Fractures And Dislocations And Non-operative Management Of Them Flashcards
Fractures
A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body.
A complete or partial break in a bone.
Causes of bone fractures include •Physical trauma,
•overuse and
•diseases that weaken bones.
•Infections
•Fall from a height
•Direct kick or blow to the body
•Accidents
Assignment
Read on the non operative management of clavicle fractures
And when do we do non operative management and operative management
Non operative management of clavicle fracture
Self-mobilisation of the elbow out of the sling is required several times a day to avoid stiffening of the elbow. The range of motion of the shoulder should usually be limited to pendulum excercises for the first 1-2 weeks followed by active movements up to the horizontal plane within the first 6 weeks.
Among other options, a simple sling or a figure-of-eight brace is commonly used. There is no clear evidence regarding the best technique and the duration of immobilization [16]. A figure-of-eight brace is often thought to prevent or reduce secondary fracture shortening during the time of fracture healing.
Surgical management of clavicle fracture
After cleaning the affected area, your surgeon will make an incision through the skin and muscle near your clavicle. Your surgeon will bring the pieces of your clavicle back into alignment (reduction). Next, your surgeon will secure the pieces of clavicle to each other (fixation).
Most patients have full range of motion and can return to activities with no limitations. Some fractures can take six to nine months to heal. If the fracture does not heal, surgery may be necessary. Some fractures of the clavicle that do not heal completely are not painful and may not need surgery.
Pathophysiology of Bone healing
Pathophysiology of Bone healing
The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed, forming a fracture hematoma. The blood coagulates to form a blood clot situated between the broken fragments.Within a few days, blood vessels grow into the jelly-like matrix of the blood clot.
The new blood vessels bring phagocytes to the area, which gradually removes the non-viable material. The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibres. In this way, the blood clot is replaced by a matrix of collagen.
Collagen’s rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied. At this stage, some of the fibroblasts begin to lay down bone matrix in the form of collagen monomers. These monomers spontaneously assemble to form the bone matrix, for which bone crystals (calcium hydroxyapatite) are deposited in amongst, in the form of insoluble crystals.
This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone callus on average is sufficiently mineralized to show up on X-ray within 6 weeks in adults and less in children.
This initial “woven” bone does not have the strong mechanical properties of mature bone. By a process of remodelling, the woven bone is replaced by mature “lamellar” bone. The whole process may take up to 18 months, but in adults, the strength of the healing bone is usually 80% of normal by 3 months after the injury.
Factors that hinder bone healing process
Factors that hinder bone healing process
•Inadequate Nutrition (including calcium intake)
•Vigorous exercise
•Smoking (especially tobacco)
•Weight-bearing stress on bone.
•Some medications may also hinder bond healing
Symptoms
Symptoms
•Pain at the site of fracture
•Inability to use fractured site
•Swelling
•Trouble using or moving the injured area
•Inability to bear weight on the fractured part ( especially lowdr limb).
Classification
Classification
1.Based on mechanism of Injury
•Traumatic fracture – a fracture due to sustained trauma. e.g., fractures caused by a fall, road traffic accident, fight, etc.
•Pathologic fracture – a fracture through a bone that has been made weak by some underlying disease is called pathological fracture. e.g., a fracture through a bone weakened by metastasis.
•Sheering Force
•Compressional force
•Twisting (rotational injury)
- Based on soft tissue involvement
•Closed fracture: This is a fracture where the fracture site or fracture hematoma is not communicating with the external environment
•Opened fracture: This is a fracture where the fracture site or fracture hematoma is communicating with the external environment through laceration of ghe skin. - Based on fracture patterns
•Linear fracture – a fracture that is parallel to the bone’s long axis
•Transverse fracture – a fracture that is at a right angle to the bone’s long axis
•Oblique fracture – a fracture that is diagonal to a bone’s long axis (more than 30°)
•Spiral fracture – a fracture where at least one part of the bone has been twisted.
•Butterfly fracture
•Impacted fracture - Based on Fragments
•A simple fracture is a bone that is broken in two pieces.
•A complex fracture is broken into more than two pieces. - Fracture based on Angulation.
Whether fracture is angulated or not .
Angulated fractures: The two ends of the broken bone are at an angle to each other. - Based on Disllacement
Displacement of fractures is defined in terms of the abnormal position of the distal fracture fragment in relation to the proximal bone - Based on anatomical site
An anatomical classification may begin with specifying the involved body part, such as the head or arm, followed by more specific localization.
NB: Anytime you are examining a fracture always examine the neurovascular status of the limb.
Fractures pattern
View in note app
Investigations
Investigations
•X-rays: An X-ray will confirm any fractures, and show how damaged your bones are.
•Magnetic Resonance Imaging (MRI): Your provider might use an MRI to get a complete picture of the damage to your bones and the area around them. An MRI will show tissue like cartilage and ligaments around your bones too.
•CT scan: A CT scan will give your provider or surgeon a more detailed picture of your bones and the surrounding tissue than an X-ray.
Management
Management
•Treatment of bone fractures are broadly classified under open and closed treatment. Open treatment refers to any treatment in which the fracture site is opened surgically, regardless of whether the fracture is an open or closed fracture.
Principles of management of Closed Fractures
•Resuscitation (ATLS protocol) Advance Trauma Life Support. Atls is divided into Primary, Secondary and Tertiary survey.
•Reduction of fracture ( Pain medication)
•Maintenance Reduction (splints such as POP or wooden board)
•Definitive Repair
•Rehabilitation (Physiotherapy)
G
Classification of open fractures
•Wound-severity classification
•Gustilo and Anderson. (JBJS 1976)
•This work largely addressed lower leg injuries, but has some value in other anatomical sites.
•The Gustilo – Anderson classification divides soft-tissue wounding of open fractures into three grades – I, II & III.
Gustilo and Anderson classifications
Note app
Principles of management open fracture
•In addition to the 5Rs (seen in management of closed fracture) you do the following;
•Copious irrigation.
•Debridement of dead necrotic tissue.
•Anti-tetanus Prophylaxis.
•Antibiotics (especially for gram positive)
•Fixation (External fixators)
Complications
Complications
•Immediate complications
1.Pain
2.Blood loss
3.Blood vessel damage
4.Shock
•Early complications
1.Infection
2.Plaster sores
3.Fracture blister
4.Haemoarthrosis
•Late complications
1.Delayed union.
2.Malunion
3.Refractures
4.Non-union
5.DVT
6.Limb-Length Discrepancies
