Samantha Fredman
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Week 1 lecture Principles of fractures and dislocations Mechanism of Injury Examples

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Samantha Fredman
Created by Samantha Fredman over 8 years ago
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Principles of fractures and dislocationsStress fracturePathological fractureabnormal bonenormal bonevsmetastatic diseasebenign lesionrepetitive stressphysiological stressForceDirectIndirectbreak at point of impact (POI)break away from POI+ soft tissue damage+/- soft tissue damageMechanism of InjurySpiralShort ObliqueButterflyTransverseCOMPRESSIONTORSIONBENDINGTENSIONrotational force applied to a leverhumerusfemurgreenstickCar accidentComminutione.g. vertebral comminutioncommon when subject tochildren due to thickenss of periosteumHow to describe a fractureopen 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 endsdisplacementtranslationalignmentrotationlengthdescribe with reference to distal fragment(50%, 100%, or complete (off endedangulationtwistdistractionseparationoverlapHEALINGINDIRECTDIRECTIn tubular bone in the absence of rigidfixaiton1. Haemotoma formation2. Inflammation and Cellularproliferation3.Callus4. Consolidation5. Remodellingresponse to movement at thefracture sitestabilisefracture immobilisedexampleFixed with metal plateimpacted cancellous bonefracturefracture healing occurs directly between fragments WITHOUT CALLUSHOW LONG?dependanton age,nutrition,generalhealth,bloodsupply, typeof fracture,fracturestabilityCLINICAL FEATURESLOOKFEELMOVEswellingbruisingdeformityskin intact?bony tendernesscrepituspulsesgratingboneagainstboneassociated injuriestense compartment= compartment syndromemaybe not if patient awake and consciousx-ray might be more appropriateNEUROVASCULAR EXAMall nerves and vessels traversing the compartmentat presentaiton AND after any interventionIMAGINGX-RAYrule of 2'sviews, joints, limbs, injuries, occassionsADVANCED IMAGINGTechnitium Bone Scanmay be "cold" if performed within 48-72 hours of injuryCTcomplex or interarticular fracturesused to define bony anatomyMRIassessment of associate structuresspinal cord, nerve root, ligament injuriessoft tissue anatomy definitionTREATMENTREDUCTIONFRACTURE IMMOBILISATIONREHABpromoted by physiological loading of bone (DONT IMMOBILISE)aim for adequate apposition andnormal alignmentclosedopen+ anasthesiadistal limb pulled in line with bonefragments disengage and arerepositionedalignment adjusted in each planeusemost fractures in childrenfor fractures that are stable after reductioncan be fixatedUnstable fractures can be reduced prior to internal fixationoperative reduction under direct visioncasting/ FIXATIONcontinuous tractioncast splintagefuncitonal bracinginternal fixationexternal fixationtypically childrenwiresplates and screwsintermedullary nailsinternal vs ExternalCOMPLICATIONSEARLYLATEvascular injurynerve injurycompartment syndromefracture blistersinfectiondelayed union/ nonunionmalunionavascular necrosisgrowth disturbancejoint impairmentpain syndromesshoulder- axillaryhumerus- radialhumerus supracondylar- radial ormedianhip- sciaticknee- fibular5 P'spain out ofproportion toinjury and painon passive stretchmost importantInjury factorstreatment factorsPt factors e.g. smoking, NSAIDs, drinkingHypertrophic non-union: florid periosteal new bone formation, wants to heal-biology of healing okay just needs stabilityAtrophic non-union- no signs of healing, needs improved biologyFemoral head, scaphoid, talusDouble click this nodeto edit the textClick and drag this buttonto create a new node