RAD 422
Lecture .4
Fractures
Types, Complications, and management
Define term the term fracture, dislocation and Subluxation
Identify the general causes, signs , symptoms of fractures
Classify the different types of fractures
Discus the general principles of the management of fractures
Describe the role of radiography in the management of
fractures
Explain the process of fracture healing
State the local and general complications of fractures
Reference
s
Text book of radiographic positioning and related anatomy; by
Kenneth
L.Bontrager,5th edition
M.A.Seraj , The new manual of basic emergency
procedures, first aid and updated CPR.
Useful websites
http://www.medicinenet.com/fracture/article.ht
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http://www.gentili.net/fracturemain.asp
What is fracture(#)?
a break in the continuity of a bone or cartilage.
common causes of
fractures:
Fall from a height
car accidents
Direct blow
Repetitive forces
Pathology
Signs and Symptoms
Swelling or tenderness
pain
Numbness
Bleeding
Broken skin with bone protruding
Limitation or unwillingness to move a
limb
Fracture Types
1/ Traumatic
Closed fracture: A closed fracture is one where the fracture hematoma
does not communicate with the outside
Open fracture: This is one where the fracture hematoma communicates
with the outside through an open wound.
Stress fracture :
It is a fracture occurring at a site in the bone subject to
repeated minor stresses over a period of time.
Birth fracture:
It is a fracture in the new born children
due to injury during delivery.
Fracture Types
2/ Pathological
It is a fracture occurring after a trivial violence in a bone weakened
by some pathological lesion. This lesion may be :
- Localized disorder
(e.g. secondary malignant deposit)
- Generalized disorder
(e.g. osteoporosis).
Fracture Types
According to the Path of the # Line
Transverse Fracture Oblique Fracture
A fracture in which the # line A fracture in which the # line is at
is perpendicular to the long oblique angle to the long axis of
axis of the bone . the bone.
Fracture Types
According to the Path of the # Line
Longitudinal Fracture
Spiral Fracture A fracture in which the # line runs
A severe form of oblique fracture nearly parallel to the long axis of
in which the # plane rotates the bone. A longitudinal fracture
along the long axis of the bone. can be considered a long oblique
These #s occur secondary to fracture.
rotational force.
Fractures
Anatomical classification of
fractures
Comminuted # : Stellate fracture:
The bone is broken into than This # occurs in the flat bones of
two fragments. the skull and in the patella, where
the fracture lines run in various
directions from one point.
Fracture Types
Anatomical classification of fractures
Impacted fracture:
Depressed fracture:
This # where a vertical force
This # occurs in the skull
drives the distal fragment of
where a segment of bone gets
the fracture into the proximal
depressed into the cranium.
fragment.
Fracture Types
Anatomical classification of
fractures
Avulsion fracture:
This is one, where a chip of bone is avulsed by the sudden and
unexpected contraction of a powerful muscle from its point of
insertion,
Examples
1. The supra spinatus muscle avulsing the
greater tuberosity of the humerus.
2. Avulsion fracture of the tibial tuberosity
Fracture Types
Summary
Simple little or no bone displacement
Compound fracture ruptures the skin & bone protrudes
Green stick occurs mostly in children whose bones have not calcified or hardened
Transverse crack perpendicular to long axis of the bone - displacement may occur
Oblique diagonal crack across the long axis of the bone
Spiral diagonal crack involving a "twisting" of the bone about the longitudinal
axis
Comminuted "crushing" fracture - more common in elderly
Impacted one end of bone is driven up into the other
Depressed broken bone is pressed inward (skull fracture)
Avulsion fragment of bone is pulled away by tendon
Other Terms used in describing
fracture
Greenstick
is the fracture in the young bone of children where the break is
incomplete, leaving one cortex intact .
Plastic - Bowing fracture in children without disruption of
cortex.
Distraction Is a separation of fragments that have been pulled apart.
