FracturesFractures

Objectives

Describe the sequence of fracture healingDifferentiate between open and closed

reduction, cast immobilization, and tractionDescribe neurovascular assessment of

injured extremityExplain common complications associated

with fracture injury and healing

DescriptionDescription

A disruption or break in the continuity of the structure of bone

Traumatic injuries account for the majority of fractures

A disruption or break in the continuity of the structure of bone

Traumatic injuries account for the majority of fractures

DescriptionDescription

Described and classified according to:TypeCommunication or

noncommunication with external environment

Anatomic location

Described and classified according to:TypeCommunication or

noncommunication with external environment

Anatomic location

Classification by Fracture Types

Classification by Fracture Communication

Classification by Fracture Location

DescriptionDescription

Described and classified according to:Appearance, position, and

alignment of the fragmentsClassic namesStable or unstable

Described and classified according to:Appearance, position, and

alignment of the fragmentsClassic namesStable or unstable

DescriptionDescription

Closed (simple)Open (compound)

Closed (simple)Open (compound)

DescriptionDescription

Stable fracturesOccur when a piece of the

periosteum is intact across the fracture

External or internal fixation has rendered the fragments stationary

Stable fracturesOccur when a piece of the

periosteum is intact across the fracture

External or internal fixation has rendered the fragments stationary

DescriptionDescription

Stable fracturesTransverseSpiralGreenstick

Stable fracturesTransverseSpiralGreenstick

DescriptionDescription

Unstable fracturesComminutedOblique

Unstable fracturesComminutedOblique

Clinical ManifestationsClinical Manifestations

Patient history indicates a mechanism of injury associated with: Immediate localized pain Function Inability to bear weight or use affected

part Guarding May not be accompanied by obvious bone

deformity

Patient history indicates a mechanism of injury associated with: Immediate localized pain Function Inability to bear weight or use affected

part Guarding May not be accompanied by obvious bone

deformity

Fracture HealingFracture Healing

Reparative process of self-healing (union) occurs in the following stages:

1. Fracture hematoma

2. Granulation tissue

3. Callus formation

4. Consolidation

5. Ossification

6. Remodeling

Reparative process of self-healing (union) occurs in the following stages:

1. Fracture hematoma

2. Granulation tissue

3. Callus formation

4. Consolidation

5. Ossification

6. Remodeling

Bone Healing

1. Fracture haematoma bleeding & oedema create haematoma which

surrounds the ends of the fragments Occurs within 72 hrs 2. Granulation tissue active phagocytosis absorbs products of local

necrosis Granulation tissue (new blood vessels,

fibroblasts & osteoblasts) produces the basis for new bone substance

Occurs 3-14 days post injury

Bone Healing (cont.)

3. Callus formation As minerals are deposited, an

unorganised network of bone is formed that is woven about the fracture parts

Callus is composed of cartilage, osteoblasts, calcium & phosphorus

Begins to appear by end of 2nd week

Bone Healing (cont.)

4. OssificationOssification (development of bone) of the

callusSufficient to prevent movement at fracture

siteOccurs from 3 weeks to 6 months

Bone Healing (cont.)

5. Consolidation As callus develops, the distance between

bone fragments diminishes & eventually closes

• 6. RemodellingExcess bone tissue is reabsorbed & union

is completed

Bone Healing

Collaborative Care

Overall goals of treatment:• Anatomic realignment of bone fragments

(reduction)• Immobilization to maintain alignment• Restoration of normal function

Fracture Reduction

Closed reduction• Nonsurgical, manual realignmento Open reduction• Correction of bone alignment through a

surgical incision

Fracture Immobilization

Casts• Temporary circumferential immobilization

device• Common treatment following closed

reduction

Fracture Immobilization

External fixation

• Metallic device composed of pins that are inserted into the bone and attached to external rods

Fracture Immobilization

Internal fixation

• Pins, plates, intermedullary rods, and screw

• Surgically inserted at the time of realignment

Traction

Application of a pulling force to an injured part of the body while counter-traction pulls in the opposite direction

