1. Anatomical location 2. Direction of fracture line 3. Type of fracture
Transcription
1. Anatomical location 2. Direction of fracture line 3. Type of fracture
1. 2. 3. 4. 5. 6. Anatomical location Direction of fracture line Type of fracture Soft tissue involvement Pathological Fracture Stress fracture Asso.Prof.Viroj Kawinwonggowit Faculty of Medicine Ramathibodi Hospital Mahidol University y y Proximal , middle or distal third of shaft Transverse Fracture y Oblique Fracture y Supracondylar , Intertrochanteric , subtrochanteric y Spiral Fracture y Comminuted Fracture y Segmental y Close Fracture y Open Fracture y Stress fractures are overuse injuries of bone result from repetitive subthreshold loading exceeds the bone's intrinsic ability to repair itself y y y Bone loss y Greenstick Fracture (in children) y Osteoporosis y Impacted Fracture y Bone cancer 1.1 Tapping Fracture : when a large force is applied over a small area , Ex : nightstick fracture 1.3 Penetrating (Gunshot) Fracture 1.2 Crush Fracture : occur when forces act on a large area causing extensive soft tissue damage 2.1 Traction or Tension fracture : common in Patella and Olecranon, mostly occur in transverse line High velocity ( > 2,000 Ft/sec) Low velocity ( < 2,000 Ft/sec) 2.2 Angulation Fracture : Convex side of long bone is under tension stress while Concave side is under compression stress. 2.3 Rotational Fracture : torsion force produces spiral fracture. 2.4 Compression Fracture : result from compression force 1. 2. 3. 4. 5. 6. 7. Pain and tenderness Loss of function Deformity Attitude Abnormal mobility and crepitus Neurovascular injury Radiographic finding 2.5 Fracture due to angulation ,rotation and axial compression : result in oblique fracture 1. 2. 3. 4. 5. 6. Pain Loss of normal contour and relationship of bony point Loss of motion Attitude Radiographic finding Neurovascular injury “Splint” 1. Emergency care 2. Definite treatment 3. Rehabilitation 1. 2. 3. 4. 5. Reduce pain Reduce rate of fat emboli Prevent further neurovascular damage Prevent fracture penetrate through soft tissue that will cause open fracture Easy to transfer y y y broken bone that penetrates the skin. need immediate treatment. Bone healing y Close treatment (Conservative) y Open treatment (Surgery) y y Fracture Reduction Immobilization 1. 2. 3. y Contraindication of Fracture reduction : Non-displaced fracture : Minimal displacement that reduction may injury to major neurovascular structure : Uneducable fracture : comminuted fracture : Unmaintainable fracture : compression fracture of vertebra : Traction fracture : Patella fracture Traction Reverse mechanism of injury Immobilization Plaster cast y Colles’ fracture (supination and dorsal angulation) reduce Æ Pronation and flexion 3-POINT FIXATION -> CURVE CAST PRODUCES A STRAIGHT BONE y CONTINUOUS TRACTION Skeletal traction CONTINUOUS TRACTION Skin traction CONTINUOUS TRACTION y Skull traction Goal of treatment 1. Keep length and alignment of bone 2. Reduce soft tissue trauma 3. Reduce pain and easily to mobilize affected part 4. Open fracture Absolute indication 1 Displaced intraarticular fractures 2 Failure of close method (Unstable fracture) 3 Major avulsion fracture associated with disruption of important musculotendinous unit 4 Displaced pathological fracture 5 Fracture with risk of malunion or nonunion such as femoral neck ,Monteggia fracture 6 Displaced epiphyseal injuries (Salter-Harris type 3 and 4) 7 Nonunion CIRCUMFERENTIAL WIRE FIXATION TENSION BAND WIRING PLATE AND SCREWS INTRAMEDULLARY NAILING DYNAMIC HIP SCREW DYNAMIC CONDYLAR SCREW