Classification of fractures and fracture healing.pptx

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Classification of fractures and fracture healing.pptx

1. FRACTURE CLASSIFICATION & BONE HEALING

2. Classification Based on Relationship with Environment CLOSED {Simple} OPEN {Compound}

3. Open Fractures A break in the skin and underlying soft tissue leading to a communicating fracture hematoma

4. Gustilo anderson Classification The Gustillo anderson classification is used to classify open fractures. Three grades that try to quantify the amount of soft tissue damage associated with the fracture Grade 1 — <1cm wound, min soft t/s injury Grade 2 — >1cm wound, mod soft t/s injury Grade 3 — >10cm wound, severe muscle devitalization Subgrades A,B,C

5. Grade 3 A Limited stripping of periosteum and soft tissue from bone. A dequate soft tissue coverage for bone, tendons and neurovascular bundle.

6. Type 3B Extensive stripping of soft tissue and periosteum from bone. Requires a local flap or free tissue transfer Type 3C A major vascular injury requiring repair

7. Muller’s (AO/OTA) Classification Each long bone has 3 segments Proximal, Diaphyseal and Distal Diaphyseal Fractures: Simple Wedge Complex Proximal & Distal Extra-Articular Partial Articular Complete Articular

8. Classification: Based on Displacement UNDISPLACED DISPLACED- 3types . Translation . Angulation .shortening

9. Displacement - Translation Translation is sideways motion of the fracture - usually described as a percentage of movement when compared to the diameter of the bone , direction of distal fragment decides

10. Displacement - Angulation Angulatio n is the amount of bend at a fracture described in degrees. Described with respect to the apex of the angle .

11. Displacement - Shortening Shortening is the amount a fracture is collapsed/ shifted proximally, expressed in centimeters.

12. Classification: Based on Pattern Transverse Oblique Spiral Comminuted Segmental Stellate

13. Transverse Fracture A fracture in which the # line is perpendicular to the long axis of the bone . Oblique Fracture A fracture in which the # line is at oblique angle to the long axis of the bone. According to the Pattern of the # Line

14. Spiral Fracture A severe form of oblique fracture in which the # plane rotates along the long axis of the bone. These #s occur secondary to rotational force. According to the Pattern of the # Line

15. Anatomical Classification of Fractures Comminuted Fracture : The bone is broken into many fragments . Stellate F racture : This # occurs in the flat bones of the skull and in the patella, where the fracture lines run in various directions from one point.

16. Anatomical Classification of Fractures Impacted Fracture : This # where a vertical force drives the distal fragment of the fracture into the proximal fragment. Depressed F racture : This # occurs in the skull where a segment of bone gets depressed into the cranium.

17. Avulsion Fracture : A chip of bone is avulsed by the sudden and unexpected contraction of a powerful muscle from its point of insertion, Examples ASIS Avulsion JONE’S 5 th MT base Avulsion Anatomical Classification of Fractures

18. Stress Fracture :   It is a fracture occurring at a site in the bone subject to repeated minor stresses over a period of time. Birth Fracture:   It is a fracture in the new born children due to injury during birth Anatomical Classification of Fractures

19. Classification: Based on E tiology TRAUMATIC PATHOLOGICAL Tumors Bone cysts Osteomyelitis Osteoporosis Osteogenesis imperfecta Rickets

20. Salter-Harris Classification Only used for pediatric fractures that involve the growth plate ( physis )

21. Salter-Harris type I fracture Type I fracture is when there is a fracture across the physis with no metaphysial or epiphysial injury

22. Salter-Harris type II fracture Type II fracture is when there is a fracture across the physis which extends into the metaphysis

23. Salter-Harris type III fracture Type III fracture is when there is a fracture across the physis which extends into the epiphysis

24. Salter-Harris type IV fracture Type IV fracture is when there is a fracture through metaphysis , physis , and epiphysis

25. Salter-Harris type V fracture Type V fracture is when there is a crush injury to the physis

26. BONE HEALING

27. INTRODUCTION Fracture is a break in the structural continuity of bone or periosteum. The healing of fracture is in many ways similar to the healing in soft tissue wounds except that the end result is mineralised mesenchymal tissue i.e. BONE. Fracture healing starts as soon as bone breaks and continues modelling for many years.

