Fractures

Diagnosis
&
Management
Diagnosis

• Clinical picture plus investigations

• Fracture is a clinical diagnosis and should
not be missed
• X-rays are mainly for confirmation of
diagnosis and for radiological classification
Complaints

• History of trauma: mechanism of injury

• Acute Severe pain: increases even with
slight movement
• Loss of function
• Swelling
• Deformity and abnormal movement –
witnesses
Signs

• Deformity
• Abnormal movement
• Tenderness
• Swelling
• Presence of wound
• Crepitus
Investigations

• Radiology
• X-rays: easy quick and confirm diagnosis
• Plain X-ray: Rule of 2, 2 views, 2 sides, 2
joints and 2 occasions
• Immobilize before x-ray
• Radiological pattern – line of #: transverse,
oblique, spiral, comminuted, greenstick
• Displacement is the movement of fractured
fragments relative to each other
• Degree of displacement – shift, tilt, twist
• Shift is movement in the horizontal plane –
lateral, antero/posterior
• Tilt is angulation
• Twist is rotation
• MRI and Ct scan can diagnose early hair-
line fractures in small bones and when plain
radiology fails
• Bone scan can show increased uptake
• Other investigations to prepare the patient
for management – assess general condition
Management

• Emergency measures: analgesia, splintage

• Management of multiple injured patient –
ATLS
• Treatment of open fractures
• Fracture management
• Three principles
• Reduction
• Immobilization
• Rehabilitation
• Perfect anatomical reduction is not the aim
but best functional outcome
Reduction

• Requires anaesthesia to achieve muscle

relaxation and pain relief
• To return the fractured fragments together
• May be closed or open(internal fixation is
then used)
• Radiology may be used to aid procedure
Immobilization

• To maintain the fractured fragments in

position till union occurs
• External splintage: casts and braces
• Internal fixation: screws, wires, nails and
plates
• Traction: skin or skeletal
• External fixation
• Plaster should be removed when there is
clinical and radiological evidence of union
• Traction and external fixation are stopped
when other means can be used
• Internal fixation may or may not be
removed
Rehabilitation
• To return patient back to maximal physical
and psychological activity
• Physical therapy – begins as soon as
possible even in hospital
• Increased as and when patient’s injuries
allow
• Return patient back as useful member of
society
Complications

• Early – either due to the injury or injury of

associated structures
• shock – hypovolaemic or neurogenic
injury to nerve or vessel
haemarthrosis
• Some are fracture specific
• Intermediate – few days to early weeks
• compartment syndrome
• infection, gas gangrene tetanus
• fracture blisters
• pressure sores
• Late – weeks to months
• union problems – delayed, non, mal
• joint stiffness and instability
• muscle weakness, muscle contractures
• myositis ossificans
• nerve compression
• avascular necrosis
• Complications related to modality of
treatment
• Surgery: infection, sepsis
• Traction: problems related to recumbency
• Plaster: plaster disease
• death