Fractures Treatment and Complications Dr.Metwally Shaheen ( FRCSI) Ortho. Consultant ( Head 0f Orthopedic Department SGH-J )

How ??? Single traumatic incident. Repetitive stress. Abnormal weakening of the bone ( pathological fracture ).

History Symptoms General signs Local signs : Look Feel Move Clinical features History Symptoms General signs Local signs : Look Feel Move

Radiological examination X. ray : Two views. Two joints. Two limbs. Special imaging. C.T scan. MRI. Isotopic scaning.

Closed Fractures Reduce Hold Exercise

The Fracture Quartet Speed/Safety Hold/Move

Reduction Manipulation Traction Open reduction Aims at adequate apposition and normal alignment More healing is expected with greater surface area in contact at the fracture surface A gap is a cause of nonunion Overlap is permissible except in articular fractures Can be achieved by: Manipulation Traction Open reduction

Manipulation Pulling Disengagement Alignment

Mechanical Traction Used when manipulation is not effective as in cases of powerful muscle pull as in femoral fractures Hold is not perfect Move is applicable Safe Speed is a problem (long bed rest) Classified as: Skin traction Skeletal traction Traction by gravity Balanced traction Fixed traction

Mechanical Traction

Forms of Splintage Cast Splintage Move is a problem Functional Bracing Move is allowed

Open Reduction Indicated in: Failure of closed reduction Soft tissue interposition Large articular fragment Avulsion fracture where fragments are held apart due to muscle pull When operation is needed for associated injury When the fracture will need anyhow internal fixation to hold it

Internal Fixation Screws Wires Plate and screws Intramedullary nailing

Internal Fixation

Open Fractures Gustilo Classification: Type I: Low energy, small clean wound, little soft tissue damage Type II: Moderate eneregy, wound > 1 cm, not much soft tissue damage Type III: High energy, extensive soft tissue damage, wound contamination Type IIIA: No periosteal stripping ( skin coverage not needed) Type IIIB: Periosteal stripping ( need skin coverage ) Type IIIC: Vascular or nerve injury

Open Fractures Principles of treatment: Aggressive wound debridement Antibiotic Prophylaxis Stabilization of fracture Early and definitive wound coverage

Complications of fractures General complications: Shock Adult respiratory distress syndrome. DVT & Pulmonary embolism. Fat embolism Disseminated intravascular coagulopathy Crush syndrome Tetanus Gas Gangrene.

Complications of Fractures Local complications: Early Late

Local Complications of Fractures Early complications - bone Infection …..esp in open fractures.

Local Complications of Fractures Early complications – soft tissues Fracture plisters. Plaster sores. Torn muscle fiberes. Haemoarthrosis. Vascular injury. Compartment syndrome. Nerve injury. Visceral injuries.

Local Complications of Fractures Early complications - joints Haemoathrosis and infection. Ligament injury. Regional pain syndrome(Sudek’s atrophy)

Local Complications of Fractures Late complications - bones Avascular necrosis. Delayed union. Non union. Malunion.

Local Complications of Fractures Late complications – sost tissues Bed sores. Myositis ossificance. Tendenitis and tendon rupture. Nerve compression and entrapment. Volkmmanns contracture.

Local Complications of Fractures Late complications – joints Instability. Stiffness. Stiffness. Regional pain syndrome(Sudek’s atrophy) Osteoarthritis.

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