Introduction to Fractures

Contents
• Definitions
• Mechanisms
• Classifications
• Fracture description
• Management – conservative or surgical
• Fracture healing
• Complications
• Non-union and delayed union
• Bone grafts
What is a fracture?
• Discontinuation in the bone cortex
• A broken bone

Normal Fractured
Classifications
• Why we use classifications?
• Ease of communication
• Occasionally helps in treatment
• Research uses
Classifications
• Every fracture has a unique classification system
• Unified classification system, e.g. AO classification
Example:
Garden classification for femoral
neck fractures

Type 1 Type 2

Type 3 Type 4
AO
Classification
 Name of injured bone
Integrity of skin

Fracture Skeletal maturity

description Location
Fracture pattern
Alignment
Integrity of skin

Closed fracture Open fracture

Integrity of skin
• Closed fracture
• Skin\soft tissues intact
• Open fracture
• Fracture exposed to the outside environment
Skeletal maturity
• Pediatric
• Adult
• ? Geriatric
Why pediatric fractures are unique?
• Thicker periosteum
• Presence of growth plate
• Anatomic reduction is not necessary
• Time to heal is shorter
• Think of child abuse
Location
• Epiphyseal
• Metaphyseal
• Diaphyseal
• Physeal (growth plate)
• Articular
Fracture patterns (descriptive
classification)
• Transverse
• Oblique
• Comminuted
• Spiral
• Segmental
• Impacted
• Avulsed
Exercises
Alignment
• Displaced
• Non-displaced
• Angulated
Fracture healing
Management
• Reduction (if needed)
• Maintain reduction
• Rehabilitation
General scheme for fracture management
• Follow trauma protocols
• Immobilize the limb
• X-Ray the injured bone
• Determine the fracture pattern
• Plan treatment accordingly
• Reduce if needed (closed)
• X-Ray after reduction
• Immobilize and follow
• Rehabilitate early
How to maintain the reduction after closed
reduction (CR)?
• Splints
• Cast
• External fixators (Ex. Fix.) [for specific indications]
What if closed reduction failed?
• May need re-reduction
• Other options?
• Open reduction
• aka needs Surgery
How to maintain reduction after open
reduction (OR)?
• Internal fixation = ORIF
• The first surgery we learned is ORIF
• Options
• Intramedullary device, e.g. IM rod, wires
• Extramedullary devices, e.g. plates and screws
• Sometimes can be treated by external fixator
Summary of fracture treatment
• Immobilization
• Closed reduction and immobilization (stabilization\fixation)
• Open reduction and external or internal fixation
Complications
Non-union and delayed union
• Non-union when fracture never heals
• Causes are diverse
• Types
• Treatment
• Treatment is to optimize local and systemic factors
• Almost always needs surgery

• Delayed union when the fracture passes the typical time of healing of
such fracture
Bone grafts
• Adjuncts used to stimulate bone healing
• Variety of types
• Autografts
• Allograft
• Synthetic