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F R A C T U R E SDiagnosis and Treatment
ORTHOPEDIC AND TRAUMATOLOGYMEDICAL FACULTY of DIPONEGORO UNIERSITY
!"#"
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MIND MAPPING
F R A C T UR E S
DEFINITION
TYPES $CLASSIFICATIONDEFORMITY
FRACTURE HEALING
DIAGNOSIS
FRACTURE TREATMENT
SPECIFIC FRACTURE
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D E F I N I T I O N
Break in continuityof bone and its
structures
tra%ma& dire't ( indire't
for'e ) stress
*at+o,ogi'fra't%res
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MIND MAPPING
F R A C T UR E S
TYPES $CLASSIFICATIONDEFORMITY
DEFINITION
FRACTURE HEALING
DIAGNOSIS
FRACTURE TREATMENT
SPECIFIC FRACTURE
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TYPES of FRACTURES
•COMPLETE FRACTURE-one di.ided into ! fragments
fra't%res 'an -e o-,i/%e0 s*ira,0 im*a't0 or'ommin%ted in its 'on1g%ration
•INCOMPLETE FRACTURE-one in'om*,ete,2 di.ided0 3it+ *erioste%m sti,,remainE4 5 greensti'6 fra't%res
TYPES and CLASSIFICATION#
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TYPES and CLASSIFICATION!
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TYPES and CLASSIFICATION7
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TYPES and CLASSIFICATION8
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TYPES and CLASSIFICATION9
S*e'ia, C,assi1'ation
fra't%res +a.e some .ariet20 t+ro%g+ t+eir s*e'i1'di.ision
#:Et+io,og2
Tra%mati' fra't%res'a%sed -2 s%dden for'e
Pat+o,ogi' fra't%res'a%sed -2 3ea6ness of -one in a''ording to its *at+o,ogi' 'ond
Stress fra't%res'a%sed -2 ,ong;time for'e < stress on 'ertain ,o'ationm%,ti*,e re*etiti.e strain '2',e0 res%,t in mi'ro'ra'6s of -one
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TYPES and CLASSIFICATION=
Tra%mati'fra't%res Pat+o,ogi' fra't%res
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TYPES and CLASSIFICATION>
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TYPES and CLASSIFICATION?
!: C,ini'a, C,assi1'ation
Sim*,e fra't%res ',osed fra't%res no 'omm%ni'ation -et3een -one and e4terna, s%rfa'e of -od2
Com*o%nd fra't%res @o*en fra't%res +a.e 'omm%ni'ation -et3een -one and e4terna, s%rfa'e of -od2
Com*,i'ated fra't%res fo,,o3ed -2 'om*,i'ation0 e:g 5 %nion0 de,a2ed %nion0 non%nion0-one infe'tion
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TYPES and CLASSIFICATIONB
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TYPES and CLASSIFICATION#"
7: Radio,ogi' C,assi1'ation
• Lo'a,iation
( Dia1sia,( Meta1sia,
( Intra;arti6%,er( Fra't%re 3<dis,o'ation
• Con1g%ration
Trans.ersa,Fra't%re
O-,i6 Fra't%reS*ira, Fra't%re Fra't%reSegmenta,Fra't%reedge Fra't%reA.%,sion Fra't%reDe*resion Fra't%reIm*a'tion Fra't%re%rst Fra't%reE*i1sea, Fra't%re
• one e4isten'e
Tota, Fra't%reCra'6 Fra't%re
%'6,e < tor%sFra't%reHair ,ine Fra't%reGreensti'6Fra't%re
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8: fragmen;to;fragmen 'onne'tion
Undis*,a'ed
Dis*,a'ed dis*,e'e of -one 'an -e r%n in = 3a2s 5
; A**osition; Rotation; O.erriding; Ang%,ation 5 .a,g%s0 .ar%s0 ant0 *ost; Im*a'tion
TYPES and CLASSIFICATION##
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TYPES and CLASSIFICATION#!
