Dr. MSM Shiffa

Definitions A fracture is a break in the continuity of a bone

TypesFractures may be transverse, oblique or spiral in shape.

In a greenstick fracture, only one side of the bone is fractured, the other simply bends (usually immature bones).

A comminuted fracture is one in which there are more than two fragments of bone.

In a complicated fracture, some other structure is also damaged (e.g. a nerve or blood vessel).

In a compound fracture, there is a break in the overlying skin (or nearby viscera) with potential contamination of the bone ends.

A pathological fracture is one through a bone weakened by disease, e.g. a metastasis.

Common causes Fractures occur when excessive force is applied to a

normal bone

or moderate force to a diseased bone, e.g. osteoporosis

Clinical features• Pain.

• Loss of function.

• Deformity, tenderness and swelling.

• Discoloration or bruising.

• (Crepitus, not to be elicited!)

Investigations• Radiographs in two planes (look for lucencies and

discontinuity in the cortex of the bone).

• Tomography, CT scan, MRI scan (rarely).

• Ultrasonography and radioisotope bone scanning. (Bone scan is particularly useful when radiographs/CT scanning are negative in clinically suspect fracture.)

ComplicationsEarly

• Blood loss.

• Infection.

• Fat embolism.

• DVT and PE.

• Renal failure.

• Compartment syndrome.

Late

• Non-union.

• Delayed union.

• Malunion.

• Growth arrest.

• Arthritis.

• Post-traumatic sympathetic (reflex) dystrophy.

ESSENTIAL MANAGEMENTGeneral

• Look for shock/haemorrhage and check ABC

• Look for injury in other areas at risk (head and spine, ribs and pneumothorax, femoral and pelvic injury).

The fracture

Immediate

• Relieve pain (opiates i.v., nerve blocks, splints, traction).

• Establish good i.v. access and send blood for group and crossmatch.

• Open (compound) fractures require debridement, antibiotics and tetanus prophylaxis.

Definitive• Reduction (closed or open).

• Immobilization (casting, functional bracing, internal fixation, external fixation, traction).

• Rehabilitation (aim to restore the patient to pre-injury level of function with physiotherapy and occupational therapy).

Kasar

It is a tafarruk-e-itisal of a bone, i.e. discontinuity of the bone

One bone is broken into two or more pieces

Asbab Asbab-e-Sabiqa

Cause in the bone itself

Asbab-e-Waasila

External impact

Asbab-e-Sabiqa Structure and the location of the bone

Dominant side

Long bone

Thin bone

Close to the body surface

Age

2-4 yrs, 5-6 yrs, 55- 80 yrs

Sex

2-5 more in girls, 5-15 Boys, elderly - females

Diseases

Niqras, Sartan, Khanazir, bone diseases

Asbab-e-Waasila External Impact

Direct Fracture

Indirect Fracture

Muscle action

Types Kasar baseet – Simple # K. muraqqab – Compound # K. Mustaqeem – Direct K. munharif – Indirect K. Kamil – Complete K. Naqis – Incomplete K. Juzu’ee – Partial K. Suqubi – Perforated K. Inkhifazi – depressed K. inshiqaqi – fissured/ cracked K. mutauddad – comminuted K. qaleel – small K. azeem - large

Usool-e-Ilaj Splinting

Reduction

Immobilisation

Maintaining Nutrition

Fasad

Mulayyint

Muhallilat

Musakkinat

Ilaj

Ghiza

Galeez and lazjat producing food (thick and viscous)

Goat

Calf leg

Cow’s fat

Egg

Rice

Fresh fish

Galeez sharab

Do not give barid sabziyan, bird’s flesh, baby goat’s mutton in the initial stage

K. qaleel

Light massage

Oil application – R.gul

Zimad

Bandage – not too tight

Safoof-e-as

Kasar Azeem Rabat/ Bandaging

3-4 layers of bandage

1st – on the # site

2nd – distal to proximal

3rd- keep small stick and apply third layer

If it is necessary 4th layer can be applied

Every day bandage can be changed if pain exist or open wound is there otherwise every other day

Apply zimad Mom zard khalis 35 g