Introduction to Fractures Nan-Ying Yu 2005 12 12 Definition

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Introduction to Fractures

• Nan-Ying Yu
• 2005 12 12

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Definition

• An interruption in the continuity of the bone
  which may be a complete break or an incomplete
  break or an incomplete break (crack).

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Classification

• There are two main types of fracture and various
  subdivisions which are named according to the
  position of the fractured parts of the bone

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Closed fracture

• This type indicates that there is no
  communication between the external surface of the
  body and the fracture.

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Open fracture

• There is a communication between the fracture and
  the skin. This could occur because the
  displacement of the bone ends has caused one or
  both to pierce the skin, or because an external
  force has pierced the skin, soft tissues, and
  fractured the bone. This type of fracture is an
  additional cause for concern because of the
  possibility of infection.

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Types of fracture

• Simple fracture
• Spiral fracture
• Transverse fracture
• Oblique fracture
• Comminuted fracture
• Greenstick fracture

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Causes

• Trauma
• Might be a direct blow
• indirect violence such as falling on a hand or
  foot
• caused by repeated minor trauma (stress or
  fatigue fractures)
• Pathological fractures
• Occur as a result of disease such as
  carcinoma, osteogenesis imperfecta, Pagers
  disease and infection.

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Clinical features
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Immediately after fracture

• Shock
• Pain
• Deformity
• Oedema
• Marked local tenderness
• Muscle spasm
• Abnormal movement and crepitus
• Loss of function

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Following reduction and fixation

• Pain
• Oedema
• Loss of functions

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After removal of the fixation

• Pain
• Oedema
• Limitation of joint movement
• Weak muscles
• Loss of functions

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Healing of features

• Stage of haematoma
• Stage of sub-periosteal and endosteal cellular
  proliferation
• Stage of callus formation
• Stage of consolidation
• State of remodelling

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Healing of cancellous bone

• Union of fractures
• It depends on the following factors
• Type of bone
• Classification of fracture
• Blood supply
• Fixation
• Age
• Delay union This indicates that healing is
  taking longer than would normally be expected.

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Complications

• Infection
• Avascular necrosis
• Mal-union (deformity of shortening)
• Joint disruption
• Adhesion
• Injury to large vessels
• Injury to muscle
• Injury to nerves
• Sudecks atrophy
• Injury to viscera
• Contracture

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Principles of management

• First aid
• The patient should not be moved
• Possible further fractures should be prevented

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Principles of management

• Principles of treatment by surgeon
• In the case of severe injury, there may be other
  problems that take priority over treatment of the
  fracture shock, bleeding, maintenance of airway
  and ventilation, and possibly other injury.
• The surgeon will aim to obtain good reduction and
  alignment of the fracture, followed by
  immobilization that is sufficient to promote good
  healing and restoration of function.

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Principles of management

• Reduction
• Closed reduction
• Reduction by traction
• Open reduction
• Immobilization
• External splinting
• Internal fixation

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Physiotherapy during immobilization

• Reduce oedema to prevent the adhesion formation
• Assist the maintenance of the circulation
  active exercise either by static or isotonic
  muscle activity
• Maintain muscle function by active or static
  contraction
• Maintain joint range where possible
• Maintain as much function as allowed by the
  particular injury and the fixation
• Teach the patient how to use special appliances
  such as crutches, sticks, frames, and how to care
  for these or any other apparatus

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Physiotherapy after the removal of fixation

• To reduce any swelling
• To regain full range of joint movement
• To regain full muscle power
• To re-educate full function

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