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Definition; classification; causes fractures

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ORTHOPEDICS History ortho straight paedia child Straightening of musculoskeletal deformities in children Current definition Orthopaedics is concerned with bones, joints, muscles, tendons and nerves the skeletal system and all that makes it move. General, regional and trauma

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fracture is a disruption in the continuity of ortical and/or cancellous bone

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Dislocation/ subluxation A dislocation is a disruption of the normal articulating anatomy of a joint a partial dislocation /disruption is subluxation

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A fracture/dislocation is a fracture occurring in or near a joint that results in a subluxation or dislocation of the joint.

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Fracture Descriptors= 1; Open versus closed 1. Open versus closed: A closed fracture -skin is intact over the fracture site An open fracture -skin is not intact

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Examples of open fracture

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Complete and incmplete fractures complete if it affects both cortices incomplete when only a single cortex is involved. greenstick is incomplete fracture when failure of the bone is under tension (convex side) buckle or torus when bone fails under compression (on the concave side)

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Simple versus comminuted: A simple fracture is one in which there are only two major fragments and one fracture line. A comminuted fracture is one in which there are multiple fragments of bone and multiple fracture lines.

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Displacement: Translation of the two fragments in relation to each other in one or more planes Measured in reference of proximal fragment to distal

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Angulation: two fracture fragments are not aligned Alignment means that the axes of the proximal and distal fragments are parallel to each other and the joint above and below are in the normal (parallel) relationship. Angulation is typically de ned by the direction in which the apex of the angle pointsmedial,lateral, dorsal, volar, etc.

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Fracture Patterns 1. Transverse 2. Spiral 3. Oblique 4. Complex (multiple patterns)

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Classification of fractures Fracture classi cations are used to recommend treatment and predict outcomes. Common examples are Gardens classi cation for intracapsular femoral neck fractures and Frykmans classi cation for distal radius fractures. In general, most of these systems are based on the displacement of the fracture and severity of the injury. The higher grades in most classi cations usually indicate a more severe injury and poor prognosis.

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Classification of fractures The most comprehensive and universally accepted system for classi cation of long bone fractures is that proposed by the Association for the Study of Internal Fixation (ASIF), commonly referred to as AO (Arbeitsgemeinschaft f ur Osteosynthesefragen). Although it is important to understand the basic principles of this classi cation system, minute details are not necessary.

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Classification of fractures In the AO classi cation, a number is assigned to each long bone (humerus = 1, radius or ulna = 2, femur = 3, tibia or bula = 4) and each bone is subdivided into segments (proximal =1, middle =2 and distal =3, ankle = 4). Letters A, B and C are used to denote the level and pattern of fracture. For example, a completely displaced intracapsular fracture of the femoral neck may be denoted with an alphanumeric value of 31B3.3, where (in order)

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Classification of fractures Bone Segment Type Group Subgroup 1234 123 ABC 123.1.2.3

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Causes of fracture Trauma a-RTA b- fall Non accidental - child abuse Pathological a-benign; malignant tumor in bone or secondaries b- severe osteoporosis c- bone infections Stress fractures- repetitive trauma