Definition - Discontinuity of bone.

Classification

• Open (compound)

• Closed

Most fractures are secondary to trauma although pathological fractures secondary to tumours, infections osteoporosis and congenital deformities also occur.

COMPOUND FRACTURES

Fractured bone segments communicate with wound “in” or “through” the skin in these cases and these fractures are always contaminated

CLOSED FRACTURES

The bone fragments do not communicate with the skin

Clinical Features

• Pain

• Swelling

• Loss of function

• Abnormal movements/deformity/crepitus

• Signs of blood loss and neurovascular complications e.g. pulselessness, cold extremity and bleeding. Always look for compartment syndromes.

Investigations

• Hb, PCV

• Group and cross match blood for fractures of major bones

• AP and Lateral x-rays of the affected bones. Some fractures may need special views e.g. hip fractures

Management

• Relieve pain and immobilize fracture.

This prevents soft tissue damage and also reduces pain

• Reduce under sedation or general anaesthesia

• Immobilize with POP, traction or splints e.g. Thomas or Braun splint

• Fixation - This can be internal or external.

Period of immobilization

Upper limbs (Adults) 6-8 weeks, (Children) 3-4 weeks

Lower limbs

- Femur (Adults) 12 weeks (Children) 6 weeks
- Tibia (Adults) 8-10 weeks (Children) 4 - 5 weeks.

Check x-ray before removing the splint.

Check for neurovascular complications and if present split the plaster or decompress the affected compartment

Hazards of POP

Reassess patient after application of POP to avoid the first two of the following:

Complications

• Compartment syndrome

• Gangrene and even loss of limb

• Stiffness of joint

• Contractures

OPEN FRACTURES

The management is as for closed fractures except that these are contaminated and the following should be done first:-

• Thorough surgical toilet and debridement (in theatre)

• Give tetanus toxoid and antibiotics

• External fixation is preferred for these fractures

Delayed healing may occur due to:

• Poor immobilization

• Poor reduction

• Poor blood supply

• Infections

• Soft tissue interposition and

• Systemic diseases

Complications

Include: Fat embolism, neurovascular injuries, infections, joints stiffness, non union, mal- union and delayed union

Rehabilitation

• Physiotherapy

• Occupational therapy