FRACTU RES

SURGERY DEPARTMENT
MEDICAL FACULTY YARSI UNIVERSITY
JAKARTA
2008

 Loss of bony continuity

Bony disruption

 Compound fractures

Simple fractures

 Direct violence

Indirect violence

 Pathological fracture
Osteoporosis
Secondary metastases

 Hair line fracture

Greenstick fracture
Greenstick fracture
March fracture

Fracture type
Depends on
Anatomic location
Region (diaphysis , metaphysis,

epiphysis, intra/extra articular)

Fracture lines (transverse, oblique,
spiral)
Condition of bone (comminuting,
pathologic, incomplete, segmental)

 Bone loss
Butterfly fragment
Stress fracture
Avulsion and impacted fracture
Deformities (length discrepancy,

angulations, rotation, translation)

Alignment

D iagnosis
1. Anamnesis
Mechanism of injury, history
A fracture is suspected from history and clinical
examination, and confirmed by radiography

2.

Physical examination

Look
Asymmetry of contour
Comparing one side with the other
Displaced, angled
Local bruising, swelling, laceration
Asymmetry of posture

Femoral neck fracture with external rotation

Angulations, shortening

 Feel
Crepitus, tenderness

Movement
false moving/ pseudoarthrosis

Assess NVD and compartment

syndrome!

N eurovascular disturbance
Neurologic
Sensor and motor fx distal to fracture

site

Vascular
Pulse palpation
Capillary refill
Warm or cold skin
Color of skin

 Compartment syndrome
Pain
Pale
Parestesia
Paralysis
Pulseless

Pain on passive stretching of the muscle

intracompartment

3.Radiologicalexam ination
Two projection
Standard projections AP and lateral

Two articulation
Above and below , dislocation?

Two extremity
Comparison, especially in child

Two times
Hair line, callus formation

FRACTU RE com plications

Delayed union
Non union
Atrophic nonunion
Hypertrophic nonunion

M ed m alleolar nonunion

D iabetic nonunion

D iabetic nonunion

Pseudoarthrosis nonunion

M alunion

Colles m alunion

Bone infection,osteom yelitis

Bone infection,osteom yelitis

D ebridem ent /guttering

 Joint contracture, stiffness

Limb shortening
Compartment syndrome
NVD
Avascular necrosis
Heterotrophic ossification

M anagem ent
Closed reduction
Splinting
Casting
Traction technique
Skin traction
Skeletal traction
Steinmanns pin

 Open reduction

 Splintage
Allows sliding between implant and bone

Bridging
To bridge an area of comminution

 Kirschner wire
Lag screw

 Kirschner

wire

 Kirschner

wire

 Kuntcher nail
Screw

 Plate and

screw

 External

fixator

Rehabilitation
Extremely important
Part of fracture management
Regain optimal function asap
Arrangements
Restoring ROM
Stretching
Strengthening

decrease pain and swelling

 Lower extremity
Cane
Crutch
walker

Fracture healing
Inflammation stage
Bleeding at fracture site
Source of hemopoetic cells

Proliferation
Fibrovascular tissue developed
Osteoblast, fibroblast proliferate

Repair stage
Primary callus or bridging callus occur 2wks
Fibrocartilage developed
Soft callus to hard callus (woven bone) by ossification
Medullary callus can supplements the bridging callus

 Remodeling stage
From midpoint repair until the fractures heal

clinically (up 7 yrs)

Woven bone replaced by lamellar bone
Bone assume its normal configuration

If there is anomaly in biological bone formation

in healing process, there will be disturbance in
the union of fractures, ex delayed or
nonunion.

Factors affecting fracture healing

Type of bone
cancellous bone
cortical bone
Patients age
Mobility fracture site
Separation bone ends
Infection
Joint involvement
Bone pathology
Disturbance of blood supply

Thank you