Adult Fracture management

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Youngs modulus

Stress / Strain curve:

Yield point Ultimate strength Break point

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BONE PROPERTIES
Lamellar bone:
cortical or cancellous.

Woven bone. Cortical bone high Young's modulus. Cancellous bone undergoes more remodelling.
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Bone tissue
Wet 70% mineralised matrix, 25% organic matrix and cells and 5% water. 90% of organic matrix is collagen

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Mechanical properties
Tensile property Compressile strength Yield strain is approximately 7000 micro strain. Ultimate strain approximately 15000 micro strains in normal bone.

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FRACTURE DISCRIPTION
Anatomical location - ? Joint Direct / Indirect Fracture configuration Simple or comminuted Open or Closed Pathological Stress fracture Greenstick Fracture
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Fracture management
Resuscitation Emergency procedures - open Diagnosis Stabilization Delayed operative procedures and Rehabilitation.
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Diagnosis

Look, Feel, Move X-rays: Rule of Three

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Treatment ATLS
Reduce Hold Move

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Direct Trauma

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Indirect Trauma

Tension

Rotation Compression

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Angulation

Combination

Classification of fractures

Evidence based medicine Communication Treatment plan

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Fracture Immobilization
Plaster Traction Internal Fixation External Fixation

Intra-articular fractures Alignment Length Rotation Rule of three

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Principles of Internal Interfragmentary compression Fixation

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Interfragmentary compression

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Principles of Internal Fixation

Tension Band Wiring

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Principles of Internal Fixation

Intramedullary fixation
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Principles of Internal Fixation

Hybrid Fixation
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External fixation
Process of manipulating, aligning, and stabilizing bony structures with pins, wires, screws, or other bone fasteners that affix the bone to an external scaffold or frame.

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External fixation

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CID / CIND VISI / DISI ACUTE / CHRONIC

1. PERILUNATE 2. RADIOCARPAL 6/26/2013 3. MIDCARPAL

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Two Types of Recurrent Instability Traumatic Unidirectional Bankart lesion (avulsion of glenohumeral ligaments fromglenoid) Surgery is often necessary

Atraumatic Multidirectional Bilateral Rehabilitation enhances stability Inferior capsular shift should be a part necessary

of repair if surgery is

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PELVIC FRACTURES
LATERAL COMPRESSION ANTEROPOSTERIOR COMPRESSION VERTICAL COMPRESSION COMBINATION

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Young System

PELVIC FRACTURES

Category Distinguishing Characteristics LC Transverse fracture of pubic rami + posterior injury ISacral compression on side of impact IICrescent (iliac wing) fracture on side of impact IIILC-I or LC-II injury on side of impact; contralateral APC injury Symphyseal diastasis or longitudinal rami fractures ISlight widening of pubic symphysis or anterior SI joint; stretched but intact anterior SI, sacrotuberous, and sacrospinous ligaments; intact posterior SI ligaments IIWidened anterior SI joint; disrupted anterior SI, sacrotuberous, and sacrospinous ligaments; intact posterior SI ligaments IIIComplete SI joint disruption with lateral displacement; disrupted anterior SI, sacrotuberous, and sacrospinous ligaments; disrupted posterior SI ligaments Symphyseal diastasis or vertical displacement anteriorly and posteriorly, usually through the SI joint, occasionally through the iliac wing or sacrum Combination of other injury patterns, LC/VS being the most common

APC

VS

CM
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LC

APC

VC

LC/VC

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Acetabular Fracture
PARTIAL ARTICULAR ONE COLUMN FRACTURE PARTIAL ARTICULAR TRANSVERSE FRACTURE COMPLETE ARTICULAR, BOTH COLUMN

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TYPE A PARTIAL ARTICULAR ONE COLUMN FRACTURE A1Posterior wall A2Posterior column A3Anterior wall and/or anterior column TYPE B PARTIAL ARTICULAR TRANSVERSE FRACTURE Portion of the roof attached to intact illium B1Transverse + posterior wall B2T types B3Anterior with posterior hemitransverse TYPE C COMPLETE ARTICULAR, BOTH COLUMN All articular segments, including the roof, are detached from the remaining segment of the intact ilium, the floating acetabulum. C1Both columnanterior column fracture extends to the iliac crest (high variety) C2Both columnanterior column fracture extends to the anterior border of the ilium (low variety) C3Both columnanterior fracture enters the sacroiliac joint
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Hip fracture dislocations

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Thompson and Epstein

Anterior or Posterior Hip Dislocations

Type I : No significant associated fractures Type II: Irreducible dislocation without significant femoral head or acetabular fractures Type III: Unstable hip after reduction or incarcerated fragments of cartilage, labrum, or bone Type IV: Associated acetabular fracture requiring reconstruction Type V: Associated femoral head or neck injury

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Posterior

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Pipkin

Type I: Fracture femoral head caudad to the fovea centralis

Type II: Fracture of the femoral head cephalad to the fovea centralis Type III: Type I and type II with fracture of the femoral neck Type IV: Type I, II, or III with associated fracture of the acetabulum
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