Principle of Fracture Management

Dr. C. Mpanga

Fracture types
Defn: A break in the continuity of bone. Once broken, does not fulfill its role of support A: whether they are in communication with skin surface i.e Open/ Compound or Closed
Regard all open fractures as being contaminated Give TTV

 B: There appearance on x-ray image

Transverse Oblique Comminuted Spiral

 C: Cause of the fracture

Acute traumatic fractures Stress Fractures Pathological Fractures

 C: Anatomical site:
Intra- articular Metaphyseal Epiphyseal Diaphyseal

NB: Diaphyseal fractures are classified with the bone divided into 3 parts

 Children:
Bones are pliable Hence the cortex does not break but bend Called green stick fractures Have open physeal plate and hence get epiphyseal injury

Describing A Fracture
Name of bone fractured The part of the bone fractured Displacement Angulation Translation Shortened Rotated

Fracture Management
Goal: Restore injured part & individual to normal. Dont forget soft tissues How?
Identify the parts injured Identifying the role we have to play in facilitating their recovery Support the individual in their environment whilst undergo recovery process Identify those who will not fully recover

 4 Rs of fracture management Recognising the fracture Reduction of the fracture Retaining/ Immobilisation of the fracture Rehabilitation

Immobilisation is required until fracture union

Recognising the fracture

History
Fall, hit by car, limb pain, unable/reluctance to use limb

Physical Examination
Swelling over limb acutely, bruising, deformity, tender area, crepitus, reduced range of motion

Investigations
Confirms diagnosis Use of plain x-rays Use of specialised x-ray images for

Reduction
Need for reduction varies from fracture to fracture Undisplaced fractures do not need reduction Intra-articular fractures need anatomical reduction Reduction can be performed as either an open or closed procedure

Reduction and Retention

Displaced fractures are manipulated with some anaesthesia External methods include
Plaster casts Traction External fixation

Internal methods include

Plates Intramedullary nails K-wires

Closed Open

 Intra-articular fractures - to stabilise anatomical reduction Repair of blood vessels and nerves - to protect vascular and nerve repair Multiple injuries (poly trauma and poly fractured
patients)

Indications for internal fixation

Elderly patients - to allow early mobilisation Long bone fractures - tibia, femur and humerus Failure of conservative management Pathological fractures Fractures that require open reduction Unstable fractures

Role of classication systems

Epiphyseal injuries Type I: opening/fracture through physis Type II:# through physis with metaphyseal fragment Type III: through physis and Epiphysis Type IV: metaphyseal and Diaphyseal fragment Type V: Crushing physeal injury

Gustillo-Anderson Classification
Grade I A wound caused by a bone spike from within out, less than 1cm long Grade II A wound between 1-10cm with minimal soft tissue crushing or stripping

Gostillo Anderson Classification

Grade IIIA A high energy injury, with soft tissue crushing or stripping but adequate cover of bone after debridement Grade IIIB A high energy injury, soft tissue crushing or stripping with exposed bone after debridement Grade IIIC Any open fracture with an associated arterial injury, or a farmyard injury with gross bacterial contamination

Complications