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

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

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

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

5. Closed Fractures
Reduce
Hold
Exercise

6. The Fracture Quartet
Speed/Safety Hold/Move

7. 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

8. Manipulation
Pulling
Disengagement
Alignment

9. 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

10. Mechanical Traction

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

12. 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

13. Internal Fixation
Screws
Wires
Plate and screws
Intramedullary nailing

14. Internal Fixation

15. 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

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

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

18. Complications of Fractures
Local complications:
Early
Late

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

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

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

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

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

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

25. Thank you