Orthopaedics - Define the term fracture.

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ORTHOPAEDICS

1. Define the term fracture.

With aid of a diagram, illustrate the types of fractures.

Fracture means the breakage of a bone, either complete or incomplete.

(Oxford medical dictionary)

For types of fracture see diagram (A)

2. Describe the stages of fracture healing.

The stages of fracture healing are as follows;

After fracture - wound bleeds and fills with clot.

After one week - clot retracts and is removed by phagocytes. Capillaries and

Fibroblasts go to damaged area. These cells have osteogenic potential which

lays Osteoid.

After three weeks - Cartilage and Osteoid is forming around the breakage.

Six to twelve weeks - Osteoid ossifies to form Callus (a cuff of provisional

woven bone).

Six to twelve months - Cortex to cortex union (bone directly joining the

fractured surfaces.

3. Identify the signs and symptoms that lead you to beleive a bone is

fractured.

- Pain. Most common symptom, but people have different pain thresholds, so

sometimes hard to tell. Also depends on the site and how instable it is.

- Swelling. Gross swelling normally means a vascular rupture.

- Weakness

- Loss of function. May be unable to move the limb or have difficulty. E.g.  An

old lady may be able to walk on a fractured neck of femur, but will limp.

- Loss of sensation or motor power. Suggests nerve or vascular damage.

- Tenderness

- Deformity. Limb may be bent or shortened, or with the spine or tibia, it may

be out of alignment.

- Local temperature increase.

4. Identify the methods used in your unit for external fixation of a fracture

and briefly describe one.

-Plaster of Paris

- Cast bracing, back/volar slabs

- Fixed traction (Thomas splint)

- Sliding or balanced traction

- Skin traction

- Bony traction, skeletal e.g. Denham/Steinman

- Simple traction

- Hoffman external fixator and Orthofix for

Femur/Tibia/Pelvis/Ankle/Humerus

- Penning fixator for Radius/Ulna hand fracture

Skin traction.

Adhesive strapping is placed on the limb securely, attached with cord to a

weight on a pulley system. The patients weight is balanced against the applied

load to keep bones in alignment.

5. In what situation may internal fixation be used? Describe any methods

employed in your unit.

To allow accurate reduction and maintenance of position, to allow the patient

more mobility, encouraging rehabilitation and avoiding joint stiffness. It also

encourages union, and shortens time spent in hospital.

Methods employed in our unit include;

Screw fixation.

For small bony fragments, e.g. Malleoli (ankle).

Self tapping screws give a good grip on cancellous bone. Standard thread

screws are screwed into opposite cortex. A single screw placed across

fracture so it bites only into the farther fragment.

Plate fixation.

Designed to apply compression to a fracture for firmer fixation. Used for

ankle, hip, radius and ulna.

Intramedullery nail.

A hollow rod is passed along the medullery cavity, introduced the end of the

bone. It is slotted to give a good grip on the medullery cavity, and because

Join now!

most bones are slightly curved, it works on a three point fixation, with nails

fixed with locking screws.

Wires

Used to hold small bone fragments in position.

Internal fixation should be used when;

- adequate reduction cannot be maintained by external methods (fractures

involving joints).

- When it is important to secure early movement of a limb or joint.

- Certain cases of multiple trauma, where internal fixation of one or more

fractures may make the treatment on other injuries easier.

- Pathological fractures, where union may be uncertain, and patients life

expectancy may ...

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