1. Anatomical location 2. Direction of fracture line 3. Type of fracture

1. Anatomical location 2. Direction of fracture line 3. Type of fracture

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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
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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
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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
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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
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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