INTRODUCTION TO FRACTURES

OBJECTIVES To define fractures and understand various types of classification. To study the salient features of open and pathological fractures. To differentiate between fracture, dislocation and subluxation.

Break in the continuity of bone DEFINITION Break in the continuity of bone

Basics of Fractures Deformation of bone is directly proportional to the nature, magnitude and direction of force. Treatment protocols are based on these deformation patterns. Deforming forces can be direct or indirect.

CLASSIFICATION Etiology Traumatic Pathological

Displacement Undisplaced Displaced

DISPLACED & UNDISPLACED

Relationship with external environment Open Closed

OPEN & CLOSED FRACTURES

Nature of fracture line / Basic Pattern Transverse Oblique Spiral Comminuted Segmented

OPEN FRACTURES Communicates with the external environment Break in overlying skin and soft tissue Can be an Open fracture from Within or Without Greater risk of infection

GUSTILO AND ANDERSON’S CLASSIFICATION OF OPEN FRACTURES Based on extent of injury and degree of contamination Type I Wound < 1 cm Little/No contamination Non-complex fracture pattern Type II Wound > 1 cm Moderate contamination Fracture pattern may be complex or simple

Type III Extensive soft tissue crushing Extensive contamination Subdivided into: IIIa : Soft tissue coverage by closure IIIb : Soft tissue reconstruction needed IIIc : Associated vascular and nerve injury; needs vascular repair

PATHOLOGICAL FRACTURE Occurs in a bone with weakened structure due to a disease Break occurs due to trivial trauma or even spontaneously Causes can be localized or generalized Commonest Cause ? Most often affected bone ?

Localized Causes Inflammatory Neoplastic Miscellaneous Osteomyelitis (pyogenic/tubercular) Neoplastic Benign : GCT Malignant : Osteosarcoma; Ewing’s; Secondaries from Lung, Kidney, Prostate Miscellaneous Cysts; Dysplasia; Granulomas

Hereditary Acquired Generalized Causes Osteogenesis imperfecta Osteopetrosis Acquired Osteoporosis Rickets/Osteomalacia Scurvy Paget’s Disease

Age Wise Distribution of Pathological Fractures At Birth : Osteogenesis imperfecta 0-5 years : Osteomyelitis 5-20 years : Osteomyelitis, Primary bone malignancies 20-50 years : Malignancy, Osteomalacia > 50 years : Osteomalacia, Multiple myeloma, Secondaries

DISLOCATION Injury to a joint Articular surfaces are wholly separated Can be traumatic and pathological Traumatic dislocations - FORA Features include Pain, Swelling, Deformity, Loss of movement, Limb shortening Treatment is based on conservative management and operative reduction

SUBLUXATION Articular surfaces are partly displaced and retain some contact

SUMMARY Fracture is break in normal continuity of bone It can be classified in many ways which alters the treatment protocols. Most important are Open fractures and Pathological fractures Dislocation is COMPLETE separation of 2 articular surfaces Subluxation is INCOMPLETE separation of 2 articular surfaces

THANK YOU SOURCES Google Image Search Essential Orthopaedics by J. Maheshwari Essentials of Orthopaedics by RM Shenoy THANK YOU