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Indian Pre-Basic Course:Indian Pre-Basic Course:

PRINCIPLES OF FRACTURE PRINCIPLES OF FRACTURE TREATMENTTREATMENT((CONCEPTSCONCEPTS) )

PROF.M.Sudhakar ShettyPROF.M.Sudhakar Shetty M.S(Orth) D.Orth., F.I.C.S.,M.S(Orth) D.Orth., F.I.C.S.,

M.Ch Orth(Liverpool) M.Ch Orth(Liverpool)

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INTRODUCTIONINTRODUCTION

AO STUDY GROUP 1950 ‘S.AO STUDY GROUP 1950 ‘S. Maurice E. Müller, Hans Maurice E. Müller, Hans

Willenegger, Martin Willenegger, Martin Allgöwer,, Robert Schneider Allgöwer,, Robert Schneider and Walter Bandi.and Walter Bandi.

Arbeitsgemeinschaft fur Arbeitsgemeinschaft fur OsteosynthesefragenOsteosynthesefragen

KNOW THE REASON FOR FAILURE KNOW THE REASON FOR FAILURE AND METHODS TO PREVENT IT .AND METHODS TO PREVENT IT .

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Ideal management of Ideal management of fracturefracture

The revolution continues - The revolution continues - methods are evolving, methods are evolving, principles remains the same.principles remains the same.

Proper understanding of the Proper understanding of the personalities of the fracture personalities of the fracture and the injury is the and the injury is the prerequisite.prerequisite.

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FRACTURE DISEASE.FRACTURE DISEASE.

PAIN AND LACK OF PAIN AND LACK OF PHYSIOLOGICAL PHYSIOLOGICAL CHALLENGE TO BONE & CHALLENGE TO BONE & MUSCLE COMPLEX.MUSCLE COMPLEX.

EDEMA.EDEMA. SOFT TISSUE ATROPHYSOFT TISSUE ATROPHY OSTEOPOROSIS.OSTEOPOROSIS.

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FRACUTRFRACUTRE E DISEASEDISEASE..

DISABILITYDISABILITY

MALUNION MALUNION OR NONUNIONOR NONUNION>>

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LIFE IS MOVEMENT , LIFE IS MOVEMENT , MOVEMENT IS LIFE.MOVEMENT IS LIFE.

GUIDING PRINCIPLE GUIDING PRINCIPLE

FOR ALL FRACTURE CAREFOR ALL FRACTURE CARE....

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TO ACHIVE FREEDOM FROM TO ACHIVE FREEDOM FROM PAIN.PAIN.

STABLE INTERNAL FIXATION STABLE INTERNAL FIXATION DURING BONE HEALING ANDDURING BONE HEALING ANDADEQUATE SOFT TISSUE CAREADEQUATE SOFT TISSUE CARE

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EARLY PAIN FREE EARLY PAIN FREE MOBILIZATIONMOBILIZATION

INCREASE BLOOD SUPPLYINCREASE BLOOD SUPPLY

ARTICULAR NUTRITION.ARTICULAR NUTRITION.

PREVENT OSTEOPOROSISPREVENT OSTEOPOROSIS

PREVENTS FRACTURE PREVENTS FRACTURE DISEASEDISEASE

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Modes of Fracture Modes of Fracture HealingHealing

Based on mechanical environment, Based on mechanical environment, 2 ways of bone healing2 ways of bone healing

Indirect Indirect (secondary) (secondary)

bone bone healinghealing

DirectDirect (primary) (primary) bone healingbone healing

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ABSOLUTE STABILITY

Complete absence of displacement between bony fragments

Direct bone healingDirect bone healing

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DIRECT BONE HEALINGDIRECT BONE HEALING

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INDIRECT BONE HEALINGINDIRECT BONE HEALING

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FOUR FOUNDING FOUR FOUNDING PRINCIPLESPRINCIPLES1.1. Anatomical Anatomical

reduction.reduction.

2.2. Stable internal Stable internal fixation.fixation.

3.3. Preservation of the Preservation of the blood supply.blood supply.

4.4. Early active pain free Early active pain free mobilizationmobilization..

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For affective application of the concepts For affective application of the concepts clear understanding that clear understanding that

Articular and diaphysis fractures have very Articular and diaphysis fractures have very different biological requirements.different biological requirements.

Type and timing of surgical intervention Type and timing of surgical intervention must be guided by injury to soft tissue must be guided by injury to soft tissue envelope.envelope.

Physiological demand of the patient.Physiological demand of the patient.

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ANATOMICAL ANATOMICAL REDUCTIONREDUCTION JOINT FRACTURESJOINT FRACTURES

– Articular cartilage does not Articular cartilage does not remodel . Incongruity becomes remodel . Incongruity becomes permanent and can lead to post permanent and can lead to post traumatic arthritis.traumatic arthritis.

