Introduction to Fractures Fractures - definitions, healing and management

Definitions n A Fracture is a break in the continuity of a bone n A comminuted fracture is one with more than two fragments n Gross comminution is usually caused by severe violence, union is often delayed or difficult

Types of Fractures(#) n Transverse # n Spiral # n Greenstick # n Crush # n Burst # n Avulsion # n # dislocation / subluxation

Fracture definitions n Open / Compound # – some communication with the outside or an internal organ. – Infection a real possibility n Complicated # – important soft tissue damage present

Fracture definitions n Impacted #’s – occurs when bone fragments are forced together – such #’s are usually stable n Unstable #’s are those that are displaced or have the potential to displace – important in spinal column #’s

Definitions n Reduction – the realigning of fractures usually by manipulation under an anaesthetic - MUA or a local anaesthetic – once reduced fractures need maintaining in the correct position, usually by a plaster of Paris cast - POP – occasionally internal fixation is used - ORIF

Definitions n Displacement – shortening, rotation, sideways shift or tilt. Reduction reverses the position of displacement n Dislocation – loss of joint integrity n Subluxation – partial loss of joint surface integrity

Fracture healing n Bleeding & fracture haematoma forms n Inflammation n 2-3 days. Phagocytosis,, Capillary budding - forms granulation tissue n Osteogenic cells invade lay down osteoid n 3 weeks soft callus – cartilage and osteoid n Callus forms, weeks n Clinical union months n Remodelling, months

Classical signs of a fracture n Pain and tenderness n Deformity n Swelling – haematoma, haemarthrosis n Local temperature increase n Abnormal mobility, occasionally crepitus n Loss of function

Fractures - management n Open #’s, avoid infection risk - osteomyelitis n Reduction if necessary e.g impacted #’s or where alignment is not so important – manipulation – traction – open reduction

Fractures - management n Maintain reduction – Intrinsic stability – External fixation Splintage POP, Cast braces, Platazote etc Traction – Internal fixation Screws, plates, grafts, intramedullary nails, wires & pins – Frame fixators

Fractures - management n How long ? Depends on method of fixation – Long bones 12 weeks – cancellous ends of long bones & in short bones 6-8 weeks – Children (& ? Elderly) 2-3 weeks – For pain relief only 2-3 weeks

Fracture - Complications n At time of injury – Haemorrhage – Damage to important internal structures – Skin loss

Fracture - Later Complications n Local – Tissue necrosis – Infection – Loss of alignment n General – Deep Vein Thrombosis, Pulmonary embolism & Fat embolism. – Pneumonia

Late Complications n Delayed and Non Union n Late wound infection n Joint stiffness and contracture n Sudek’s atrophy – sympathetic malfunction ? n Osteoarthritis