Wherever the art of medicine is loved,there is also a love of humanity.

– Hippocrates

Yahyia Khalfan Mohammed Al-Abri

90440

Junior

Definitions

Causes of fractures

fracture classification

Clinical features of fractures

Pain control in fractures

Fractures treatment

Dislocation

Clinical features of dislocations

Outline

What is fracture?

Is a break in the structural continuity of bone.

What is dislocation?

The joint surface is completely displaced and are no longer in contact.

Definitions

Sudden trauma.

Most common

Direct vs indirect

Stress and fatigue fractures.

Most in tibia , fibula , and metatarsal.

Pathological fractures

osteoporosis , osteogenesis imperfecta ,Paget's disease ,bone cyst and metastasis.

Causes of fractures

fracture classification

Displacement

Pattern

Location

Integrity of Skin and Soft Tissue

Closed (simple)

skin/soft tissue over and near fracture is intact

open (compound )

skin/soft tissue over and near fracture is lacerated or abraded, fracture exposed to outside environment

Integrity of Skin and Soft Tissue

Name of bone?

Right or left ?

Where in the bone? Epiphyseal

end of bone, forming part of the adjacent joint

Metaphyseal

the flared portion of the bone at the ends of the shaft

Diaphyseal

the shaft of a long bone (proximal, middle, distal)

Physis

growth plate

Location

Pattern

Complete

Transverse

Oblique

Butterfly

Segmental

Spiral

Comminuted

Avulsion

Compression/impacted

Incomplete

Greenstick

Torus

Stress fracture

Compression Fractures

Orientation/Fracture Pattern

Transverse ObliqueButterfly SegmentalSpiralComminuted/multi-fragmentaryAvulsion Compression/impactedGreen-stick Torus

Questions

Non-displaced

Displaced

Angulated

Rotated

Distracted

Translated

Displacement

Non-displaced : fracture fragments are in anatomic

alignment

Displaced: fracture fragments are not in anatomic alignment

Displacement

Displacement

Angulated: direction of fracture apex, e.g. varus/valgus

Rotated: fracture fragment rotated about long axis of bone

Distracted : fracture fragments are separated by a

gap

Translated percentage of overlapping bone at fracture site

Displacement

Sign andsymptoms

pain and tenderness Swelling or bruising

Deformity Loss of function bone protruding

Numbness and tingling.Crepitus

History

History of injury followed by inability to use the injured limb. Age and mechanism of injury. If fracture occurs with trivial trauma suspect pathological lesion. Pain, swelling and bruising are common symptoms but they do not

distinguish a fracture form soft tissue injury. Deformity more suggestive Symptoms of associated injury( numbness or loss of movement , skin

pallor or cyanosis, blood in the urine, difficulty with breathing or transit lose of consciousness) get distract by the main injury.

Pervious injury or musculoskeletal problems( confusion with the x-ray)

General medical history (preparation for anesthesia or operation)

Clinical features( history)

Clinical features( Examination)

look feel Move

Look:

Swelling, bruising and deformity

skin is intact?

posture of the distal extremity and the color of the skin (for tell-tale signs of nerve or vessel damage).

Feel:

Palpate for tenderness

Test for vascular and peripheral nerve abnormalities

Move:

Crepitus and abnormal movement

Examination

Crepitus and abnormal movement should be tested

for only in unconscious patient. Usually it is more important to ask if the patient can move the joint distal to the injury.

Move

X-Ray is mandatory (rule of two)

Two views

Two joints

Two limbs

Two injuries

Two occasion

Imaging

Pain control in fracturesPharmacological:

systemic analgesia (e.g morphine, NSAIDS)

Nerve block

neuraxial anesthesia (spinal and epidural anesthesia)

Non-pharmacological: Transcutaneous Electrical Nerve Stimulation (TENS)

stabilization of the fracture using traction

The general aim of early fracture management is to

control hemorrhage, provide pain relief, prevent ischemia-reperfusion injury, and remove potential sources of contamination (foreign body and nonviable tissues)

Fracture treatment

Fractures treatment

Reduce

Hold

Exercise

Reduce (Closed reduction )

1-Pull the distal of the limp2-Reposition (reverse the original direction)

3- Alignment is adjust in each plane.

Open reduction

Operative reduction

When to use it??

When closed reduction failed

When there is large articular fragment that needs accurate positioning

Avulsion fracture

When an operation needed for associated injuries Arterial damage

Reduce (open reduction )

The aim is to Splint the fracture, not necessarily

entire limp.

Hold

Sustained traction Cast splintage Functional bracing

Internal fixation external fixation

More correctly restore function not only to the

injured part but also to the patient as whole.

The objective are to

Reduce edema

Preserve joint movement

Restore muscles power

Guide patient to normal activity

Exercise

The aim is to try to prevent them from becoming infected : the four essentials are:

Open fracture

Early definitive wound coverStabilisation of the fracture

DebridementAntibiotic prophylaxis

Common site of dislocations

The most commonly dislocated is the shoulder joint.[13]

Elbow: Posterior dislocation, 90% of all elbow dislocations[14]

Wrist: Lunate and Perilunatedislocation most common[15]

Finger: Interphalangeal (IP) or metacarpophalangeal (MCP) joint dislocations[16]

Hip: Posterior and anterior dislocation of hip

Diagnosis

History:

• pain, swelling, characteristic posturing, and the inability to move

Physical examination:

Shoulder dislocation:

Arm in a characteristic position of external rotation and slight abduction

Fullness anteroinferior to the coracoid process is palpable

Elbow dislocation:

elbow held in flexion

significant amount of soft tissue swelling around the elbow

Finger dislocation:

oedema and ecchymosis (bruising)

Patellar dislocation

swollen knee held in flexion and no obvious lateral prominence

often associated with haemarthrosis (bleeding into joint spaces)

Hip dislocation:

Posterior hip dislocation is with the hip in a position of flexion, internal rotation, and adduction

Anterior hip dislocations, the hip is classically held in external rotation, with mild flexion and abduction.

Imaging

Anteroposterior x-ray view of a shoulder showing an anteroinferior dislocation

Anteroposterior x-ray view of an elbow dislocation

Comprehensive medical reference and review for the

Medical Council of Canada.

Apley's concise system of orthopaedics and fracture

Medscape

radiologymasterclass.co.uk

Pain Management Interventions for Hip Fracture(http://www.ncbi.nlm.nih.gov/books/NBK56661/)

References