Transcript PRINCIPLE OF FRACTURE MANAGEMENT

PRINCIPLE OF FRACTURE
MANAGEMENT
DR S SOMBILI
2012
DEFINITION
•Fracture is an open or close soft tissue injury of varying
severity with a break in the continuity of the underlying bone
•The soft tissue component is important
DIAGNOSIS
HYSTORY
Minor trauma- Falling
- Assault
Major trauma- MVA
- PVA
- Motorcycle accident
- Industrial accident
- Air tarffic accident
PHYSICAL EXAMINATION
Swelling
Abrasion
Ecchymosis
Deformity
Wound
Tenderness
Abnormal movement
Crepitus
N/V examination
INVESTIGATION
X-Ray
•Anteriorposterior view
•Lateral view
•Two sides
• Joint above and below
•Before and after reduction
CT- Scan
• For complex fractures
FRACTURE TYPE
•Transverse
•Oblique
•Spiral
•Impaction
FRACTURE PATTERNS
•Simple
•Segemental
•Comminuted
PRINCIPLE OF TREATMENT
Think
•Patient,Limb,Fracture
•Resucitation:ABC
Splintage- Temporary
- Plaster slab
- Well padded cramers wire
- Traction
Displaced fractures
- Close reduction
- Splintage:cast,joint above and
below,traction.
-Reduction must be done within 72hrs.
Undisplaced fractures
Splintage: cast,traction,collar and cuff sling
Post- Reduction
•Check:N/V status,swelling
•Compartment syndrome
•Control X-ray
•Rehabilitation
•Discharge patient
•Review after 10 days to check pop
•Reapply pop
•Patient may be reviewed after every 4 weeks from now until
fracture union.
Indication for open reduction and
internal fixation of fractures
•Failure of close reduction (C/R)
•Failure to maintain C/R
•Intra-articular fractures
•Floating knee,elbow,shoulder
•Multiple fractures
•Pathological fractures
•Neck of femur fractures in young patients
•Galeazzi fractures
•Monteggia fractures
devices:
-plate and screws
-Intramedullary nails
-Kirschner wires
Fracture healing
Upper limb
Children: about 3 to 4 weeks
Adults: about 6 to 8 weeks
Lower limb
Children: about 6to 8 weeks
Adults : about 12 to 16 weeks
OPEN FRACTURES
•Orthopaedic emergency
•Definition:a fracture that communicates with an epithelial surface
Principle of treatment :
-Resuscitation –ABC
-Dress the wound with a saline dressing
-Splint the fracture
-Tetanus toxoid
-Analgesia
- Opiod
- No NSAIDS
Antibiotics:
First generation
Cephalosporins e.g. kefzol
IV. Augmention
Cloxacillin
Triple regime:
Cloxacillin
Flagyl
Gatamycin
for farm yard or train injuries
Investigations
-X-Rays
-CT Scan
Admit patient in the ward
Book patient for theatre
In theatre
•General anaesthesial \ regional
•Wound - Irrigation
- Debridement
•Fracture reduction
•Maintanance of reduction – exfix
•No internal fixation of open fractures
•Leave wound open
In the ward
•Wound inspection in 24 hours, if no sign of sepsis by
72hours –wound closure
•External fixator is removed after 6 weeks
•A cast is applied for the remainder of treatment
•The pin tracts must be cleaned with hibitane in 70% alcohol
daily
THE END