Complications of orthopedic fracture.pptx

fracture complications

1. Complications of fracture compartment syndrome malunion non union delayed union

2. DR. SAURABH AGRAWAL MBBS, DNB(ORTHO), FJRS Assistant Professor deptt . of orthopedics aiims , bedwas

3. IMMEDIATE COMPLICATIONS: AT THE TIME OF FRCATURE EARLY COMPLICATIONS: IN INITIAL FEW DAYS LATE COMPLICATIONS: LATER ON

4. IMMEDIATE COMPLICATIONS SYSTEMIC COMPLICATIONS: HYPOVOLUMIC SHOCK LOCAL COMPLICATIONS: UNJURY TO MAJOR BLODD VESSELS INJURY TO MUSCLES AND TENDONS INJURY TO NERVES INJURY TO VISCERA INJURY TO JOINTS

5. EARLY COMPLICATIONS SYSTEMIC: HYPOVOLAEMIC SHOCK ARDS FAT EMBOLISM SYNDROME DVT & PULMONARY EMBOLISM ASEPTIC TRAUMATIC FEVER SEPTICEMIA (OPEN FRACTURES) CRUSH SYNDROME

6. LOCAL: INFECTION COMPATEMENT SYNDROME

7. LATE COMPLICATIONS BONE UNION RELATED NON UNION MAL UNION DELAYED UNION CROSS UNION

8. OTHER COMPLICATONS: AVASCULAR NECROSIS SHORTENING JOINT STIFFNESS SUDECK’S DYSTROPHY (REFLEX SYMPATHETIC DYSTROPHY) OSTEOMYELITIS ISCHAEMIC CONTRACTURE MYOSITIS OSSIFICANS OSTEO ARTHRITIS

9. COMPARTMENT SYNDROME COMPARTMENT SYNDROME IS A CONDITION IN WHICH INCREASED PRESSURE WITHIN ONE OF THE BODY’S ANATOMICAL COMPARTMENT RESULTS IN INSUFFICIENT BLOOD SUPPLY TO TISSUE WITHIN THAT SPACE. CAUSES: INJURY & OEDMA TO MUSCLES FRACTURE HEMATOMA ISCHEMIA LEADING TO MUSCLE OEDEMA

10. VISCIOUS CYCLE

11. RISK FACTORS HIGH RISK INJURIES SUPRACONDYLAR # HUMERUS FOREARM BONES # CLOSED TIBIAL # CRUSH INJURIES TO LEG & FOREARM ACUTE EXERTION DURING SPORT

12. DIAGNOSIS SIGNS: STRETCH TEST – EARLIEST SIGN TENSE COMPARTMENT HYPOAESTHESIA OF INVOLVED NERVES MUSCLE WEAKNESS COMPARTMENTAL PRESSURE OF >40 MM OF H2O

13. SYMPTOMS: EXCESSIVE PAIN THE "5 P'S" ARE OFTENTIMES ASSOCIATED WITH COMPARTMENT SYNDROME:  PAIN PALLOR (PALE SKIN TONE) PARESTHESIA (NUMBNESS FEELING) PULSELESSNESS (FAINT PULSE) AND PARALYSIS (WEAKNESS WITH MOVEMENTS).

14. TREATMENT EARLY PREVENTION – LIMB ELEVATION, ACTIVE FINGER MOBILIZATION EARLY SURGICAL DECOMPRESSION EG: FASCIOTOMY

15. OUTCOMES ISCHEMIC MUSCLE NECROSIS MUSCLE FIBROSIS – VOLKMANS ISCHEMIC CONTRACTURES NERVE DAMAGE MOTOR SENSORY LOSS GANGRENE

16. DELAYED UNION AND NON-UNION DELAYED UNION: A "DELAYED UNION" IS WHEN A FRACTURE TAKES LONGER THAN USUAL TO HEAL. NON UNION: MOST AGREED-UPON STANDARD DEFINITION OF NONUNION MADE BY THE FDA IS A FRACTURE THAT PERSISTS FOR A MINIMUM OF NINE MONTHS WITHOUT SIGNS OF HEALING FOR THREE MONTHS.

17. CAUSES: RELATED TO PATIENTS: AGE – COMMON IN OLD AGE ASSO SYSTEMIC ILLNESS EG: MALIGNANCY, OSTEOMALACIA

18. RELATED TO FRACTURE: DISTRACTION AT FRACTURE SITE MUSCLE PULLING EG: PATELLA & OLECRANON # GRAVITY EG: # SHAFT OF HUMERUS SOFT TISSUE INTERPOSITION EG: # SHAFT HUMERUS, FEMUR BONE LOSS AT THE # SITE INFECTION FROM OPEN # DAMAGE/POOR BLOOD SUPPLY EG:# NECK OF FEMUR, L/3 RD TIBIA PATHOLOGICAL #

19. RELATED TO TRETMENT: INADEQUATE REDUCTION INADEQUATE IMMOBILIZATION DISTRATION DURING TREATMENT

20. TYPES OF NON UNION

21. CLINICAL FEATURES PERSISTANT PAIN PAIN ON STRESSING THE # UNNATURAL MOBILITY (NONUNION) INCREASING DEFORMITY

22. X-RAY FINDINGS FRACTURE LINE IS VISIBLE INADEQUATE BRIDGING CALLUS (DELAYED) NO BRIDGING CALLUS (NON-UNION)

23. TREATMENT BONE GRAFTING BG + INTERNAL FIXATION EXCISION OF FRAGMENT EG: # NECK OF FEMUR IN ELDERLY (HEMIARTHROPLASTY) ILIZAROV’S METHOD

24. MALUNION # UNITES IN IMPROPER POSITION DISABILITY OF CLINICAL SIGNIFICANCE EG: DEFORMITY, SHORTENING, LIMITATION OF MOTION IMPROPER TREATMENT COMMONEST EG: COLLES #, CLAVICLE

25. TREATMENT OSTEOCLASIS CORRECTIVE OSTEOTOMY NO TREATMENT – REMODELLING CHILDREN, 5 TO 10 DEG OF ANGULATION, ANGULATION IN THE PLANE OF MOVEMENT, #’S NEAR JOINT

26. THANK YOU