Fractures and Dislocations

Muhammed Yesuf, MD

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Outline
• General considerations of fractures
• General considerations of dislocations
• Common Upper limb fractures and dislocations
• Common Lower limb fractures and dislocations

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General Considerations Of
Fractures

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Introduction
• A fracture is a break in the structural continuity of bone.
Mechanism of injury
• Direct force
• Indirect force

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Clinical Features
Trauma evaluation
History • Skin pallor or cyanosis
• Age • Blood in the urine, abdominal
• Mechanism of injury pain
• Pain, bruising, swelling, • Difficulty with breathing
deformity • Transient loss of consciousness.
• Associated injuries • Previous injury
• Numbness or loss of movement • Medical conditions

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• AMPLE History
• Allergy
• Medications
• Previous medical history or illness/pregnancy
• Last Meal
• Events/environment related to injury:

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Examination
• Look
• Swelling, bruising, deformity, skin breach, posture of the distal extremity and
colour of the skin
• Feel
• Tenderness, temperature, tenseness of compartments, neurovascular
evaluation
• Move
• Crepitus, abnormal movement
• Joint movement

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Imaging
X-ray CT
• Rule of two MRI
• Two views Bone scan
• Two joints
• Two limbs Ultrasound
• Two injuries Arthrography
• Two occasions Arthroscopy
Angiography

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Classification
Etiologic
• Traumatic
• Stress
• Pathologic

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Soft tissue
• Open vs closed

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Physeal fracture Classification
• Salter-Harris

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Descriptive
• Site
• Pattern
• Displacement
• Stable/unstable

Gunshot injuries
• High velocity
• Low velocity
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Eponyms
• Proximal humerus ……….. Neer classification
• Olecranon ……………………. Schatzker, Mayo classification
• Distal radius………………….. Frykman, Fernandez classification
• Pelvis ……………………………. Tiles, Young and burgess classification
• Acetabulum ………………….. Judet and Letournel classification
• Femur neck ……………………Garden classification
• Tibial plateau …………………Schatzker Classification
• Ankle fracture ………………..Weber, Lauge-Hansen classification
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AO/OTA

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Healing
Primary The process of fracture repair varies
• Contact healing according to the type of bone involved and
the amount of movement at the fracture site.
• Gap healing

Secondary
• Hematoma
• Inflammation
• Soft callus
• Hard callus
• Remodeling
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Treatment
• General trauma assessment - ATLS
• Wound inspection, irrigation, saline soaked dressing
• Antibiotics
• Tetanus immunization
• Analgesics
• Splinting

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Principles of definitive management
• Reduction
• Immobilization/hold
• Rehabilitation/exercise

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Reduction
• Closed
• Open
• Failed closed reduction
• Articular fracture
• Open fracture / neurovascular injury
• Traction (avulsion) fracture

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Immobilization
• Continuous traction
• Cast / splintage
• Functional bracing
• External fixation
• Internal fixation

• Arthroplasty
• Arthrodesis
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Continuous traction
• Traction by gravity – upper limb injuries
• Skin traction – no more than 4–5 kg
• Skeletal traction

• Fixed traction
• Balanced traction
• Combination

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Cast splintage
• Swelling
• Joint above and below – control rotation
• Moulding - Bent casts make straight bones
• Three point pressure
• Wedging
• Cast disease

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Functional bracing
• Prevents joint stiffness while permitting
fracture splintage and loading.
• Segments of a cast are applied over the
shafts of the bones, leaving the joints
free

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External fixation
• Open fracture
• Periarticular fracture
• Multiple injury, poly trauma
• Pelvic fracture hemorrhage
• limb lengthening
• Infected fractures
• Bone loss
• Dislocated joint

• Safe corridors

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Internal fixation
• Screw
• Plate and screw
• IM rod, nail
• Wires

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Rehabilitation/Exercise
• Prevent edema –elevate and exercise; never dangle, never force
• Joint movement
• Muscle power

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Complications
General
• Bleeding
• Shock
• Fat embolism, ARDS
• Venous thromboembolism
• Sepsis

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Local
Early
• Visceral injury • Infection
• Vascular injury • Gas gangrene
• Nerve injury • Fracture blisters
• Compartment syndrome • Plaster and pressure sores
• Hemarthrosis

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Late
• Delayed union, Non-union, • Osteoarthritis
Malunion • Heterotopic ossification
• Avascular necrosis • Ligament injury
• Growth disturbance • Tendon lesions
• Bed sores • Nerve compression
• Muscle contracture • Joint stiffness
• Joint instability • Complex regional pain syndrome

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General Considerations Of
Dislocations

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Introduction
• A dislocation is a complete disruption of a joint so that the articular
surfaces are no longer in contact.
• Subluxations are minor disruptions of joints where a portion of the
articular surface is still in contact

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Classification
• Congenital
• Acquired Description
• Pathological • The part which loses contact with the
• Traumatic rest of the body is considered as
• Acute minor segment. The position of the
• Old minor segment gives the name for
• Recurrent the dislocation.
• Fracture dislocation

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Pathoanatomy
• Dislocation occur with damage to the protective ligaments and joint
capsule.

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Diagnosis
Clinical findings Radiographic examination
• Pain • X ray
• Swelling • Two views

• Characteristic deformity • CT scan

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Treatment
• Reduction
• Closed
• Open
• Immobilization
• Rehabilitation

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Complications
• Infection
• Neurovascular injury
• Avascular necrosis
• Instability
• Joint stiffness
• Myositis ossificans
• osteoarthritis

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