FRACTURES

Dr Deepaka Weerasekera

Fracture

A complete or incomplete break in the

continuity of bone

Results in shortening, angulation and/or

rotation of bone

Aetiology

Trauma

Stress/Fatigue

Pathological – e.g Bone tumours

Patterns of Fracture

Stages of fracture healing

1. Haematoma

2. Sub-periosteal & endosteal cellular

proliferation

3. Callus formation

4. Consolidation

5. Remodeling

Clinical features Pain

Visible or palpable deformity

Local swelling

Visible bruising (ecchymosis)

Marked local tenderness

Marked impairment of function

Investigations

X-rays

Isotope Scans

CT Scans

Principles of fracture management

Immediate Management

– Initial Resuscitation –ABC

– Control bleeding

– Immobilize the fractured limb (splinting)

– Analgesia

– Tetanus Toxoid

– Appropriate antibiotics (for compound fractures)

Treatment of uncomplicated closed fractures

Reduction

Immobilization (Maintenance of

reduction)

Rehabilitation

Reduction

Closed Reduction

Mechanical traction

Operative reduction

Immobilization

External Splints e.g. Casts, Collar etc.

Continuous traction

External Fixation

Internal Fixation

What is the probable fracture ?

Traction

Skin traction

Bone Traction

Skin Traction

What is the name of the pin used for bone traction ?

Fixation

External

When do you use External fixation ?

Internal

Rehabilitation Is important in order:

to preserve function as far as possible

when the fracture is uniting

to restore function to normal when the

fracture is united

Complications of fractures

Early Complications

Massive haemorrhage and hypovolaemia

Neurovascular damage

Infection

Injuries to viscera

Injuries to soft tissues

Fracture blisters

Compartment Syndrome

Late Complications Delayed union

Non-Union

Mal-Union

Shortening

Fat embolism

Avascular Necrosis

Post-traumatic ossifications

Sudeck’s post-traumatic osteodystrophy

Osteoarthritis

THANK YOU