Principles of Fracture Treatment：骨折的治疗原则

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Principles of Fracture Treatment,Definition of Fracture,It is disruption of bone continuity.,Although most of #s occur as a result of a single episode by a force powerful enough to fracture a normal bone, there are 2 types of # in which this is not so :,Pathological fract.,Stress fract.,Pathological fracture :,It is one in which a bone is broken through an area weakened by pre-existing disease , & by a degree of force that would have left normal bone intact e.g osteoporosis , O.M. , bone tumours.,Stress fracture :,Bone , like other materials , reacts to repeated loading . On occasion , it becomes fatigued & a crack develops e.g military installations , ballet dancers & athletes.,Diagnosis,Clinical picture,Radiography,Clinical Features of Fracture,History of trauma,Symptoms & signs:,1. Pain & tenderness 2. Swelling,3. Deformity 4. Crepitus,5. Loss of function 6. Abnormal move.,7. N.V. injuries,Radiographic Findings,Plain x-ray: should show joint above & joint below , in at least 2 views , special views on request.,C.T.,MRI : It is not helpful in fract. diagnosis other than delineating associated injuries to the CNS , S.T. disruption or occasionally fatigue fract.,Fracture Classification,Anat. Location,Direction of fract. Line,Wherther the fract. Is linear or comminuted,Condition of overlying S.T.,Mechnism of injury,AO classification,AO Classification,A :,Simple fract.,B :,Wedge fract.,C :,Complex fract.,AO Classification,AO Classification,B= wedge fract.,B3 wedge fract,fragmented wedge,AO Classification,OPEN AND CLOSED FRACTURES,Mechanism of Injury Classification,Direct trauma,Indirect Trauma,Direct trauma :,Tapping fractures,Crushing fractures,Penetrating fractures,- High velocity missiles 2500 f/s,- Low velocity missiles 2500 f/s,Indirect Trauma :,Traction or tension fract.,angulation fract.,Rotational fract.,Compression fract.,Fracture Management,Fracture Management,Emergency care,(splinting),Definitive fracture treatment,Rehabilitation,Emergency care,(splinting),Splint them where they lie.,Adequate splinting is desirable , why ?,Types of splints :,- improvised,- conventional,Definitive fracture treatment,The goal of fracture treatment is to obtain union of the fracture in the most anatomical position compatible with maximal functional return of the extremity.,Conservative,Operative,Conservative,Reduction : if displaced, under G.A. the sooner the better.,steps :- traction , align (which fragment), reverse mechanism of injury.,Immobilization : POP cast , slab , traction (fixed or balanced).,Rehab.,CLOSED, UNDISPLACED,CLOSED, REDUCIBLE, CONSERVATIVE TREATMENT,2- CAST,Below Knee,Above Knee,POP,(Plaster Of Paris),POP,Slab or Splint,Traction,Operative,ORIF (open reduction internal fixat.),Percutineous pinning,External fixation,Indications of ORIF,- absolute,- relative,Types of Internal Fixation,- Pin & wire fixat.,- Screw fixat.,- Plate & screws fixat.,- Intra-medullary fixat.,Plate & screws fixat.,Functional types:,Compression plates,Neutralization plates,Buttress plates,Bridge plates,LC- DCP,Liss plates,Locking plates & screws,Intra-medullary fixat.,Centro-medullary,- Unlocked,-Interlocking(static,dynamic,double locked),Condylocephalic,Cephalomedullary,CONTRAINDICATIONS TO SURGICAL REDUCTION AND STABILIZATION,Situations in which there is a high probability for failure with operative treatment are as follows:,1.,Osteoporotic bone that is too fragile to allow stabilization by internal or external fixation.,2. Soft tissues overlying the fracture or planned surgical approach of such poor quality because of scarring, burns,active infection, or dermatitis .,3. Active infection or osteomyelitis.,4. Fracture comminution to a degree that does not allow successful reconstruction. This is most commonly seen in severe intraarticular fractures.,5. General medical conditions that are contraindications to anesthesia are generally contraindications to the surgical treatment of fractures.,6. Undisplaced or stable impacted fractures in acceptable position do not require surgical exposure or reduction.,7. Inadequate equipment, manpower, training, and experience.,Rehabilitation,When ?,How ?,External fixat.,Advantages.,Disadvantges.,Complications.,Indications.,Frame,Thank you,