4 - Treatment of Fractures

4 - Treatment of Fractures - Treatment of Fractures...

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Treatment of Fractures Prepared by: Ola Ahmad Abu-Laban 20052010056 Gp D1
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Principles of Treatment Treat the Patient, not only the fracture Treatment of the fracture: Manipulation Splintage Joint movement and function: must be preserved Exercise and early weight bearing Main obj’s = REDUCE! HOLD! EXERCISE!
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The Fracture Quartet Dual Conflict Hold vs Move Speed vs Safety
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Closed Fractures REDUCTION No undue delay in attending to the fracture Reduction unnecessary when: There is little or no displacement Displacement does not matter Reduction is unlikely to succeed Aim of reduction Adequate apposition Normal alignment of the bone fragments Methods of reduction Manipulation Mechanical traction Open operation
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1. Manipulation Closed manipulation is suitable for 1. All minimally displaced fractures 2. Most fractures in children 3. Fractures that are likely to be stable after reduction Unstable fractures are sometimes reduced ‘closed’ prior to mechanical fixation Three fold maneuver: under anesthesia and muscle relaxation 1. The distal part of the limb is pulled in the line of the bone 2. The fragments are repositioned as they disengage 3. Alignment is adjusted in each plane
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2. Mechanical Traction Some fractures are difficult to reduce by manipulation They can often be reduced by sustained mechanical traction, which then serves also to hold the fracture until it starts to unite In some cases, rapid mechanical traction is applied prior to internal fixation
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3. Open Operation Operative reduction under direct vision is indicated: 1. When closed reduction fails 2. When there is a large articular fragment that needs accurate positioning 3. For avulsion fractures in which the fragments are held apart by muscle pull 4. When an operation is needed for associated injuries 5. When a fracture will anyhow need internal fixation to hold it
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Hold Restriction of movement Prevention of displacement Alleviation of pain Promote soft-tissue healing Try to allow free movement of the unaffected parts Splint the fracture, not the entire limb Methods of holding reduction: Sustained traction Cast splintage Functional bracing Internal fixation External fixation Closed vs. operative methods
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Traction is applied to the limb distal to the fracture, so as to exert a continuous pull in the long axis of the bone In most cases a counterforce will be needed Particularly useful for spiral fractures of long-bone shafts, which are easily displaced by muscle contraction The “hold” is not perfect, but it is “safe” and the patient can “move” the joints and exercise the muscles. The problem is the lack of “speed”
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4 - Treatment of Fractures - Treatment of Fractures...

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