Fractures

 The break down in the continuity

of the Bone mainly occurs when
the bone is subjected to stress
which it can not bear.

 In old age female it is commonly

due to osteoporosis
Sakhawat Baloch (N.I SON Male Jacoba
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 CAUSES
Crushing force.
Accident
Twisting motion.
Extreme muscular contraction.
Osteoporosis etc.

Sakhawat Baloch (N.I SON Male Jacoba

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 Types:
Complete Fracture:
Fracture involves a break occurs the
entire cross section of the bone and is
frequently displaced (remove from
normal position).
Incomplete Fracture:
The break occurs through only part of the
cross section of the bone.
Sakhawat Baloch (N.I SON Male Jacoba
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 CONT….
Open Fracture/Compound Fracture:
Type of fracture in which skin & mucus
membrane wound extends to the
fractured bone. Open fracture is graded
on Grade I= Clean wound less than 1 cm
Grade II= Large wound without extensive
soft tissue damage Grade III= Highly
contaminated wound with damage of soft
tissue.

Sakhawat Baloch (N.I SON Male Jacoba

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 CONT….
Closed Fracture/Simple Fracture:
Fracture does not produce break in skin.
Other Specific Types are:
Green Stick: fracture and in which one side of
bone is broken and other side is bent.
Transverse: Fracture that is straight across
the bone.
Oblique: Fracture that occurs at an angle
across the bone.
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 CONT….
Spiral: Fracture twisting around the shaft
of the bone
Communited: Fracture in which bone is
broken unto several fragments.
Depressed: Bone fragments are driven
inward (e.g. in skull and facial bone)
Epiphyoeal: Fracture through the
epiphyseal.

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 CONT….
Impacted: Fracture in which bone
fragment is driven into an other bone
fragment.
Pathological: Fracture of diseased bone
e.g. osteoporosis, peget’s disease.
Avulsion: Fracture of bone that occurs
due to the pull of the tendon or ligameny.

Sakhawat Baloch (N.I SON Male Jacoba

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 Clinical Features:
Severe pain, which is continuous until
bone is immobilized
False or unnatural motion .
Deformity
Shortening of extremity.
Grating sensation when touched (crepitus).
Localized swelling & edema.
Skin discoloration.
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Principles Of Managing Fracture:
1. Fracture Reduction:
Reduction of fracture (“setting the bone”)
refers to restoration of the fracture fragments
into the anatomic alignment.
In closed reduction bone fragments are
brought into apposition ends by manipulating
and manual traction.
Open reduction requires open surgery,
internal fixation devices in the form of metallic
pins, wires, screw, slates, nails or rods may be
used to hold the bone fragments in the
position.
Sakhawat Baloch (N.I SON Male Jacoba
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2. Fracture Immobilization:
After fracture reduction bone fragments
must be immobilized or held in correct
position. Immobilized bone may be
accomplished by external or internal
fixation. External fixation include cast,
splint, bandage etc.

Sakhawat Baloch (N.I SON Male Jacoba

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3. Maintaining The Function:
Efforts should be taken to maintain the
function.

4. Restoring The Function:

Assessment for neurovascular status.
Involvement of patient in self-care etc

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A. Factors Enhancing Fracture
Healing:
Immobilization of fracture fragments.
Maximum bone fragment contac.
Sufficient blood supply.
Proper nutrition.
Hormones growth hormones, calcitonin
etc.

Sakhawat Baloch (N.I SON Male Jacoba

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 Factors Inhibiting Fracture
Healing:
Extensive local trauma.
Bone loss
Inadequate immobilization.
Space between bone fragment.
Infection.
Local malignancy.
Metabolic bone disease.
Vascular necrosis.
Old age
Corticosteroid
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 Complications Of Fracture
 Shock
 Embolism.
 Compartment syndrome.
 Permanent loss of extremity.
 Infection
 Thromboembolism

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 Contusion:
This is an injury of the soft tissue
produced by the blunt force (e.g. a
kick, fall etc). The resultant rupture of
many vessels lead to bleeding into
soft tissue ( Ecchymosis, bruising).
The local symptoms are pain,
swelling and discoloration. Most of
them are resolve in 1-2 weeks.
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 Strain:
This is muscle pull due to over use, over
stretching or excessive stress. Patient
experience local tenderness upon the
muscle use and isometeric contraction.
Sprain:
It is an injury to ligamentous structured
surrounding the joint caused by twisting
motion. The joint becomes tender and
movement is limited. .

Sakhawat Baloch (N.I SON Male Jacoba

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 Management
Treatment of contusion, sprain & strain consists
of resting and elevation of effected part and
applying cold and using a compression
bandage.
Cold should be applied intermittently for 20-30
minutes during first 24-48 hours.
Cast is necessary if joint is unable to perform
function.
After 48 hours injury heat may be applied to
reduce muscle spasm and promote vasodilation,
absorption & repair.

Sakhawat Baloch (N.I SON Male Jacoba

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 CONT….
Excessive exercise should be avoided,
these may lead to severe tissue damage.
Strain & sprain may take weeks to months
for healing.
Painkiller may be used to reduce pain,
swelling etc.
Antibiotic may be used to prevent from
secondary infection.

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 Joint Dislocation
A dislocation of a joint is a condition in which the
articular surface of the bones forming the joint
are no longer in anatomic contact. The bones
are literally “out of joint”.
Dislocation may be congenital (present at birth),
spontaneous (pathologic) & traumatic.
The signs and symptoms are pain, change in
conteur of joint, change in length of extremity,
loss of normal mobility. X-rays confirm the
diagnose.
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 Management:
The affected joint needs immobilization.
The dislocation is reduced (i.e. displaced
parts are brought in normal position).
The head of dislocated bone is brought on
the cavity of other bone.
The joint is immobilized by splint or cast.
Analgesic to control the pain
Antibiotic to control any infection etc.
Sakhawat Baloch (N.I SON Male Jacoba
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