1. INTRODUCTION TO FRACTURES

2. 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.

3. Break in the continuity of bone
DEFINITION
Break in the continuity of bone

4. 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.

5. CLASSIFICATION
Etiology
Traumatic
Pathological

6. Displacement
Undisplaced
Displaced

7. DISPLACED & UNDISPLACED

8. Relationship with external environment
Open
Closed

9. OPEN & CLOSED FRACTURES

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

12. 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

13. 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

14. 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

16. 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 ?

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

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

19. 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

20. 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

22. SUBLUXATION
Articular surfaces are partly displaced and retain some contact

23. 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

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