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Fractures - Diagnosis and Management

This document discusses the diagnosis and management of fractures. It covers the clinical presentation of fractures including signs and symptoms as well as investigations like x-rays and other imaging tests. The management of fractures involves emergency measures, reduction of the fracture, immobilization using casts, splints or other devices, and rehabilitation. Complications can occur early on due to the injury itself or later due to issues with healing or treatment methods. The overall goal in managing fractures is to return the patient's function through anatomical reduction, immobilization and rehabilitation.

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drthanalla
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278 views28 pages

Fractures - Diagnosis and Management

This document discusses the diagnosis and management of fractures. It covers the clinical presentation of fractures including signs and symptoms as well as investigations like x-rays and other imaging tests. The management of fractures involves emergency measures, reduction of the fracture, immobilization using casts, splints or other devices, and rehabilitation. Complications can occur early on due to the injury itself or later due to issues with healing or treatment methods. The overall goal in managing fractures is to return the patient's function through anatomical reduction, immobilization and rehabilitation.

Uploaded by

drthanalla
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Fractures

Diagnosis
&
Management
Diagnosis

• Clinical picture plus investigations


• Fracture is a clinical diagnosis and should
not be missed
• X-rays are mainly for confirmation of
diagnosis and for radiological classification
Complaints

• History of trauma: mechanism of injury


• Acute Severe pain: increases even with
slight movement
• Loss of function
• Swelling
• Deformity and abnormal movement –
witnesses
Signs

• Deformity
• Abnormal movement
• Tenderness
• Swelling
• Presence of wound
• Crepitus
Investigations

• Radiology
• X-rays: easy quick and confirm diagnosis
• Plain X-ray: Rule of 2, 2 views, 2 sides, 2
joints and 2 occasions
• Immobilize before x-ray
• Radiological pattern – line of #: transverse,
oblique, spiral, comminuted, greenstick
• Displacement is the movement of fractured
fragments relative to each other
• Degree of displacement – shift, tilt, twist
• Shift is movement in the horizontal plane –
lateral, antero/posterior
• Tilt is angulation
• Twist is rotation
• MRI and Ct scan can diagnose early hair-
line fractures in small bones and when plain
radiology fails
• Bone scan can show increased uptake
• Other investigations to prepare the patient
for management – assess general condition
Management

• Emergency measures: analgesia, splintage


• Management of multiple injured patient –
ATLS
• Treatment of open fractures
• Fracture management
• Three principles
• Reduction
• Immobilization
• Rehabilitation
• Perfect anatomical reduction is not the aim
but best functional outcome
Reduction

• Requires anaesthesia to achieve muscle


relaxation and pain relief
• To return the fractured fragments together
• May be closed or open(internal fixation is
then used)
• Radiology may be used to aid procedure
Immobilization

• To maintain the fractured fragments in


position till union occurs
• External splintage: casts and braces
• Internal fixation: screws, wires, nails and
plates
• Traction: skin or skeletal
• External fixation
• Plaster should be removed when there is
clinical and radiological evidence of union
• Traction and external fixation are stopped
when other means can be used
• Internal fixation may or may not be
removed
Rehabilitation
• To return patient back to maximal physical
and psychological activity
• Physical therapy – begins as soon as
possible even in hospital
• Increased as and when patient’s injuries
allow
• Return patient back as useful member of
society
Complications

• Early – either due to the injury or injury of


associated structures
• shock – hypovolaemic or neurogenic
injury to nerve or vessel
haemarthrosis
• Some are fracture specific
• Intermediate – few days to early weeks
• compartment syndrome
• infection, gas gangrene tetanus
• fracture blisters
• pressure sores
• Late – weeks to months
• union problems – delayed, non, mal
• joint stiffness and instability
• muscle weakness, muscle contractures
• myositis ossificans
• nerve compression
• avascular necrosis
• Complications related to modality of
treatment
• Surgery: infection, sepsis
• Traction: problems related to recumbency
• Plaster: plaster disease
• death

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