– Perfect anatomical restoration and Perfect anatomical restoration and freedom of joint motion can only be freedom of joint motion can only be obtained by internal fixation –obtained by internal fixation –

Sir John CharnleySir John Charnley

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ARTICULAR FRACTUREARTICULAR FRACTURE

ANATOMICAL REDUCTION AND STABLE INTERNAL FIXATION ANATOMICAL REDUCTION AND STABLE INTERNAL FIXATION - AO- AO

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ANATOMICAL REDUCTIONANATOMICAL REDUCTION

LENGTH,ROTATION, AXIAL ALIGNMENT.LENGTH,ROTATION, AXIAL ALIGNMENT.

CORTICAL CIRCUMFRENCE CORTICAL CIRCUMFRENCE RECONSTRUCTED TO ACHIVE MECHANICAL RECONSTRUCTED TO ACHIVE MECHANICAL STRENGTH. STRENGTH.

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ANATOMICAL ANATOMICAL REDUCTIONREDUCTION

LENGTH,LENGTH,

ROTATION,ROTATION, AXIAL AXIAL ALIGNMENALIGNMENTT

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STABLE INTERNAL STABLE INTERNAL FIXATIONFIXATION ADEQUATE STABILITY ADEQUATE STABILITY

TO MAINTAIN LENGTH, TO MAINTAIN LENGTH, ROTATION.ROTATION.

ABSOLUTE STABILITY ABSOLUTE STABILITY ‘LAG SCREW, PLATING” ‘LAG SCREW, PLATING” DIRECT HEALING.DIRECT HEALING.

CALLUS FREE HEALING CALLUS FREE HEALING IS NOT THE MAIN AIMIS NOT THE MAIN AIM..

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STABLE INTERNAL STABLE INTERNAL FIXATIONFIXATION

MECHNICAL ERA(ABSOULTE STABILITY AND (ABSOULTE STABILITY AND

PRIMARY BONE HEALING )PRIMARY BONE HEALING )

BIOLOGICAL ERABIOLOGICAL ERA (RELATIVE STABILITY AND INDIRECT (RELATIVE STABILITY AND INDIRECT

BONE HEALING)BONE HEALING)

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ATRAUMATIC SURGICAL ATRAUMATIC SURGICAL TECHNIQUE TECHNIQUE

INDIRECT INDIRECT REDUCTION.REDUCTION.

MINIMAL MINIMAL EXPOSURE.EXPOSURE.

PERCUTANEOUS PERCUTANEOUS SCREW SCREW FIXATIONFIXATION

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ATRAUMATIC SURGICAL ATRAUMATIC SURGICAL TECHNIQUE (INTERNAL TECHNIQUE (INTERNAL

FIXATOR)FIXATOR)

REDUCE CONTACT REDUCE CONTACT BETWEEN THE BETWEEN THE “PLATE BODY”“PLATE BODY”

CONTACT TO CONTACT TO ISOLATED POINTS.ISOLATED POINTS.

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MINIMALLY INVASIVE PLATE MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO)OSTEOSYNTHESIS (MIPO)

MIMICK ALL ADVANTAGES OF MIMICK ALL ADVANTAGES OF NAILNAIL

1.1. MINIMAL EXPOSURE.MINIMAL EXPOSURE.

2.2. CLOSED SURGICAL TECHNIQUE.CLOSED SURGICAL TECHNIQUE.

3.3. INDIRECT REDUCTION.INDIRECT REDUCTION.

4.4. SPLINTING OF FRACTURESPLINTING OF FRACTURE

5.5. RAPID CALLUS FORMATIONRAPID CALLUS FORMATION

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ATRAUMATIC SURGICAL ATRAUMATIC SURGICAL TECHNIQUE(INTERNAL TECHNIQUE(INTERNAL

FIXATOR)FIXATOR)

SUBMUSCULAR SUBMUSCULAR APPROACH--LISSAPPROACH--LISS

COMBINATION COMBINATION PLATE HOLE-LCPPLATE HOLE-LCP

EARLY PAIN FREE MOBILIZATIONEARLY PAIN FREE MOBILIZATION

““functional functional afterafter

treatment.”treatment.”

Early mobilization prevents :FRACTURE DISEASE, pressure sores,

pulmonary problems and blood clots

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INDICATION FOR INDICATION FOR INTERNAL FIXATIONINTERNAL FIXATION

LONG LASTING IMMOBILISATION LONG LASTING IMMOBILISATION OF SOFT TISSUE.OF SOFT TISSUE.

LOAD BEARING ARTICULAR LOAD BEARING ARTICULAR SURFACES.SURFACES.

EXACT AND EXACT AND STABLERECONSTRUCITON STABLERECONSTRUCITON ( FOREARM# , SUPRACONDYLAR FEMUR#).( FOREARM# , SUPRACONDYLAR FEMUR#).

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Summary “3 Surgeons with 4

Principles”

1.1. Anatomical reduction.Anatomical reduction.

2.2. Stable internal fixation.Stable internal fixation.

3.3. Preservation of the blood supply.Preservation of the blood supply.

4.4. Early active pain free mobilizationEarly active pain free mobilization..

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THANKS FOR THANKS FOR LISTENINGLISTENING

ANY QUESTIONS?........ANY QUESTIONS?........