Fracture Reduction - Traction

Skin traction (short-term)Skeletal traction (longer periods)

Purpose of Traction

Prevent or reduce muscle spasmImmobilizationReductionTreat a pathologic condition

Neurovascular Assessment

ColourTemperatureCapillary refillPeripheral pulsesOedemaSensationMotor functionPain

Complications of FracturesInfectionComplications of FracturesInfection

Open fractures and soft tissue injuries have incidence

Osteomyelitis can become chronic

Open fractures and soft tissue injuries have incidence

Osteomyelitis can become chronic

Complications of FracturesInfectionComplications of FracturesInfection

Open fractures require aggressive surgical debridement

Post-op IV antibiotics for 3 to 7 days

Open fractures require aggressive surgical debridement

Post-op IV antibiotics for 3 to 7 days

Complications of FracturesCompartment SyndromeComplications of FracturesCompartment Syndrome

Condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space

Condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space

Complications of FracturesCompartment SyndromeComplications of FracturesCompartment Syndrome

Two basic etiologies create compartment syndrome:Decreased compartment size

Restrictive dressingsSplintsCasts

Two basic etiologies create compartment syndrome:Decreased compartment size

Restrictive dressingsSplintsCasts

Complications of FracturesCompartment SyndromeComplications of FracturesCompartment Syndrome

Two basic etiologies create compartment syndrome: Increased compartment content

BleedingOedema

Two basic etiologies create compartment syndrome: Increased compartment content

BleedingOedema

Complications of FracturesCompartment SyndromeComplications of FracturesCompartment Syndrome

Clinical Manifestations Six Ps:

1. Paresthesia

2. Pain

3. Pressure

4. Pallor

5. Paralysis

6. Pulselessness

Clinical Manifestations Six Ps:

1. Paresthesia

2. Pain

3. Pressure

4. Pallor

5. Paralysis

6. Pulselessness

Complications of FracturesVenous ThrombosisComplications of FracturesVenous Thrombosis

Veins of the lower extremities and pelvis are highly susceptible to thrombus formation after fracture, especially hip fracture

Veins of the lower extremities and pelvis are highly susceptible to thrombus formation after fracture, especially hip fracture

Complications of FracturesVenous ThrombosisComplications of FracturesVenous Thrombosis

Precipitating factors:Venous stasis caused by incorrectly

applied casts or tractionLocal pressure on a vein Immobility

Precipitating factors:Venous stasis caused by incorrectly

applied casts or tractionLocal pressure on a vein Immobility

Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)

Characterized by the presence of fat globules in tissues and organs after a traumatic skeletal injury

Characterized by the presence of fat globules in tissues and organs after a traumatic skeletal injury

Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)

Fractures that most often cause FES:Long bonesRibsTibiaPelvis

Fractures that most often cause FES:Long bonesRibsTibiaPelvis

Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)

Tissues most often affected:LungsBrainHeart Kidneys Skin

Tissues most often affected:LungsBrainHeart Kidneys Skin

Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)

Clinical ManifestationsUsually occur 24 to 48 hours after injury Interstitial pneumonitis

Produce symptoms of ARDS

Clinical ManifestationsUsually occur 24 to 48 hours after injury Interstitial pneumonitis

Produce symptoms of ARDS

Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)

Clinical ManifestationsSymptoms of ARDS:

Chest painTachypneaCyanosis PaO2

Clinical ManifestationsSymptoms of ARDS:

Chest painTachypneaCyanosis PaO2

Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)

Clinical ManifestationsSymptoms of ARDS:

DyspneaApprehensionTachycardia

Clinical ManifestationsSymptoms of ARDS:

DyspneaApprehensionTachycardia

Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)

Clinical ManifestationsRapid and acute courseFeeling of impending disasterPatient may become comatose in a

short time

Clinical ManifestationsRapid and acute courseFeeling of impending disasterPatient may become comatose in a

short time