Introduction to fractures and trauma

Principles of fractures Fracture : it is break in the structural continuity of the bone. the bone. It is of two main types : 1- simple fracture ( closed ). 2- compound fracture (open ).i.e. associated with wound connecting it to the external connecting it to the external environment. environment. How fracture happen : 1- single traumatic incident. 2- repetitive stress. 3- abnormal weakening of the bone ( pathological fracture ).

In single traumatic incident the bone sustained sudden and excessive force which may be direct or indirect : In direct force the bone break at the point of impact ; while in indirect force the bone is break at distant from the site of force where it applied. The force which break the bone is of different types : A- twisting force. B- bending force. C-compression force. D- tension force. Each of them influence the shape of the fracture which is either spiral,oblique, transverse, or fracture with butter – fly segment. all this is applied to the long bones. So the fractures either complete or incomplete : Complete could be transverse, oblique, spiral, or comminuted. And incomplete could be green stick or compression fracture.

Types of fracture displacement

Fracture healing : immobilization of the fracture is not mandatory for fracture healing ; the mandatory for fracture healing ; the splinting of the fracture to ensure : splinting of the fracture to ensure : 1- pain relief. 2- union take place in good position. 3- early movement and return to function. Steps of fracture healing : 1- tissue destruction and haematoma formation. 2- acute inflammatory reaction and cellular proliferation. 3- callus formation (step of union). 4- consolidation. 5- remodeling.

Time table : For fracture healing the time change according to age, blood supply, type of the fracture ……etc. Perkin`s time table is very simple table to asses that time : Spiral or oblique fracture in the upper limb unite in 3 weeks. Transverse fracture in the upper limbs unite in 6 weeks. For consolidation multiply by 2. In the lower limbs : Oblique or spiral fracture need 6 weeks for union. Transverse fracture need 12 weeks. For consolidation multiply by 2.

Clinical features of the fracture : A – symptoms : 1- history of trauma followed by inability to use the injured limb ; if the trauma is simple and weak force we suspect limb ; if the trauma is simple and weak force we suspect pathological fracture. pathological fracture. 2- pain. 3- brusing. 4- swelling. 5- deformity. B – signs : 1- swelling. 2- Bruising. 3- deformity. 4- tenderness. 5- crepitus. 6- loss of function.

X – ray : it is mandatory for diagnosis of fractures. Role of twos : 1 – two views. 2 – two joints. 3 – two limbs. 4 – two injuries. e. g. fracture calcaneum.. 5 – two occasions e.g. fracture scaphoid 6 - two tissue. Special imaging: 1- tomography. 2- C.T. 3- MRI. 4- bone scan.

Treatment of closed fracture : A – the general treatment is the first consideration i. e. the air way patency, breathing and circulation. the air way patency, breathing and circulation. B – treatment of the fracture itself : this include : 1- reduction. 2- holding. 3- physiotherapy and rehabilitation. 1- reduction of the fracture : It should be taken in the first 12 hours from the trauma, because the oedema and swelling make the reduction difficult after that time. Two types of reduction : 1- closed reduction ( by manipulation ). 2-open reduction ( by surgical approach ).

Open reduction is indicated in : 1- when close reduction fail. 2- when there is large articular fragment need accurate reduction. reduction. 3- for traction fractures in which the fragments are held apart. apart. Holding of the fractures : by : 1- continuous traction. 2- cast splintage ( plster of paris P.O.P). 3- functional bracing. 4- internal fixation. 5- external fixation.

Traction : types of traction : 1- traction by gravity : this is used only in upper limb.e.g hanging cast. 2- skin traction : it is available in special kit, it is used mainly in the lower limb. mainly in the lower limb. 3- skeletal traction. Skin traction Principle of it's use : 1- applied distal to the fracture site. 2- weight used is 10% of the body wt. and not more than 5 kg, if we need more than 5 kg then we use skeletal traction. then we use skeletal traction. 3- removal of the hair before application. Indication of skin traction : 1- used in fractures of the lower limbs vertebras and pelvis. 2- in dislocations of the lower limbs. 3- for resting of the limb e.g. in arthritis, osteomyelitis, septic arthritis, irritable hip etc……. septic arthritis, irritable hip etc……. 4- in treatment of back ache.

Hanging cast/skin traction/thomas splint

Skin traction kit

skin traction skin traction

Complication of skin traction : 1- allergy to the adhesive material of the plaster lead to ulceration of the skin. ulceration of the skin. 2- compression of the vessels lead to compartment syndrome. syndrome. 3- compression of the nerves lead to neuropraxia. 4- excessive traction (when use over wt.) lead to non union 5- failure of the kit. 3- skeletal traction : Pin is inserted distal to the fracture site usually behind the tibial tuberosity or lower femoral condyles, the wt. used is one six (1/6) of the body wt.. Complication : 1- broken of the pin. 2- pin tract infection. 3- over (excessive ) traction. 3- over (excessive ) traction.

Skeletal traction

Methods of traction : A- fixed traction e.g. Thomas splint. B- balanced traction ( over pulleys ). C- combined traction. D- counter traction. Cast splintage (p.o.p) : Plaster of Paris is calcium sulphate hemihydrates, it is very safe and easily used in holding of the fractures. Principles of using p.o.p : 1- in acute fractures, use the p.o.p in form of slabs to avoid compartments syndrome. compartments syndrome. 2- it should involve the joint below and the joint above of the fracture. 3- never applied directly on the skin (use cotton or any other material). 4- it should never be done too tight or too loose, too heavy or too light.

Balanced traction//counter traction

Counter traction//gallos traction

Plaster of paris