Fracture disease

orthopaedic Fracture disease

1. Fracture diseases Dr . Arhab Alshabi Resident Orthopaedic Surgery

2. Definition: it is the complication of fracture treatments due to prolong immobilisation .

3. Principle of fracture treatment : - anatomical reduction - rigid fixation - preservation of soft tissue -Early Active Mobilisation

4. The fracture Diseases include : - Musculoskeletal. -Cardiovascular .

5. Musculoskeletal: - muscle weakness, atrophy - Soft tissue Contracture. - Osteoporosis - Joint Stiffness. - Skin Atrophy Cardiovascular : - Increase the hart rate ,circulatory dysfunction. - Orthostatic hypotension. - venous Thromboembolism, pulmonary problem.

6. Muscle weakness: - it is the most obvious effect of prolonged Immobilisation ,muscle at complete rest loss about 10-15 % of it’s strength in each week. - Half of normal strength loss within 3-5 weeks of immobilisation . - First muscle become weak and atrophy are those of lower extremities . - muscle strength can be maintain without loss or gain with daily muscle contraction. - Unfortunately the rate of recovery from weakness is slower than rate of loss.

7. Muscle Atrophy : -It is the loss of muscle mass. normal muscle at rest loss half of their bulk after 2 months . Soft tissue Contracture : The connective tissue contain collagen fibbers that maintain the muscle length if frequently stretching , but shorten if immobilised which lead to contracture.

8. Disuse Osteoporosis : Like connective tissue ,bone is dynamic tissue ,the constant equilibrium is maintain between the bone formation and desorption of bone density depend on force that act upon bone. Joint stiffness: - it’s limitation of movement , after periods of inactivity. Skin atrophy : - decrease circulation in skin due to pressure in immobilisation patient then ischemia ,skin breakdown and ulcer .

9. Cardiovascular: Prolonged immobilisation stimulate sympathetic nerve system activity ,increase the heart rate ,less diastolic filling time ,shortened systolic ejection end by circulatory dysfunction . venous thromboembolism and pulmonary problem : Due to venous stasis in the leg following decrease contraction of Gastrocnemius ,solus muscle the emboli formation. may occur within 7-10 days of immobilisation. characteristic by pain, tenderness, swelling, venous distension, in the calf muscle and confirm by Doppler study .

10. Prevention: -Proper fixation (rigid fixation) -free pain early mobilisation and as soon as pt.'s can. - Daily muscle stretching ,contraction for 20-30 seconds. - ROM of adjacent joint below and above the fracture. -leg stocking to prevent DVT -anticoagulant ,antiplatelet drugs -change patient position every 2H.

11. Thank You Prepared by : Arhab Alshabi