How to Deal With Fractures.
description
Transcript of How to Deal With Fractures.
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HOW TO DEAL HOW TO DEAL WITH A FRACTUREWITH A FRACTURE
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FRACTURESFRACTURES
SYMPTOMS:SYMPTOMS: History of trauma,History of trauma,
Pain,Pain,
Swelling,Swelling,
Limited movements.Limited movements.
SIGNSSIGNS
SYSTEMIC: SHOCKHYPOVOLAEMIC
NEUROGENIC SPINAL
DISTAL:NEURO-VASCULAR
LOCALLOCAL:: SwellingSwelling,,
EcchymosisEcchymosis , , TendernessTenderness,,
Limited movementsLimited movements DeformityDeformity,,
Length discrepancyLength discrepancy,, Abnormal Abnormal
movementsmovements,, CrepitusCrepitus
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TRAUMA TRAUMA Direct Direct
IndirectIndirect Vehicular accidentsVehicular accidents Fall from heightFall from height Crushing accidentsCrushing accidents Avulsion fracturesAvulsion fractures
Fall on out-stretched Fall on out-stretched armarm
FRACTURE FRACTURE DISLOCATION DISLOCATION FRACTURE-DISLOCATIONFRACTURE-DISLOCATION
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FRACTURESFRACTURESPROBABLE(SUSPICIOUS) PROBABLE(SUSPICIOUS) SIGNS OF FRACTURESIGNS OF FRACTURE
SwellingSwelling
Local painLocal pain
Tenderness Tenderness Ecchymosis, abrasionsEcchymosis, abrasions
Limited joint Limited joint movementmovement
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Sure SignsSure Signs:: Deformity,Deformity, Length discrepancy,Length discrepancy, Abnormal Abnormal movements,movements, CrepitusCrepitus
DINNER FORK
VARUSS-SHAPE
CrepitusCrepitus
Abnormal MAbnormal M
Length discrepancyLength discrepancy,,
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OPEN AND CLOSED OPEN AND CLOSED FRACTURESFRACTURES
- Definition- Precautions
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FRACTURE PLETHORA (BULLAE)
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MULTIPLE INJURIES RISK
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InvestigationsInvestigations
Plain X-rayPlain X-ray
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Transverse ObliqueSpiral
GREENSTICK
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X-RAYSX-RAYS
-Comminuted - Segmental
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Special Types
COLLES FR.
SMITH FRSMITH FR
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SUPRACONDYLAR FRACTURESUPRACONDYLAR FRACTURETwo typesTwo types::
Flexion typeFlexion typeₒExtension typeₒExtension type
Caused by fall onCaused by fall on caused by fall on caused by fall on
tip of elbow(tip of elbow(15%15%))outstretched hand(outstretched hand(85%85%))
EXT
FLEX
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MONTEGGIA FRACTURE-DISLOCATION
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GALEAZZI FRACTURE-DISLOCATION
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Hip FracturesHip FracturesFemoral neck 45%Femoral neck 45% intracapsular, intracapsular, disruption of blood supply to disruption of blood supply to
femoral head, femoral head, high incidence of healing high incidence of healing
complications (nonunion, complications (nonunion, osteonecrosisosteonecrosis))
Intertrochanteric 45%Intertrochanteric 45% extracapsular, extracapsular, no interference with the no interference with the
blood supply of the femoral blood supply of the femoral head, head,
less complicationsless complications MalunionMalunion
SubtrochantericSubtrochanteric extracapsularextracapsular MalunionMalunion Blood lossBlood loss
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DISLOCATIONSDISLOCATIONS
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SHOULDER ANTERIOR
RECURRENCE
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ELBOW POSTERIOR
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HIP POSTERIORSCIATIC N. INJMYOSITIS OSSIFICANS
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PATHOLOGICAL FR.
