Outline of Fracture

Management & Complication

Presented By:
Dr. Md. Taufiq Ul Islam
Resident
 Fracture
• It is a break in the continuity of bone or
cartilage.

• A fracture is a soft tissue injury with

underlying broken bone
 Causes of Fracture
Fractures may be caused by:
2. A single traumatic event
3. Repetative stress
4. Abnormal weakening of a bone i.e.
pathological fracture.
 Types of Fracture
• Etiologically: Traumatic, Stress or Pathological.
• Depending upon fracture pattern:
a. Simple: Spiral, Oblique or transverse.
b. Wedge: Spiral wedge or bending wedge
c. Multifragmentory.
• Deformity and displacement:
a. Rotation
b. Angulation
c. Displaced or translation (occurs in two planes)
• Associated soft tissue injury:
a. Open or closed
b. Neurovascular status
c. Ligamentous injuries
 Biomechanics of Fracture Healing
• The changes associated with fracture
healing may be considered as three
phases that occur sequentially but may
overlap. These are:
2. Phase of inflammation
3. The development of osteogenic repair
tissue
4. Phase of remodelling.
 Healing of Fracture
1. Fracture & Hematoma
2. Formation of granulation • Reactive phase or phase
tissue of inflammation
3. Replacement of
granulation tissue by
callus • Reparative phase
4. Replacement of callus by
lamellar bone
5. Remodeling of bone to
• Remodeling phase
normal contour
 Factors Affecting Fracture Healing
• Local Factors: • General Factors:
2. Movement between 2. Age of the patient
fracture fragments 3. General health condition
3. Extensive damage 4. Drugs e.g.
4. Surrounding soft tissue Corticosteroids
injury 5. Associated other bone
5. Interruption of blood pathology e.g.
supply Osteoporosis
6. Infection 6. Comorbid conditions.
7. Interposition of soft
tissue in fracture gap
8. Fracture near or
including joint
9. Repeated trauma
Principles of Fracture Treatment
• Need to consider
2. Reduction
3. Rigid Immobilization
4. Rehabilitation
• Necessity for reduction depends on type of
fracture.
• Undisplaced vs. displaced fractures.
• Closed vs. open reduction.
• Immobilization is always needed until the
fracture unites.
• Can be done by external or internal
methods
• External methods include Plaster casts,
Tractions and External Fixation.
• Internal methods include Plates,
Intramedullay Nails, K-wires.
• Indication for internal • Indication for
fixation: external fixation
2. Fracture requiring 2. Open fractures
open reduciton 3. Non-union of
3. Unstable fracture fracture
4. Intra-articular 4. Filling of segmental
fractures limb defects –
5. Pathological fracture trauma, tumor and
osteomyelitis.
6. Multiple injury
patients 5. Limb lengthening
 Advantages
• Internal fixation: • External fixation:
2. Anatomical reduction, 2. Rapid application
absolute stability 3. Can be applied in
3. Allows primary bone acutely injured.
healing 4. Stablizes comminuted
4. Earlier mobilization. fractures that are
5. Early discharge. unstable for ORIF
5. Provides outside # zone
fixation for open
fractures.
 Disadvantages
• Internal fixator: • External fixation:
2. Infection 2. Discomfort for the
3. Anaesthetic risk patient
4. Failure of fixation 3. Pin tract infection
5. Malposition of metal 4. Failure of fixation.
work.
 Management
• Management of fracture depends upon the
condition of the patient and type of
fracture.
 Traumatic Fractures
• Diagnose and treat life threatening injuries
• Emergency orthopaedic involvement
a. Life threatening
i. Traumatic amputation
ii. Major vascular injury
iii. Pelvic fracture disruption
iv. Haemorrhage from open fracture
v. Multiple long bone fracture
vi. Severe crush injury
b. Limb threatening
i. Vascular injury
ii. Major joint dislocation
iii. Crush injury
iv. Open fractures
v. Compartment syndrome
vi. Nerve injury
 Management of Traumatic
Fractures
– Emergency orthopaedic management (Day 1)

– Monitoring of fracture (Days to weeks)

– Rehabilitation + treatment of complications

(weeks to months)
 Compound Fractures
• All open fractures must be assumed to be contaminated
• Object of treatment is to prevent them becoming infected
• First aid treatment is the same as for a closed fracture
• Peripheral neurovascular status should be assessed
• In addition the wound should be covered with a sterile
dressing
• Wound should be photographed so that repeated
uncovering is avoided repeated exposure
• Antibiotic prophylaxis should be given
• Tetanus immunisation status should be evaluated
 Management of Compound
Fractures.
• Open fractures require early
operation
• Ideally this should be performed
within 6 hours of injury
• Aims of surgery are to:
o Clean the wound
o Remove devitalised tissue
o Stabilise the fracture
• Small clean wounds can be sutures
• Large dirty wounds should be
debrided and left open
• Debrided wounds can be closed by
delayed primary suture ar 5 days
 Pathological fracture
Generalised bone disease
• Osteoporosis
• Metabolic bone disease - osteomalacia, hyperparathyroidism
• Paget's disease
• Myelomatosis
Localised benign bone disorder
• Chronic infection
• Solitary bone cyst
• Fibrous cortical defect
• Chondroma
Primary malignant bone tumours
• Osteosarcoma
• Chondrosarcoma
• Ewing's tumour
 Early Complications
• Local • General
2. Neurovascular injury 2. DIC
3. Visceral injury 3. Hypovolaemic shock
4. Haematoma 4. Crush injury
5. Infection 5. Atelectesis
6. Soft tissue swelling 6. SIRS
7. Skin loss 7. Fat embolism.
8. Compartment syndrome
9. Neurovascular injury
 Late Complications
• Local • General
2. Delayed union 2. DVT
3. Malunion 3. PE
4. Non union 4. Disuse atrophy
5. Joint stiffness 5. Psychological impact
6. OA of joint 6. Economic loss
7. Pressure sore
8. Contracture
9. AVN
10. Sudek’s atrophy/RSD/
Complex regional pain
syndrome
11. Myositis ossificans
Thank You