Fractures: principal and management

Intro:

Fracture is discontinuity of a bone

Describing a fracture:

Type : Close / Open
Nature : oblique / transverse / spiral / comminuted (more than 2 fragments)
Site : which bone, R / L
Displacement : angulation, overriding, translation, twisting

Fracture: can be divided into OPEN and CLOSED


- Open fx: fracture which communicates with a wound
- Closed: fracture with intact skin

Classification:

Gustilo classification for open fracture

Grade:
1 : CLEAN wound, less than 1 cm
2 : CLEAN wound, 1-10 cm
3 A : DIRTY wound, adequate soft tissue covering
   B : DIRTY wound, inadequate soft tissue covering
   C : Involve neuro/vascular injury


Management

The general rule is, fracture heals on its own. We manage fracture by aligning it so that i can fix itself correctly. The physiological process of fracture healing (HICCR):

H: Hematoma 
I  : Inflammation
C : Callus formation
C : Consolidate 
R : Remodeling


Time to heal:

Adult:
Upper limb:  3x2 (6 weeks)
Lower limb:  3x2x2 (12 weeks)



Management of Closed fractures:

Reduce: Close manipulation, Open reduction, mechanical traction
Hold: Traction - Fixed / Balance(skeletal / skin), Cast, Internal fixation (screw/wire/plates and screw/intermedulary nail, External fixator  (illizarof)
Exercise: to reduce oedema, restore muscle power

a. screw b. nail and plate c. intermedullary nail d. locked intermedullary nail e. dynamic hip screw

Management of Open fracture:

Debridement: clean wound
Antibiotic prophylaxis : prevent infection
Fracture stabilization: usually external fixation
Closure of wound: delayed primary closure, secondary closure


Complication of fracture

Early (Insanely Hot Nude Nice Fat Chick)
- Infection
- Heamarthosis
- Neuro/Vascular injury

- Fat embolism (explained in orthopedic emergencies)

- Compartment syndrome (explained in orthopedic emergencies)

Late (DAMN)
- Delayed union
- Avascular necrosis
- Malunion
- Non-union (hypertrophic / atrophic)