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FRACTURES

Diagnosis and Treatment

ORTHOPEDIC AND TRAUMATOLOGY
MEDICAL FACULTY of DIPONEGORO UNIVERSITY
2010

MIND MAPPING

DEFINITION
TYPES & CLASSIFICATION

DEFORMITY
FRACTURE HEALING

FRACTURES
DIAGNOSIS

FRACTURE TREATMENT

SPECIFIC FRACTURE

DEFINITION

Break
 trauma in continuity
of bone
( direct – and
indirectits
force )
 stress
structures
 pathologic fractures

MIND MAPPING

DEFINITION
TYPES & CLASSIFICATION

DEFORMITY
FRACTURE HEALING

FRACTURES
DIAGNOSIS

FRACTURE TREATMENT

SPECIFIC FRACTURE

TYPES and CLASSIFICATION 1

TYPES of FRACTURES

•COMPLETE FRACTURE
bone divided into 2 fragments
fractures can be oblique, spiral, impact, or comminuted in
its configuration

•INCOMPLETE FRACTURE
bone incompletely divided, with periosteum still remain
Ex : greenstick fractures

TYPES and CLASSIFICATION 2 .

TYPES and CLASSIFICATION 3 .

TYPES and CLASSIFICATION 4 .

TYPES and CLASSIFICATION 5 Special Classification fractures have some variety. Ethiology  Traumatic fractures caused by sudden force  Pathologic fractures caused by weakness of bone in according to its pathologic condition  Stress fractures caused by long-time force / stress on certain location multiple repetitive strain cycle. result in microcracks of bone . through their specific division 1.

TYPES and CLASSIFICATION 6 Traumatic fractures Pathologic fractures .

TYPES and CLASSIFICATION 7 .

Clinical Classification  Simple fractures  closed fractures  no communication between bone and external surface of body  Compound fractures  ‘open’ fractures  have communication between bone and external surface of body  Complicated fractures  followed by complication. nonunion.g : union. delayed union. e. TYPES and CLASSIFICATION 8 2. bone infection .

TYPES and CLASSIFICATION 9 .

TYPES and CLASSIFICATION 10 3. Radiologic Classification • Localization • Configuration • Bone existence – Diafisial Transversal Fracture Total Fracture – Metafisial Oblik Fracture Crack Fracture – Intra-artikuler Spiral Fracture Buckle / torus Fracture – Fracture w/ dislocation Z Fracture Hair line Fracture Segmental Fracture Greenstick Fracture Wedge Fracture Avulsion Fracture Depresion Fracture Impaction Fracture Burst Fracture Epifiseal Fracture .

post . TYPES and CLASSIFICATION 11 4. ant. varus.Impaction .Apposition . fragmen-to-fragmen connection  Undisplaced  Displaced  displece of bone can be run in 6 ways : .Overriding .Rotation .Angulation : valgus.

TYPES and CLASSIFICATION 12 .

MIND MAPPING DEFINITION TYPES & CLASSIFICATION DEFORMITY FRACTURE HEALING FRACTURES DIAGNOSIS FRACTURE TREATMENT SPECIFIC FRACTURE .

FRACTURE HEALING 1 Fracture healing depends on types of bone and amount of movement Divided into 5 stage : oTissue injury and haematoma oInflammation and cellular proliferation oCallus forming oConsolidation oRemodelling .

FRACTURE HEALING 2 Fracture healing is influenced by many factors : Age  Space between both fragments and soft tissue interposition Localization and Configuration  Presence of infection Early dislocation of fracture  Synnovial fluid Vascular supply in both fragments  Passive and active movement of Reduction and Immobilitation extremity Immobilitation period .

FRACTURE HEALING 3 Fracture healing abnormalities : oMalunion oDelayed union oNonunion .

FRACTURE HEALING 4 Metacarpal shaft malunion with dorsal angulation Note : red circle shows the location of malunion in the same patients .

FRACTURE HEALING 5 .

MIND MAPPING DEFINITION TYPES & CLASSIFICATION DEFORMITY FRACTURE HEALING FRACTURES DIAGNOSIS FRACTURE TREATMENT SPECIFIC FRACTURE .

DIAGNOSIS 1 Clinical Features o History examination Radiograph o General Features Other Imaging o Local Features .

DIAGNOSIS 2 History Anamnesa Age ( pathological fracture ?? ) Symptomps pain sensory loss motor loss pale haematuri abdominal pain unconsciousness  neurovascular status of extremity distal to the fractures .

Neurological exam.g : pathological factors ) Local Features Local Examination Inspection ( Look ) Palpation ( Feel ) Movement exam. . DIAGNOSIS 3 General Features Early Physical Examination Shock / anemia / bleeding ?? injury of organs within body’s cavity predispose factors ( e.

DIAGNOSIS 4 Inspection Compare with normal site Extremity position Face expression (  pain ) Palpation Anemic signs (  bleeding )  local temperature Skin / soft tissue wound  pain Subcutan extravasasion  crepitus ( one bone fragments grants on Deformity of bone fragments the other ) Trauma of other organs  neurovascular status on the distal site  Limb length ( compared w / normal lenght on the other side ) .

 sensoric and motoric examination vascular. and nerves  other neuroligic consideration : neuropraksia aksonotmesis neurotmesis . DIAGNOSIS 5 Movement  allow patient to move at the site of injury  must be done carefully. to avoid Neurologic Examination further injuries of soft tissues.

