1. General Principles of Fractures Muhammad Shahiduzzaman Professor and Head Department of Orthopaedic Surgery Dhaka Medical College

2. Definition Break in the continuity of bone. It is basically a soft tissue trauma where the bone happens to be broken.

3. Types of Fractures Simple or Closed Bone can break within its soft tissue envelope and may not communicate to the exterior. Compound or Open When the fracture haematoma communicates with the exterior.

4. Types of fracture..

5. Types of fracture Based on extent of fracture line: Incomplete Fracture Complete Fracture – Displaced, Undisplaced Based on fracture pattern : Linear fractures- Transverse, oblique, spiral Comminuted Fractures. Segmental fractures

8. Types of Fracture

9. Types of Fracture Depressed # Compression #

10. Remember Greenstick fracture-occurs in children. Stress fracture- common in athletes. Fatigue fracture- in occupation like police Pathological fractures-usually seen in elderly.

11. Approach to Orthopaedic injury History Age: Birth, early childhood, Late childhood Adult, Elderly. Sex Mechanism of injury

12. Clinical Features Symptoms: Pain, Swelling, deformity, inability to use the affected part. O/E Look – Deformity, swelling, Shortening Feel: Tenderness, Move : Abnormal mobility, Crepitus

13. Remember Clinical manifestation in a fracture is due to : Fracture per se ,Its complications or both Impendening vascular damage is detected by five ‘P’ Pain, Pallor, Paraesthesia, Pulselessness, Paralysis

14. Investigations in Orthotrauma Radiography- most important diagnostic tool for fractures. Minimum two views (AP and Lateral) are required. Sometimes an oblique and other special views are required. CT Scan and MRI – both are noninvasive and extremely useful in detecting both soft tissue and bony injury.

15. Remember the rules in X-ray Better no X-ray than one view X-ray X-ray is a shadow. It conceals and distorts so Interpret x-ray with caution. A joint above andjoint below should be included with the fracture under study. Read x-ray holding it in anatomical position. Exposure should be adequate.

16. Management of Fracture The goal of fracture management is to restore the anatomy back to its normal or near to normal as possible. The responsibility of the doctor is to ensure that there is no functional disability to the patient following the treatment of fracture.

17. Management of fractures Can be discussed under the following : Management of closed uncomplicated fracture Management of open fracture Management of complicated fracture.

18. Management of closed fracture Managed by conservative or operative methods. Conservative methods : For undisplaced #,incomplete #,Impacted # : Collar and cuff sling, Strapping, plaster slab, For displaced fracture : the aim is to restore anatomy as near as possible by either closed or open reduction.

19. Management of Closed fracture

20. Management of # by closed reduction Resuscitation, Reduction Retention Rehabilitation

21. Fracture management by open reduction Where closed reduction fails Displaced intra articular fractures Type III and IV epiphyseal injuries Major avulsion fracture Nonunion Multiple fractures

22. Retention after open reduction Fracture fragments invariably needs to be fixed by various implants. Choice of implants K-wire Intramedullary nails Plate and screw Interlocking nail Hip implants, Spine implants, Steel wires

23. Implants for Retention

24. Remember Success by open reduction depends on : Proper indication Proper timing Proper Surgical approach Proper technique Proper selection of implant Proper Surgeon

25. Thank Youforyour attention