Distraction #
Greenstick #
Terms used in fracture follow-
up
1.Position - changed or unchanged .2. Healing -central or peripheral
bony bridging
Delayed
Terms usedunion - the follow-
in fracture healing
process is slower than normal.
up
Non-union - the healing
stopped before union occurred.
Malunion - the fracture
healed in unacceptable position.
Fractures
management and healing
Principles of Management:
Aims : (A)- safe life (B)-save the limb (C)-save the
function
1. Efficient First Aid: This relieves the pain and prevents
complications.
2. Safe transport: This help to minimize complications in injures to the spine,
fracture of the lower limbs, ribs etc (all fractures should be immobilized
immediately ) .
3. Assessment of condition of the patients for shock & other injuries.
4. Assessment of local condition of the injured limb regarding
complications like vascular injury, nerve involvement and injury to
neighboring joints .
5. Resuscitation. If needed
X-ray before plaster AP & LAT( to determine site and degree of
6. Radiography of the part
displacement)
Post Reduction films ( wet plaster) for insurance of good alignment
Follow up films to assess healing
Films Before removal of plaster to confirm complete healing
7.Reduction of the
fracture(correction of displacement of
fragments and done by :
closed Manipulation
open reduction
Principles of Management:
8. Immobilization of the fragments.
External fixation
Cast (plaster)
Internal fixation
Screws
Plates
intramedullary nails and rod
wires & pins
9. Early physiotherapy : for the preservation of function of the limb
(local complication such as ischemia ,nerve damage ,joint
stiffness ,infection ..etc may endanger the function of the limb.
10. Rehabilitation : After union of the fracture to restore full
muscle power and joint movements and to make the patient fit for
his original job.
NOTE:
Fractures are treated by reduction (realignment) &immediate
immobilization
In most cases, simple fractures heal completely in approximately
6 - 8 weeks
Compound # better to deal with it within6hrs of injury to avoid
infection
The accurate diagnosis of the fracture (site ,lines and
displacement ) is made from X- ray examination.
Tow projections is required AP or PA +lateral or oblique
Tow joints above and below the site of the # should be included
in the radiographs
Tow limbs radiographs for comparison of value in children.
FRACTURE HEALING
Fracture healing is considered as a series of phases which
occur in sequence as follows:
(I) Inflammatory Phase.
(A)Stage or hematoma formation.
(B)Stage of granulation tissue. (more
fibrin to the hematoma and increase
blood flow
(II) Reparative Phase.
(A) Stage of fibro cartilaginous callus.
(B) Stage of bony callus (woven bone
become calcified)).
(III) Remodeling Phase.
Excess material inside bone shaft is
replaced by more compact bone
Factors Affecting Bone Healing
Enhancing Inhibiting
Youth Age (e.g. Average # Femur Healing Time)
Early Immobilization of Infant: 4 weeks
fracture fragments Teenager: 12 to 16 weeks
Bone fragments contact Extensive local soft tissue trauma
Adequate blood supply Bone loss due to the severity of the
Proper Nutrition fracture
Adequate hormones Inadequate immobilization (motion at
Growth hormone the fracture site)
Thyroxin Infection
Calcitonin Avascular Necrosis
Fracture - Complications
At time of injury (Immediate)
◦ Haemorrhage
◦ Damage to important internal structures (brain ,heart..)
◦ Skin loss ,Shock ,Nerve damage
Later Complications
Local General
Tissue necrosis ,Deep Vein Thrombosis
Local wound Infection Pulmonary embolism
Loss of alignment Osteoarthritis
Delayed and malunion
Joint stiffness
Joints
Dislocation
What is Dislocation?
Is the total displacement of the articular end of a bone from the
joint cavity.
Subluxation : Is an incomplete displacement.
Reduction : Is the restoration of the normal alignment of the
bones.
Classification:
Dislocations are classified
as follows:
A. Congenital
B. Traumatic
C. Pathological
D. Paralytic
Dislocation & Subluxation
(Sample Radiographs)
Elbow joint
PIPJ Subluxation Dislocation.
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QUESTI ONS
