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8/18/2019 177690513 Student Fracture Ortho
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PRINCIPLES OF TREATMENT
OF FRACTURES
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GOALS OF FRACTURE
TREATMENT
Restore the patient to optimal functional state
Prevent fracture and soft-tissue complications
Get the fracture to heal, and in a position whichwill produce optimal functional recovery
Rehabilitate the patient as early as possible
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HOW FRACTURES HEAL
In nature
Regeneration vs repair
Three phases of healing by callus
Rapid process, rehabilitation slow, low risk
With operative intervention reduction ! compression" Primary bone healing
#low process, rehabilitation rapid, high risk
With operative intervention nailing or e$ternal %$ation"
&ealing by callus
Rapid process, rehabilitation rapid, lesser risk
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FACTORS AFFECTING
FRACTURE HEALING
The energy transfer of the in'ury
The tissue response
Two bone ends in opposition or compressed
(icro-movement or no movement
)# scaphoid, talus, femoral and humeral head"
*#
*o infection
The patient
The method of treatment
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HIGH-ENERGY
INJURY
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LOW ENERGY INJURY
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DESCRIBING THE FRACTURE
(echanism of in'ury traumatic, pathological, stress"
+natomical site bone and location in bone"
on%guration isplacement
three planes of angulation
translation
shortening
+rticular involvement.epiphyseal in'uries
fracture involving 'oint
dislocation
ligamentous avulsion
#oft tissue in'ury
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MINIMALLY DISPLACED DISTAL RADIUS FRACTURE
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COMMINUTED
PROXIMAL-
THIRD
FEMORALFRACTURE
WITH
SIGNIFICANT
DISPLACEMENT
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MANAGEMENT OF THE
INJURED PATIENT
/ife saving measures iagnose and treat life threatening in'uries 0mergency orthopaedic involvement
1 /ife saving
1 omplication saving
0mergency orthopaedic management ay 2"
(onitoring of fracture ays to weeks"
Rehabilitation ! treatment of complications weeks tomonths"
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LIFE SAVING MEASURES
+ +irway and cervical spine immobilisation
) )reathing
irculation treatment and diagnosis of cause"
isability head in'ury"
0 0$posure musculo-skeletal in'ury"
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EMERGENCY ORTHOPAEDIC
MANAGEMENT
/ife saving measures
Reducing a pelvic fracture in haemodynamically unstable
patient
+pplying pressure to reduce haemorrhage from open fracture
omplication saving
0arly and complete diagnosis of the e$tent of in'uries
iagnosing and treating soft-tissue in'uries
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DIAGNOSING THE SOFT
TISSUE INJURY
#kin
3pen fractures, degloving in'uries and ischaemic necrosis
(uscles
rush and compartment syndromes
)lood vessels
4asospasm and arterial laceration *erves
*eurapra$ias, a$onotmesis, neurotmesis
/igaments
5oint instability and dislocation
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SEVERE SOFT-TISSUE INJURY
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TREATING THE SOFT TISSUE
INJURY
+ll severe soft tissue in'uries666e7uire urgent
treatment
3pen fractures , 4ascular in'uries, *erve in'uries, ompartment
syndromes, 8racture.dislocations
+fter the treatment of the soft tissue in'ury the fracture
re7uires rigid %$ation
+ severe soft-tissue in'ury will delay fracture healing
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DIAGNOSING THE BONE
INJURY
linical assessment
&istory
o-morbidities
0$posure.systematic e$amination
98irst-aid: reduction
#plintage and analgesia
Radiographs Two planes including 'oints above and below area of in'ury
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TREATING THE FRACTURE I
oes the fracture re7uire reduction;
Is it displaced;
oes it need to be reduced; e
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TREATING THE FRACTURE II
&ow are we going to hold the reduction;
#emi-rigid Plaster"
Rigid Internal %$ation"
What treatment plan will we follow;
When can the patient load the in'ured limb;
When can the patient be allowed to move the 'oints;
&ow long will we have to immobilise the fracture for;
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DIFFERENT TYPES OF RIGID FRACTURE FIXATION
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TREATING THE FRACTURE III
3perative *on-optve
Rehabilitation Rapid#low
Risk of 'oint sti>ness/ow PresentRisk of malunion /ow Present
Risk of non-union Present Present
#peed of healing #low Rapid
Risk of infection Present /ow
ost ; ;
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INDICATIONS FOR OPERATIVE
TREATMENT
General trend toward operative treatment last ?@ yrs
Improved implants and antibiotic prophyla$is, Ase of closed and
minimally invasive methods
urrent absolute indicationsB-
Polytrauma isplaced intra-articular fractures 3pen C=s C=s with vascular in' or compartment syn, Pathological C=s
*on-unions
urrent relative indicationsB- /oss of position with closed method, Poor functional result with non
anatomical reduction, isplaced fractures with poor blood supply,0conomic and medical indications
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WHEN IS THE FRACTURE
HEALED?
linically
Apper limb /ower limb
+dult D-E weeks 2F-2D weeks
hild ?- weeks D-E weeks
Radiologically
)ridging callus formation
Remodelling
)iomechanically
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REHABILITATION
Restoring the patient as close to pre-in'ury
functional level as possible
(ay not be possible withB-
1 #evere fractures or other in'uries
1 8rail, elderly patients
+pproach needs to beB-
Pragmatic with realistic targets
(ultidisciplinary
1 Physiotherapist, 3ccupational therapist, istrict nurse, GP,#ocial worker
COMPLICATIONS OF
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COMPLICATIONS OF
FRACTURES0arly /ate
General 3ther in'uries hest infection
P0 ATI80#.+R# )ed sores
)one Infection *on-union
(alunion
+4*
#oft-tissues Plaster sores.WI Tendon rupture
*.4 in'ury *erve compression
ompartment syn< 4olkmann contracture
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