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Fractures (Description (Deformity of Fracture/Fragments (Deformity of…
Fractures
Description
-
Open/ClosedClosed
- Simple Non complicated Fx
- No Skin wounds at or near fracture site
Open
- Complicated
- Skin Wounds - Bony Fragment protruding
- Often Comminuted and Dislocated
- SURGICAL EMERGENCY
1.Immefiate Surgical Tx required
- Stop Bleeding
- IV Abx
- Tetanus
- Pain Management
- Surgical Debridement ( Excision, Irrigation) & reduction
Anatomical Description
- Fracture Location
- Left/Right Side
- Which Bone
Location within bone
- Proximal/Middle/Distal part
- Bone Thirds: Epi, Meta, Diaphysis
- Propagation/Joint Involvement
Neurovascular Status
ASSESSED CLINICALLY
Fracture Lines/Fracture Pattern
- Transverse → Fracture line perpendicular to long axis of the bone, Direct high energy force
- Oblique → Angular fracture line, angular/rotational force
- Hairline → Slight Crack in Bone surface
- Stress →
- Spiral → Complex, multi-planar fracture, Rotation, low energy
- Comminuted → >2 Fragments
- Avulsion → Tendon/Ligament pulls off bone fragment, Common in children/high energy
- Compression → Impaction of bone, Vertebrae/Proximal Tibia
- Fracture-Dislocation → In energy Injury
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Lower Limb
PATELLA
- Direct blow to patella ( Fall/MVA)
*Sudden flexion against contracted quads
- tenderness, Inability to extend knee/straighten leg, Displacement of patella, Effusion/haemarthrosis
- Consider whether Quads are intact or not
TIBIA
Tibial Plateau
- Varus/Valgus load with axial loading ( falling from height)
- Femoral condyles driven into proximal tibia
- Osteoporosis and minor trauma
- lateral>medial, knee effucion, no weight bearing, swelling, compartment syndrome
Complications: Ligemtnaous injuries, menisial lesions, AVN, Infection, OA
Tibial Shaft
most common leg and open fracture
- Low energy → Torsion
*High Energy → MVA, falls, sport
- Open/closed, Neurovascular signs
FEMUR
Diaphysis Fracture
- High Energy trauma
*Low energy → Children
- shortened &externally rotated, No weight bearing, often open injury
- Sometimes hip dislocation
Distal Femoral Fracture
- High Energy Force or axial loading
- Extreme Pan,Knee effusion (heamarthrosis), shortened &externally rotated, Neurovascular deficits if displaced fracture
ANKLE
- Pattern depends on position when injured
HIP
* Subcaptial (femoral Neck) → Garden Classification
- Interotrochanteric fracture
- Subtrochanteric Fracture
- Occurs in Elderly
- Acute Onset Pain, Unable to weight bear, shortened &externally rotated,
Healing Mechanism
-
Healing Evaluation
- Clinical → No longer tender on palpation or stressing on physical exam
- Xray- Trabecular cross fracture site, visible callus bridging site on at least 3/4 cortices
PROCESS *
- Blood Clot
- Granualation Tissue from periosseum And endosteum
- Fbrous change to granulation tissue
- Hyalinecartiliage
- Firm Provisional allus
- Calcification of cartilage
- Osteo progenitior cells from periosteum and endosteum
- woven bone to form BONY CALLUS
- Union
- Functional stresses --> remodelling
Management
- Primary Survey → ABC's
- Secondary Survey→ Head to toe; Front to back examination
- Examine Limb → Inspect, Palpate, Move, Special Tests
- AMPLE Hx: Alllergies, Medications, PMH,Last Meal, Events surrounding Injury
- Analgesia
- Imaging
- Splint Extremitity
- Reduction --> rest correct alignment and allow for blood to flow if impinged
- Maiintain Reduction ( Splints, pins, screws etc)* and Avoid joint stiffness
-
-
TYPES
- Pathological
- Trauma
- Stress: Occurring from repetitive stress ( abnormal stress, normal bone)
- Insufficiency