and numbness. Effects include traumatic aneurysm,
vascular occlusion, gangrene, ischamic paralysis of nerves or
muscle contracture.
2. Injury to Nerves
 Neurapraxia – slight or mild, causes transient (temporary)
block. Recovery is spontaneous in few weeks.
 Axonotmesis – occurs at axon level, internal structure is
maintained. Peripheral degeneration occurs. Regeneration
takes about 1mm per day / 2-3 cm per month.
 Neurotmesis – occurs at neuron level. Structure is
completely destroyed, sever scarring can be seen. Recovery
can only be possible through surgical procedure.
Sutures (jahitan) of nerves or nerve grafting may be needed
depending on the severity of nerve injury.
3. Injury to Viscera
Injury of the internal organs due to fracture, for example a
fractured rib poking the lungs. Surgical procedures to manage
this injury first before the fracture, especially in life threatening
situations.
4. Injury to Tendons
Caused by agents of fracture. For example, rupture of tendon
extensor pollicis longus, which can be managed via surgical
procedures.
5. Fat Embolism Syndrome
Occlusion of small blood vessels by fat globules
6. Compartment Syndrome
Swelling or bleeding occurs within a compartment. Painful
condition that occurs when pressure within the muscles builds
to dangerous levels. This pressure can decrease blood flow,
which prevents nourishment and oxygen from reaching nerve
and muscle cells.
7. Injury to Joints
 Dislocation – total separation of bone and joints
 Subluxation – partial separation of bone and joins
 Strain