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Osteogenesis Osteogenesis imperfectaimperfecta
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OTHER INVESTIGATIONSOTHER INVESTIGATIONS
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CT
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CT & 3D-CT
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MRI
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BONE SCAN
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US examinationUS examination
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LAB INVESTIGATIONSLAB INVESTIGATIONS
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METHODS OF METHODS OF TREATMENTTREATMENT
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TREATMENT OF CLOCED FRACTURES
UNDISPLACEDREDUCIBLE CONSERVATIVE TREATMENT
GALLOW,s TRACTION
BALANCED SKIN TRACTIONSKELETAL TRACTION
1-TRACTION
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22..CAST (POP) CAST (POP) FOR SIMPLE NONDISPLACED FRACTURES WITH NO FOR SIMPLE NONDISPLACED FRACTURES WITH NO
SKIN NOR NEUROVASCULAR COMPROMISESKIN NOR NEUROVASCULAR COMPROMISE
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OPEN FRACTURESDEBRIDEMENTEXTERNAL FIXATOR
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EXTERNAL FIXATOR
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percutaneous pinning.percutaneous pinning.
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K-WIRES
ORIFORIF
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METHODS OF INTERNAL FIXATION
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INTER TROCHANTERIC FRACTUREDHS
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Displaced Femoral neck Displaced Femoral neck Fracture esp. in elderly pt.Fracture esp. in elderly pt.
Prosthetic replacementProsthetic replacement
HEMIARTHROPLASTY
TOTAL ARTHROPLASTY
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COMPLICATIONSCOMPLICATIONS
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MalunionMalunion Cross unionCross union
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NonunionNonunion
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ULNAR N PALSY
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Axillary nerve injuryAxillary nerve injury
Deltoid wasting
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VOLKMANN,s ISCHAEMIC CONTRACTURE
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MYOSITIS OSSIFICANSMYOSITIS OSSIFICANS
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Recurrence of dislocationRecurrence of dislocationof the shoulderof the shoulder
This is the most common complication.This is the most common complication. Causes of recurrence:Causes of recurrence:
1- Patient age: High incidence below the age of 1- Patient age: High incidence below the age of 40 years.40 years.
2- 2- Inadequate immobilizationInadequate immobilization: less than 3 : less than 3 weeks.weeks.
3- associated head fractures: (3- associated head fractures: (Hill-Sachs lesionHill-Sachs lesion))
increase the incidence of recurrence.increase the incidence of recurrence.
4- Glenoid labral injury (4- Glenoid labral injury (Bankart lesionBankart lesion))
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INFECTIONSINFECTIONS
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Pathology:Pathology:Affected bone is Affected bone is
destroyed or devitalized with destroyed or devitalized with cavities cavities
containing pus and pieces of dead containing pus and pieces of dead bone (bone (sequestrumsequestrum), ),
surrounded by vascular tissue, surrounded by vascular tissue, and beyond that by areas of and beyond that by areas of
sclerosis.sclerosis.Sequestra act as Sequestra act as
substrates for bacterial substrates for bacterial adhesion causing persistence adhesion causing persistence of the infection until removed of the infection until removed or discharged through draining or discharged through draining sinuses.sinuses.
SinusesSinuses may close may close spontaneously then reopen spontaneously then reopen when tissue tension rises. when tissue tension rises.
Pathological Pathological fracturefracture may develop.may develop.
•New bone formation
Involucrum•Bone necrosis Sequestrum•Cavity,discharging sinus Cloaca
CHRONIC OSTEOMYELITIS
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Imaging :Imaging :X-ray X-ray shows bone shows bone
resorption with resorption with thickening and thickening and sclerosis of the sclerosis of the surrounding bone.surrounding bone.
SequestraSequestra seen seen as unnaturally dense as unnaturally dense fragments in contrast fragments in contrast with the surrounding with the surrounding vascularized bone.vascularized bone.
Sometimes the Sometimes the bone is crudely bone is crudely thickened and thickened and misshapen resembling misshapen resembling a bone a bone tumour,tumour,involucruminvolucrum..
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DeformitieDeformitiess
Genu varum & valgumGenu varum & valgum
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Cubitus varus “Carrying angle”
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Cubitus varus “Carrying angle”
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Cubitus valgum “Carrying angle”
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Coxa vara Neck shaft angle
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