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FRACTURE HEALING
Fracture healing depends onFracture healing depends on
types of bonetypes of bone
andand
amount of movementamount of movement
Divided into 5 stage :
oTissue injury and haematoma
oInflammation and cellular proliferation
oCallus forming
o
Consolidation
oRemodelling
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FRACTURE HEALING
Fracture healing is influenced by many factors :Fracture healing is influenced by many factors :
Age
ocali!ation and Configuration
"arly dislocation of fracture
#ascular supply in $oth fragments
Reduction and Immo$ilitation
Immo$ilitation period
%pace $et&een $oth fragments and soft
tissue interposition
'resence of infection
%ynnovial fluid
'assive and active movement of
e(tremity
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FRACTURE HEALING
Fracture healing abnormalities :Fracture healing abnormalities :
o)alunion
oDelayed union
o*onunion
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FRACTURE HEALING
Metacarpal shaft malunion with dorsal angulationMetacarpal shaft malunion with dorsal angulation
*ote : red circle sho&s the location of malunion in the same patients
8
http://www.emedicine.com/orthoped/images/1230552-1243899-2655.jpghttp://www.emedicine.com/orthoped/images/1230552-1243899-2654.jpghttp://www.emedicine.com/orthoped/images/1230552-1243899-2658.jpg
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MIND MAPPING
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MIND MAPPING
F R A C T UR E S
DEFINITION
TYPES $CLASSIFICATIONDEFORMITY
FRACTURE HEALING
DIAGNOSIS
FRACTURE TREATMENT
SPECIFIC FRACTURE
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o +istory
o ,eneral Features
o ocal Features
D I A G N O S I S #
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D I A G N O S I S !
+istory+istory Anamnesa
Age - pathological fracture .. /
%ymptomps
pain
sensory loss
motor loss
pale
haematuri
a$dominal pain
unconsciousness
neurovascular status of e(tremity distal to the fractures
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D I A G N O S I S 7
,eneral Features,eneral Features
"arly 'hysical "(amination
%hoc0 1 anemia 1 $leeding ..
injury of organs &ithin $ody2s cavity
predispose factors - e3g : pathological factors /
ocal Featuresocal Features
ocal "(amination
Inspection - oo0 /
'alpation - Feel /
)ovement e(am3
*eurological e(am3
G O S S
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D I A G N O S I S 8
InspectionInspection
Com*are 3it+ norma, site
E4tremit2 *osition
Fa'e e4*ression & *ain )
Anemi' signs &
-,eeding )
S6in < soft tiss%e 3o%nd
S%-'%tan e4tra.asasion
Deformit2 of -one
fragments
Tra%ma of ot+er organs
PalpationPalpation
,o'a, tem*erat%re
*ain
're*it%s & one -one fragments
grants on t+e ot+er )
ne%ro.as'%,ar stat%s on t+e dista,
site
Lim- ,engt+ & 'om*ared 3 <
norma, ,eng+t on t+e ot+er side )
D I A G N O S I S
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D I A G N O S I S 9
MovementMovement
a,,o3 *atient to mo.e at
t+e site of in%r2
m%st -e done 'aref%,,20 to
a.oid f%rt+er in%ries of soft
tiss%es0 .as'%,ar0 and ner.es
Neurologic ExaminationNeurologic Examination sensori' and motori'
e4amination
ot+er ne%ro,igi'
'onsideration 5
ne%ro*ra6sia
a6sonotmesis
ne%rotmesis
D I A G N O S I S
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D I A G N O S I S =
D I A G N O S I S
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D I A G N O S I S >
Radiograph e(aminationRadiograph e(aminationDefine :
o *ormal structure of $one and joints
o Confirm of fracture
o Fragments structure and movements
o )edical treatments
o Fractures types
o 'athological conditions of $one
o 'resence of alienete $ody - projectile4 etc /
'rinciples :
T&o sides projection
T&o joints affected
T&o e(tremities
T&o times of radiograph imaging
D I A G N O S I S
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D I A G N O S I S ?
D I A G N O S I S
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%uperior vie&
ateral vie&
Radiograph sho&s fracture line at the junction of
the middle and distal onethird diaphysis appears
transverse &ith no angulation nor displacement3
+o&ever4 in the lateral vie&4 the fracture line is
o$li6ue and the distal segment is displaced
superiorly
D I A G N O S I S B
D I A G N O S I S
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D I A G N O S I S =
Tomogr Tomogr aphaph44 e3g3 : one3g3 : on verte$raverte$rall
fracture or condylus ti$iafracture or condylus ti$ia
CTscanCTscan )RI)RI Radioisotop scanningRadioisotop scanning
MIND MAPPING
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MIND MAPPING
F R A C T UR E S
DEFINITION
TYPES $CLASSIFICATIONDEFORMITY
FRACTURE HEALING
DIAGNOSIS
FRACTURE TREATMENT
SPECIFIC FRACTURE
FRACTURE TREATMENT
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FRACTURE TREATMENT #
Early stage treatment :Early stage treatment :
73 First Aid 8 A9C 8 Assesment
&ound closing
immo$ili!e to relief pain
3 Clinical evaluation $one injury .
neurovascular injuries .
find other condition : D) . ; Cardiovascular
disease . ; Allergic .
