Complication

Muscular complication
Traumatic myositis
ossificans
(posttraumatic
ossification)
Rapidly enlarging
painful tender mass
develop in the injured
tissues
New bone formation in
an abnormal site
Heterotopic ossification

Complication
Neurological
complication
Tardy Nerve Palsy
Remote
Complication
Renal Calculi
Accident Neurosis

Special Types of
Fractures
Stress Fractures (Fatigue
fractures)
Result of repeated stresses and
consequently may develop a
small crack or fatigue fracture
Treatment consist of desisting
from the responsible activity
until the crack has healed.
Subsequently, gradual
resumption of activity result in
sufficient work hypertrophy of
the bone to increase its
strength and gradually
condition it for the stresses of
the particular activity involved

Pathological Fractures
Pathological fracture is one that
occurs through abnormal bone
Bone that is pathological, weaker, and
more suspectible to fracture than
normal bone.
Pathological fractures can occur in
variety of disorders, some localized,
some disseminated, and others
generalized

Classification of Disorders
That Predispose Bone to
Pathological Fracture

Congenital abnormalities
Localized: Congenital defect of tibia
Disseminated: Enchondromatosis
Generalized: Osteogenesis imperfecta,
osteoporosis
Metabolic bone disease: Rickets, osteomalacia
Disseminated bone disorders of unknown
etiology: Polyostotic fibrous dysplasia, skletal
reticuloses
Inflammatory disorders: Hematogenous
osteomyelitis, Tuberculous osteomyelitis, RA

Classification of Disorders
That Predispose Bone to
Pathological Fracture

Neuromuscular disorders: Polymyelitis,

Muscular dystrophy
Avascular necrosis of bone: Posttraumatic
avascular necrosis, postirradiation necrosis
Neoplasms of Bone
Osteogenic: Osteosarcoma, surface osteosarcoma
Chondrogenic: Benign chondroblastoma,
chondrosarcoma
Fibrogenic: fibrosarcoma, Osteofibrous dysplasia
Angiogenic: Aneurysmal bone cyst, angiosarcoma
Myelogenic: Multiple myeloma, Hodgkins
lymphoma

Prognosis of Pathological Fractures

Most pathological fractures will
unite, because the rate of bone
deposition in fracture healing is
usually more rapid than the rate of
bone resorption of the underlying
pathological process
In certain highly malignant primary
neoplasm such as osteosarcoma,
the rate of bone destruction and
resorption may be almost as great
as that of bone deposition
Pathological fractures through
metastatic neoplasm in the limbs
usually merit internal fixation
with /without methylmethacrylate
combined with irradiation and, if
indicated , hormone therapy.

Dislocations and Associated

Injuries
Synovial joints are design to permit
smooth movement through a normal
range that is specific for each joint.
Three structural: Reciprocal contours
of the opposing joint surfaces, integrity
of the fibrous capsule and ligament,
protective of muscles
Dislocation: Structural loss of its
stability Physical factors

Dislocations and Associated

Injuries
Three degrees of joint
instability:
Occult joint instability
(apperent only when the
joint is stressed)
Subluxation: In which the
joint surfaces have lost
their normal relationship
but still retain considerable
contact
Dislocation: In which the
joint surface have
completely lost contact
with each other

Occult joint instability

Dislocations and Associated

Injuries
Subluxation

Dislocation

Associated Injury to the Fibrous

Capsule
Fibrous capsule and contiguous periosteum may be
stripped up from the bony margin of the joint and
stresthed intracapsular dislucation
Fibrous capsule is torn and one bone end perforate
the rent in the capsule extracapsular dislocation
Large bone end becomes trapped in the dislocated
position by the small rent in the capsule
Phenomenon Buttonhole dislocation
Closed of dislocation, a flap of torn capsule becomes
trapped between the joint surfaces, preventing
perfect reduction and resulting in residual
subluxation

Diagnosis of Joint
Injuries
Dislocation and subluxation may go
unrecognized because of inadequate physical
examination and consequent failure to obtain
the appropriate radiographic examination
Physical examination must also include a diligent
search for any associated injury to spinal cord,
peripheral nerves, or major vessels.
At least two projections at right angels to each
other (AP and Lateral) are essential for acurate
diagnosis.

Diagnosis of Joint
Injuries

Normal Healing of
Ligament
Torn ligament heal by fibrous scar tissue
that is not as strong as the normal ligament
Partial tears in a ligament is protected
during the healing process.
Complete tears of ligament, there is usually
a considerable gap between the shredded
ends of ligament
Time required for normal healing of a torn
ligament varies according to its size and the
forces to which it is normally subjected.

Complication of Dislocation and

Associated Injuries
Much the same as those of fracture
Immediate local complication include
associated injury to skin, bv, peripheral
nerves, and spinal cord
Early local complication include infection
(septic arthritis), after open joint injury or
open reduction; and avascular necrosis of
one of the articulating bone end
Late complication include persistent joint
stiffness, persistent joint instability and
recurrent dislocation, etc.

General Principle of Treatment

for Joint Injuries
Fracture treatment are equally
applicable to treatment of dislocation
and associated injuries.
Dislocation and subluxations must be
reduces perfectly to restore normal
congruity of the joint surfaces and
prevent posttraumatic arthritis.
Short-term use NSAIDs,
Corticosteroids is not indicated

Specific Types of Joint

Injuries
Contusion Direct
blow, the synovial
membrane reacts to the
injury by producing an
effusion
Ligamentous Sprain
Sudden stretching of
the ligament with a
minor, incomplete tears
and local hemorrhage
but no loss of continuity

Specific Types of Joint

Injuries
Dislocations and Subluxations
To restore normal congruity to joint surfaces,
perfect reduction ofdislocations and subluxations
must be achieved, by closed manipulation or open
reduction
Torn Ligaments
Complete tear of certain major ligament should be
repaired surgically as soon as possible after injury.
For many other ligaments, the reduced joint needs
to be immobilized to protect the injures ligament
and capsule

Muscle Injuries
When severe tension is
suddenly applied to an
already contracted
muscle, some of the
muscle bundles may
rupture and produce the
painful local lesion
More extensive rupture
occurs at the
musculotendinous
junction of a major muscle

Tendon Injuries
Closed Tendon Injuries
Normal tendon seldom
ruptures even with
strenuous activity
friction or has
degenerated
Sudden tension on a
normal tendon may
avulse a fragment of
its bony insertion

Tendon Injuries
Open Tendon Injuries
Open division of
tendons in most sites
should be treated by
immediate surgical
injury Adhesions
between injured
tendons interfere
significant