PRINCIPLE OF FRACTURE MANAGEMENT DR S SOMBILI 2012

DEFINITION Fracture is an open or close soft tissue injury of varying severity with a break in the continuity of the underlying bone The soft tissue component is important

DIAGNOSIS HYSTORY Minor trauma- Falling - Assault Major trauma- MVA - PVA - Motorcycle accident - Industrial accident - Air tarffic accident

PHYSICAL EXAMINATION Swelling Abrasion Ecchymosis Deformity Wound Tenderness Abnormal movement Crepitus N/V examination

INVESTIGATION X-Ray CT- Scan Anteriorposterior view Lateral view Two sides Joint above and below Before and after reduction CT- Scan For complex fractures

FRACTURE TYPE FRACTURE PATTERNS Transverse Oblique Spiral Impaction Simple Segemental Comminuted

PRINCIPLE OF TREATMENT Think Patient,Limb,Fracture Resucitation:ABC

Splintage- Temporary - Plaster slab Well padded cramers wire Traction

Displaced fractures - Close reduction Splintage:cast,joint above and below,traction. Reduction must be done within 72hrs.

Undisplaced fractures Splintage: cast,traction,collar and cuff sling

Post- Reduction Check:N/V status,swelling Compartment syndrome Control X-ray Rehabilitation Discharge patient Review after 10 days to check pop Reapply pop Patient may be reviewed after every 4 weeks from now until fracture union.

Indication for open reduction and internal fixation of fractures Failure of close reduction (C/R) Failure to maintain C/R Intra-articular fractures Floating knee,elbow,shoulder Multiple fractures Pathological fractures Neck of femur fractures in young patients Galeazzi fractures Monteggia fractures devices: plate and screws Intramedullary nails Kirschner wires

Fracture healing Upper limb Children: about 3 to 4 weeks Adults: about 6 to 8 weeks Lower limb Children: about 6to 8 weeks Adults : about 12 to 16 weeks

OPEN FRACTURES Orthopaedic emergency Definition:a fracture that communicates with an epithelial surface Principle of treatment : -Resuscitation –ABC Dress the wound with a saline dressing Splint the fracture Tetanus toxoid Analgesia - Opiod - No NSAIDS Antibiotics: First generation Cephalosporins e.g. kefzol IV. Augmention Cloxacillin

Triple regime: Cloxacillin Flagyl Gatamycin for farm yard or train injuries Investigations -X-Rays CT Scan Admit patient in the ward Book patient for theatre

In theatre General anaesthesial \ regional Wound - Irrigation - Debridement Fracture reduction Maintanance of reduction – exfix No internal fixation of open fractures Leave wound open

In the ward Wound inspection in 24 hours, if no sign of sepsis by 72hours –wound closure External fixator is removed after 6 weeks A cast is applied for the remainder of treatment The pin tracts must be cleaned with hibitane in 70% alcohol daily

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