Prof. Mamoun KremliAlMaarefa College

Principles of Fractures& Fracture Management

Trauma History

Mechanism of injuryDate, time, type, method of impact, …

Consciousness

Function of injured part

Open wound / bleeding

Other injuries

Anti-Tetanus status (if skin breached)

Type of injury

Mechanism of injury helps expect theExtent and type of bone injuryExtent of soft tissue injurySuggests treatment and reduction techniqueExpected prognosis

Type of injury

Fall: height, point of impact, twist

Type of injury

Fall: height, point of impact, twist

Sport: type, direction of force

Type of injury

Fall: height, point of impact, twist

Sport: type, direction of force

Road traffic accident (RTA)):Car (MVA) , motorcycle, pedestrian

Type of injury

Fall: height, point of impact, twist

Sport: type, direction of force

Road traffic accident (RTA)):Car (MVA) , motorcycle, pedestrian

Heavy object fall: TV, wall, metal, earthquake

Type of injury

Fall: height, point of impact, twist

Sport: type, direction of force

Road traffic accident (RTA)):Car (MVA) , motorcycle, pedestrian

Heavy object fall: TV, wall, metal, earthquake

Assault & firearms / blast

http://simple.wikipedia.org/wiki/Blast_injury

Mechanism of Injury

Low velocity

High velocity

Direction of force

Blunt / Sharp

Open / Closed

Mechanism of Injury

Low velocity

High velocity

Direction of force

Blunt / Sharp

Open / Closed

http://eorif.com/

Kinetic Energy = ½ MV2

If a Simple fall = 1

Skiing injury = 3-5

High-velocity gunshot = 20

Car bumper (25 km/hr) = 100

Energy dissipated during injury

What is a fracture?

A fracture is a break in the structural continuity of boneAlways associated with some soft tissue

injury

A fracture is a soft tissue injury in which bone is broken!

Fracture Classification

According to site of Fracture:DiapyhsealMetaphysealArticular

Epiphyseal (in children)

Epiphysis

Metaphysis

Diaphysis

(Shaft)

Physis

Articular Surface

Fracture Classification

According to fracture line:Complete (usual)

Cortex fractured on both sides

Fracture Classification

According to fracture line:Complete (usual)

Cortex fractured on both sidesIncomplete (green stick) (Torus)

One cortex fractured, the other intactIn children

Fracture Classification

According to fracture pattern:SimpleWedge comminutedComplex comminuted

multifragmentedA

SimpleB

WedgeC

Complex

Fracture Classification

According to type of injury (force):Ordinary fracture

Expected from force of injuryStress fracture

Repetitive stressPathological fracture

Force too weak to cause fractureBone is pathologically weak

Avulsion fractureResisted muscle action, where ligaments and

tendons pull a bone fragment off

Stress Fractures

Bone reacts to repeated loading, may become fatigued & a crack develops

Fatigue fracturesAbnormal stress or torque on a bone that has normal

elastic resistanceExamples:

military recruits, athletes, ballet dancers

Insufficiency fracturesNormal muscular activity stresses a bone that is

deficient in mineral or elastic resistance

Stress Fractures

Fatigue fractures2nd metatarsalTibiaFibula

Insufficiency fracturesIn osteopenia, osteomalaciaNeck of femurRibsNeck of humerusScapula

www.sanluispodiatrygroup.comwww.imaging.birjournals.org

www.studyblue.com

Pathological fractures

Fractures may occur even with normal stresses if the bone has been weakened by a change in its structure. Seen in:

Local bone diseaseOsteomyelitisBenign tumors and Bone cystsMalignant tumors and matastasis

Generalized diseaseMetabolic: osteoporosis, riketsCongenital: osteogenesis imperfectaOthers: Paget’s disease

Avulsion fractures

Part of bone separated by forceful sudden resisted muscle actionCaused by ligament or tendon pull on bonePart of bone avulsed – bone weaker than

tendon/ligament

Type of injury

DirectSimple contusion or severe comminutionSoft tissue more injured

IndirectPattern of fracture depends on force directionLess soft tissue injury

Penetrating Missiles

Low velocity < 300 m/s - damage along the tractComminution

High velocity: >300m/s - sever comminutionComminution with wide soft tissue damage

Force & fracture pattern

Fracture pattern suggests mechanism of force

Spiral: (twisting)

Short oblique: (compression)

Wedge: (compression + bending)

Transverse: (angulation) (avulsion)

Force & fracture pattern

AO/OTA fracture classification

A comprehensive universal classification system that describes the injury, guides treatment, and suggests prognosis

Based on a five-part code:

— .Bone Segment Type Group Subgroup

AO/OTA fracture classification

Bone:

— .Bone Segment Type Group Subgroup

1 2 3 4

AO/OTA fracture classification

Location:

1

2

3

1

2

3

— .Bone Segment Type Group Subgroup

AO/OTA fracture classification

Type:

ASimple

BWedge

CComplex

— .Bone Segment Type Group Subgroup

AO/OTA fracture classification

Group:

— .Bone Segment Type Group Subgroup

1 2 A 2

AO/OTA fracture classification

Humerus

Diaphysis

Simple

Oblique

Bone

Segment

Type

Group

1

2

A

2

Subgroup

Middle 2

2

Displacement

Described as: Distal in relation to proximal

Un-displaced

ShiftSidewaysShorteningDistraction

Angulation In all planes

Rotation

SHIFT ANGULATION /TILT

TWIST/ROTATION

Sideways Overlap Impaction