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Samantha Fredman
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Week 1 lecture Principles of fractures and dislocations Mechanism of Injury Examples
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Samantha Fredman
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5336941
mind_map
2018-04-06T16:38:38Z
Principles of fractures and dislocations
Stress fracture
Pathological fracture
abnormal bone
normal bone
vs
metastatic disease
benign lesion
repetitive stress
physiological stress
Force
Direct
Indirect
break at point of impact (POI)
break away from POI
+ soft tissue damage
+/- soft tissue damage
Mechanism of Injury
Spiral
Short Oblique
Butterfly
Transverse
COMPRESSION
TORSION
BENDING
TENSION
rotational force applied to a lever
humerus
femur
greenstick
Car accident
Comminution
e.g. vertebral comminution
common when subject to
children due to thickenss of periosteum
How to describe a fracture
open or closed?
bone(s)?
location?
simple or comminuted?
complete or incomplete?
involvement of joint?
displaced or non displaced?
traumatic, stress or pathological?
open- antibiotics + cleaning of bone ends
displacement
translation
alignment
rotation
length
describe with reference to distal fragment
(50%, 100%, or complete (off ended
angulation
twist
distraction
separation
overlap
HEALING
INDIRECT
DIRECT
In tubular bone in the absence of rigid
fixaiton
1. Haemotoma formation
2. Inflammation and Cellular
proliferation
3.Callus
4. Consolidation
5. Remodelling
response to movement at the
fracture site
stabilise
fracture immobilised
example
Fixed with metal plate
impacted cancellous bone
fracture
fracture healing occurs directly between fragments WITHOUT CALLUS
HOW LONG?
dependant
on age,
nutrition,
general
health,
blood
supply, type
of fracture,
fracture
stability
CLINICAL FEATURES
LOOK
FEEL
MOVE
swelling
bruising
deformity
skin intact?
bony tenderness
crepitus
pulses
grating
bone
against
bone
associated injuries
tense compartment= compartment syndrome
maybe not if patient awake and conscious
x-ray might be more appropriate
NEUROVASCULAR EXAM
all nerves and vessels traversing the compartment
at presentaiton AND after any intervention
IMAGING
X-RAY
rule of 2's
views, joints, limbs, injuries, occassions
ADVANCED IMAGING
Technitium Bone Scan
may be "cold" if performed within 48-72 hours of injury
CT
complex or interarticular fractures
used to define bony anatomy
MRI
assessment of associate structures
spinal cord, nerve root, ligament injuries
soft tissue anatomy definition
TREATMENT
REDUCTION
FRACTURE IMMOBILISATION
REHAB
promoted by physiological loading of bone (DONT IMMOBILISE)
aim for adequate apposition and
normal alignment
closed
open
+ anasthesia
distal limb pulled in line with bone
fragments disengage and are
repositioned
alignment adjusted in each plane
use
most fractures in children
for fractures that are stable after reduction
can be fixated
Unstable fractures can be reduced prior to internal fixation
operative reduction under direct vision
casting/ FIXATION
continuous traction
cast splintage
funcitonal bracing
internal fixation
external fixation
typically children
wires
plates and screws
intermedullary nails
internal vs External
COMPLICATIONS
EARLY
LATE
vascular injury
nerve injury
compartment syndrome
fracture blisters
infection
delayed union/ nonunion
malunion
avascular necrosis
growth disturbance
joint impairment
pain syndromes
shoulder- axillary
humerus- radial
humerus supracondylar- radial or
median
hip- sciatic
knee- fibular
5 P's
pain out of
proportion to
injury and pain
on passive stretch
most important
Injury factors
treatment factors
Pt factors e.g. smoking, NSAIDs, drinking
Hypertrophic non-union: florid periosteal new bone formation, wants to heal-
biology of healing okay just needs stability
Atrophic non-union- no signs of healing, needs improved biology
Femoral head, scaphoid, talus
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5336941
mind_map
2018-04-06T16:38:38Z
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