28. The essential event in fracture healing is the creation of a bony bridge between the two fragments which can be readily built upon and modified to suit the particular functional demands .

29. Components of BONE Formation Cortex Periosteum Bone marrow Soft tissue

30. FACTORS EFFECTING The TYPE , AMOUNT and LOCATION of bone formed depends upon----- FRACTURE TYPE GAP CONDITION FIXATION RIGIDITY LOADING BIOLOGICAL ENVIRONMENT

31. FRACTURE HEALING TYPES Fracture healing is divided according to bone-- Cortical bone of the shaft. Cancellous bone of the metaphyseal region of the long bones and the small bones.

32. STAGES OF FRACTURE HEALING TISSUE DESTRUCTION AND HAEMATOMA FORMATION INFLAMATION AND CELLULAR PROLIFERATION STAGE OF CALLUS FORMATION STAGE OF CONSOLIDATION STAGE OF REMO DELLING

33. Tissue destruction and Hematoma formation Torn blood vessels hemorrhage A mass of clotted blood (hematoma) forms at the fracture site Site becomes swollen, painful, and inflamed

34. Tissue destruction and Hematoma formation

35. INFLAMATION AND CELLULAR PROLIFERATION Within 8 hours inflammatory reaction starts. Proliferation and Differentiation of mesenchymal stem cells. Secretion of TGF-B , PDGF and various BMP factors.

36. Callus Formation Fibrocartilaginous callus forms Granulation tissue (soft callus) forms a few days after the fracture Capillaries grow into the tissue and phagocytic cells begin cleaning debris

37. Callus Formation Theory OSTEOPROGENITOR CELL present in all ENDOSTEAL and SUBPERIOSTEAL surface give rise to CALLUS. CALLUS arises from NON-SPECIALISED CONNECTIVE TISSUE CELLS in the region of fracture which are induced into conversion to OSTEOBLASTS.

38. Callus Formation

39. STAGE OF CONSOLIDATION New bone trabeculae appear in the fibrocartilaginous callus Fibrocartilaginous callus converts into a bony (hard) callus Bone callus begins 3-4 weeks after injury, and continues until firm union is formed 2-3 months later

40. STAGE OF REMODELLING Excess material on the bone shaft exterior and in the medullary canal is removed Compact bone is laid down to reconstruct shaft walls

41. Variables Influence Fracture Healing INJURY VARIABLES Open Fractures Impeding or preventing formation of # Hematoma Delaying formation repair tissue Risk of infection

42. INJURY VARIABLES Intra- articular fractures; If the alignment & congruity of joint surface is not restored Delayed healing or non union Joint stiffness * Segmental fractures * Soft tissue interposition * Damage to the blood supply

43. Patient Variables AGE NUTRTION HEALING PROCESS NEEDS Energy Proteins & carbohydrates

44. Patient Variables cont…. Systemic hormones Corticosteroid ( ) Growth hormone Thyroid hormone Calcitonin Insulin Anabolic steroids DM Hypervitaminosis D Rickets Inhibit fracture healing ( Vascularization) Nicotine Rate fracture healing Rate fracture healing

45. Tissue Variables Cancellous or cortical bones Bone necrosis Infection

46. Treatment Variables Apposition of fracture fragments Loading & micromotion at the fracture site Loading a fracture site stimulates bone formation Micromotion promotes fracture healing

47. Treatment Variables Fracture stabilization Traction Cast Immobilization External Fixation Internal Fixation Facilitate fracture healing by preventing repeated disruption of repair tissue.

48. THANK U