Fractures and dislocations

1. Wherever the art of medicine is loved, there is also a love of humanity. – Hippocrates

2. Overview of Fractures and dislocations Yahyia Khalfan Mohammed Al- Abri 90440 Junior

3. Definitions Causes of fractures fracture classification Clinical features of fractures Pain control in fractures Fractures treatment Dislocation Clinical features of dislocations Outline

4. What is fracture ? Is a break in the structural continuity of bone. What is dislocation? The joint surface is completely displaced and are no longer in contact. Definitions

5. Sudden trauma. Most common Direct vs indirect Stress and fatigue fractures . Most in tibia , fibula , and metatarsal. Pathological fractures osteoporosis , osteogenesis imperfecta ,Paget's disease ,bone cyst and metastasis. Causes of fractures

6. fracture classification Displacement Pattern Location Integrity of Skin and Soft Tissue

7. Closed ( simple ) skin/soft tissue over and near fracture is intact open ( compound ) skin/soft tissue over and near fracture is lacerated or abraded, fracture exposed to outside environment Integrity of Skin and Soft Tissue

8. Name of bone? Right or left ? Where in the bone? Epiphyseal end of bone, forming part of the adjacent joint Metaphyseal the flared portion of the bone at the ends of the shaft Diaphyseal the shaft of a long bone (proximal, middle, distal) Physis growth plate Location

9. Pattern Complete Transverse Oblique Butterfly Segmental Spiral Comminuted Avulsion Compression/impacted Incomplete Greenstick Torus Stress fracture Compression Fractures

10. Orientation/Fracture Pattern Transverse O blique B utterfly Segmental Spiral Comminuted/ multi-fragmentary Avulsion Compression/impacted Green-stick Torus

11. Questions

12. Non-displaced Displaced Angulated Rotated Distracted Translated Displacement

13. Non-displaced : fracture fragments are in anatomic alignment Displaced: fracture fragments are not in anatomic alignment Displacement

14. Displacement Angulated : direction of fracture apex, e.g. varus / valgus Rotated : fracture fragment rotated about long axis of bone

15. Distracted : fracture fragments are separated by a gap Translated percentage of overlapping bone at fracture site Displacement

16. Sign and symptoms pain and tenderness Swelling or bruising Deformity Loss of function bone protruding Numbness and tingling. Crepitus

17. History History of injury followed by inability to use the injured limb. Age and mechanism of injury. If fracture occurs with trivial trauma suspect pathological lesion. Pain, swelling and bruising are common symptoms but they do not distinguish a fracture form soft tissue injury. Deformity more suggestive Symptoms of associated injury( numbness or loss of movement , skin pallor or cyanosis, blood in the urine, difficulty with breathing or transit lose of consciousness) get distract by the main injury. Pervious injury or musculoskeletal problems( confusion with the x-ray) General medical history (preparation for anesthesia or operation) Clinical features( history)

18. Clinical features( Examination) look feel Move

19. Look: Swelling, bruising and deformity skin is intact? posture of the distal extremity and the color of the skin (for tell-tale signs of nerve or vessel damage). Feel: Palpate for tenderness Test for vascular and peripheral nerve abnormalities Move: Crepitus and abnormal movement Examination

20. Crepitus and abnormal movement should be tested for only in unconscious patient. Usually it is more important to ask if the patient can move the joint distal to the injury. Move

21. X-Ray is mandatory (rule of two) Two views Two joints Two limbs Two injuries Two occasion Imaging

22. Pain control in fractures Pharmacological: systemic analgesia ( e.g morphine, NSAIDS) Nerve block neuraxial anesthesia  ( spinal and epidural anesthesia )

23. Non-pharmacological: Transcutaneous Electrical Nerve Stimulation (TENS ) stabilization of the fracture using traction

24. The general aim of early fracture management is to control hemorrhage, provide pain relief, prevent ischemia-reperfusion injury, and remove potential sources of contamination (foreign body and nonviable tissues) Fracture treatment

25. Fractures treatment Reduce Hold Exercise

26. Reduce (Closed reduction ) 1-Pull the distal of the limp 2-Reposition (reverse the original direction) 3- Alignment is adjust in each plane.

27. Open reduction Operative reduction When to use it?? When closed reduction failed When there is large articular fragment that needs accurate positioning Avulsion fracture When an operation needed for associated injuries Arterial damage Reduce (open reduction )

28. The aim is to Splint the fracture, not necessarily entire limp. Hold Sustained traction Cast splintage Functional bracing Internal fixation external fixation

29. More correctly restore function not only to the injured part but also to the patient as whole. The objective are to Reduce edema Preserve joint movement Restore muscles power Guide patient to normal activity Exercise

30. The aim is to try to prevent them from becoming infected : the four essentials are: Open fracture Early definitive wound cover Stabilisation of the fracture Debridement Antibiotic prophylaxis

31. Common site of dislocations The most commonly dislocated is the shoulder joint. [13 ] Elbow : Posterior dislocation, 90% of all elbow dislocations [14] Wrist: Lunate and Perilunate dislocation most common [15] Finger: Interphalangeal (IP) or metacarpophalangeal (MCP) joint dislocations [16] Hip: Posterior and anterior dislocation of hip

32. A dislocated joint may be: Accompanied by numbness or tingling at the joint or beyond it Intensely painful, especially if you try to use the joint or put weight on it Limited in movement Swollen or bruised Visibly out of place, discolored, or misshapen Acutely dislocated joint clinically

33. Diagnosis History: pain, swelling, characteristic posturing, and the inability to move Physical examination: Shoulder dislocation: Arm in a characteristic position of external rotation and slight abduction Fullness anteroinferior to the coracoid process is palpable

34. Elbow dislocation: elbow held in flexion significant amount of soft tissue swelling around the elbow Finger dislocation: oedema and ecchymosis (bruising ) Patellar dislocation swollen knee held in flexion and no obvious lateral prominence often associated with haemarthrosis (bleeding into joint spaces)

35. Hip dislocation: Posterior hip dislocation is with the hip in a position of flexion, internal rotation, and adduction Anterior hip dislocations, the hip is classically held in external rotation, with mild flexion and abduction.

36. Imaging Anteroposterior x-ray view of a shoulder showing an anteroinferior dislocation Anteroposterior x-ray view of an elbow dislocation

37. Comprehensive medical reference and review for the Medical Council of Canada. Apley's concise system of orthopaedics and fracture Medscape radiologymasterclass.co.uk Pain Management Interventions for Hip Fracture( http://www.ncbi.nlm.nih.gov/books/NBK56661/ ) References