DIAGNOSIS 6 Clinical Features Radiograph examination Other Imaging .

etc ) . DIAGNOSIS 7 Radiograph examination Define : Principles : o Normal structure of bone and joints Two sides projection - o Confirm of fracture Two joints affected - o Fragments structure and movements Two extremities - o Medical treatments Two times of radiograph imaging - o Fractures types o Pathological conditions of bone o Presence of alienete body ( projectile.

DIAGNOSIS 8 .

the fracture line is oblique and the distal segment is displaced superiorly . in the lateral view. However. DIAGNOSIS 9 Lateral view Radiograph shows fracture line at the junction of the middle and distal one-third diaphysis appears Superior view transverse with no angulation nor displacement.

e. : on vertebral fracture or condylus tibia Radiograph examination  CT-scan  MRI  Radioisotop scanning Other Imaging .g. DIAGNOSIS 6 Clinical Features  Tomograph.

MIND MAPPING DEFINITION TYPES & CLASSIFICATION DEFORMITY FRACTURE HEALING FRACTURES DIAGNOSIS FRACTURE TREATMENT SPECIFIC FRACTURE .

Cardiovascular disease ? .wound closing .‘ ABC ‘ Assesment . Clinical evaluation .immobilize to relief pain 2.neurovascular injuries ? . Allergic ? 3.find other condition : DM ? .patient w/ shock .bone injury ? . FRACTURE TREATMENT 1 Early stage treatment : 1. Resusitation . First Aid .

Based on physioligic fracture healing 5. Realistic and practice treatment 6. Restore normal function 4. Do not worsen the patient’s condition 2. Treatment with spesific aim .FRACTURE TREATMENT 2 BASIC CONSIDERATION 1. Reposition of fragments . Relief pain . Treatment is based on correct diagnosis and prognosis 3. According to individual condition of patient . Support bone union .

FRACTURE TREATMENT 3 BASIC PRINCIPLES Recognition Reduction Retention Rehabilitation .

types of fracture . radiograph exam o Consider : . FRACTURE TREATMENT 4 Recognition o Diagnosis and evaluation o Anamnesis.treatment technique .complication prediction . clinical exam.fracture localization .

FRACTURE TREATMENT 5 Reduction o if necessary o place bone fragments in proper relationship to each other o Alignment and Apposition Retention o immobilize fracture  free of motion Rehabilitation o restore function of invovled part .

FRACTURE TREATMENT 6 CLOSED FRACTURE Tscherne ( 1984 ) classification of closed fracture Level 1 : fracture with shallow abrasion or oedema on skin and subcutaneous tissue Level 2 : higher fracture with contusion of soft tissue and oedema Level 3 : severe injury with obviously soft tissue damage and compartement syndrome threats .

Immobilization . Dressing ( Gips ) . Internal Fixation . FRACTURE TREATMENT 7 1. Reduction . Traction . Excersise . Close reduction . External Fixation 3. Open reduction 2.

FRACTURE TREATMENT 8 Traction Open reduction .

FRACTURE TREATMENT 9 Figure-of-eight splint dressing Long-arm hanging cast .

FRACTURE TREATMENT 10 Figure-of-eight dressing Long-leg plaster .

< 10cm ). or lesser skin lesion with gross contamination Type IIIB : have significant stripping of periosteum. FRACTURE TREATMENT 11 OPEN FRACTURE Gustillo . require soft tissue flap for coverage Type IIIC : have major vascular injury that requires repair .Anderson classification of open fracture Type I : have small opening ( < 1 cm ) in the skin and no signficant muscle necrosis or stripping of bone periosteum Type II : have larger skin disruption ( > 1cm. gross contamination Type IIIA : have extensive lacerations of tissue flaps ( >10cm ). no significant stripping of periosteum.

FRACTURE TREATMENT 12 o Treated with emergency surgery to minimize the risk of infection and non-union o Debridement o Wound closing o Fracture stabilization (  fixation ) o Post-operative care .

. FRACTURE TREATMENT 13 FIGURE 1 Grade IIIC distal tibia injury of 57-year-old involved in high velocity motorcycle accident.

FRACTURE TREATMENT 14 FIGURE 2 Grade IIIB foot injury of 9-year-old run over by an ice cream truck. .

.FRACTURE TREATMENT 15 FIGURE 6 Versajet™ debridement and gravity irrigation.

FRACTURE TREATMENT 16 FIGURE 7 Final appearance after debridement and irrigation. .

bone grafting and open reduction internal fixation. treatment of infection.FRACTURE TREATMENT 17 FIGURE 13 6 month post-operative anteroposterior radiograph after debridement. .

circumferential bands. etc . pen. metal plate.FRACTURE TREATMENT 18 internal fixation material Screw.

couldn’t tolerate a prolonged salvage procedure .The limb is nonviable .the patient has shock and severe multisystem injuries.the patient has severe chronic medical illness ( DM / vascular disease ) . FRACTURE TREATMENT 19 AMPUTATION o Patient with severely injured extremity o early amputation indicated under following circumstances : .

victory will be complete.” -. “When one has a thorough knowledge of both the enemy and oneself. China . victory is assured. When one has a thorough knowledge of both heaven and earth.General Sun Tzu.