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FRACTURE TREATMENT !
BASIC C!SI"E#A$I!BASIC C!SI"E#A$I!
73 Do not &orsen the patient2s condition
3 Treatment is $ased on correct diagnosis and prognosis
3 According to individual condition of patient
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FRACTURE TREATMENT
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FRACTURE TREATMENT 8
R cognition
cognition
o Diagnosis and evaluation
o Anamnesis4 clinical e(am4 radiograph e(am
o Consider :
fracture locali!ation
types of fracture
complication prediction
treatment techni6ue
FRACTURE TREATMENT
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FRACTURE TREATMENT 9
R duction
duction
o if necessary
o place $one fragments in proper relationship to each other
o Alignment and Apposition
R t ntion
t ntion
o immobili'e fracture free of motion
R habilitation
habilitation
o restore function of invovled part
FRACTURE TREATMENT =
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FRACTURE TREATMENT =
CLOSE FRACTURECLOSE FRACTURE
$scherne ( )*+, - classification of closed fracture$scherne ( )*+, - classification of closed fracture
evel 7 : fracture &ith shallo& a$rasion or oedema on s0in and
su$cutaneous tissue
evel : higher fracture &ith contusion of soft tissue and oedema
evel < : severe injury &ith o$viously soft tissue damage and
compartement syndrome threats
FRACTURE TREATMENT >
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FRACTURE TREATMENT >
).). #eduction#eduction Close reduction
?pen reduction
/./. Immobili'ationImmobili'ation
Traction
Dressing - ,ips /
Internal Fi(ation
"(ternal Fi(ation
0.0. E1cersiseE1cersise
FRACTURE TREATMENT ?
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FRACTURE TREATMENT ?
?pen reduction
Traction
FRACTURE TREATMENT B
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FRACTURE TREATMENT B
ongarm hanging cast
Figureofeight splint dressing
FRACTURE TREATMENT #"
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Figureofeight dressing
ongleg plaster
FRACTURE TREATMENT #"
FRACTURE TREATMENT ##
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FRACTURE TREATMENT ##
OPEN FRACTUREOPEN FRACTURE
2ustillo 3 Anderson classification of open fracture2ustillo 3 Anderson classification of open fracture
Type I : have small opening - @ 7 cm / in the s0in and no signficant
muscle necrosis or stripping of $one periosteum
Type II : have larger s0in disruption - 7cm4 @ 7Bcm /4 no significant
stripping of periosteum4 gross contamination
Type IIIA : have e(tensive lacerations of tissue flaps - 7Bcm /4 or lesser
s0in lesion &ith gross contaminationType III9 : have significant stripping of periosteum4 re6uire soft tissue flap for
coverage
Type IIIC : have major vascular injury that re6uires repair
FRACTURE TREATMENT #!
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FRACTURE TREATMENT #!
o Treated &ith emergency surgery to minimi!e the ris0 of infection
and nonunion
o De$ridement
o ound closing
o Fracture sta$ili!ation - fi(ation /
o 'ostoperative care
FRACTURE TREATMENT #7
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FI24#E )
,rade IIIC distal ti$ia injury of 5yearold involved in high velocity
motorcycle accident3
FRACTURE TREATMENT #7
FRACTURE TREATMENT #8
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FI24#E /
,rade III9 foot injury of Eyearold run over $y an ice cream truc03
FRACTURE TREATMENT #8
FRACTURE TREATMENT #9
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FI24#E 5
#ersajet de$ridement and
gravity irrigation3
FRACTURE TREATMENT #9
FRACTURE TREATMENT #=
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FI24#E 6
Final appearance after
de$ridement and irrigation3
FRACTURE TREATMENT #=
FRACTURE TREATMENT #>
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FRACTURE TREATMENT #>
FI24#E )0> month postoperative anteroposterior
radiograph after
de$ridement4 treatment of infection4 $one
grafting and
open reduction internal fi(ation3
FRACTURE TREATMENT #?
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internal fi1ation material%cre&4 pen4 metal plate4 circumferential
$ands4 etc
FRACTURE TREATMENT #?
FRACTURE TREATMENT #B
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FRACTURE TREATMENT #B
AMPUTATIONAMPUTATION
o 'atient &ith severely injured e(tremity
o early amputation indicated under follo&ing circumstances :
The lim$ is nonvia$le
the patient has shoc0 and severe multisystem injuries4
couldn2t tolerate a prolonged salvage procedure
the patient has severe chronic medical illness - D) 1
vascular disease /
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