177690513 Student Fracture Ortho

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


3/27

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


4/27

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


8/27

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"


11/27

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


13/27


14/27

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


15/27

SEVERE SOFT-TISSUE INJURY


16/27

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


17/27

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


18/27

TREATING THE FRACTURE I

oes the fracture re7uire reduction;

Is it displaced;

oes it need to be reduced; e


19/27


20/27


21/27

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;


22/27

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 ; ;


24/27

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


25/27

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


26/27

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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177690513 Student Fracture Ortho