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Fracture -
violation of the integrity of the bone throughout,
caused by mechanical action or

influence of pathological

process in bone
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Classification by etiology

ÿ Traumatic (trauma) ÿ
Pathological, occurring
due to damage to bone tissue (tumor,
osteomyelitis, osteodystrophy,
osteoporosis)
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ÿ A complete fracture is
an injury in which the plane of the
fracture passes through the entire diameter
of the bone

ÿ Incomplete fracture - damage in which the fracture

plane does not pass through the entire diameter
of the bone (fracture, subperiosteal fracture -
like a "green branch"), the connection between the
parts of the bone is partially broken
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Origin Classification

ÿ Congenital (intrauterine) ÿ Acquired

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Classification by type of
fracture

ÿ Closed fractures ÿ Open

fractures - damage in which there is a violation of
the integrity of the skin and mucous
membranes (primarily infected) ÿ
Complicated - accompanied by
damage to large vessels, nerve trunks,
joints, brain and spinal cord and other
internal organs
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Complications of fractures
ÿ Traumatic shock ÿ Open
fracture ÿ Damage to
internal organs ÿ Bleeding, pulsating

hematoma
ÿ Fat embolism ÿ
Thrombosis of arteries, superficial and
deep veins ÿ
Wound infection, osteomyelitis ÿ Sepsis
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Classification by
anatomical localization

ÿ Diaphyseal ÿ
Epiphyseal ÿ
Metaphyseal
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Classification by fracture plane

1. Transverse 2.
Oblique
3. Helical 4.
Longitudinal 5.
Comminuted
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ÿ Fractures without displacement

ÿ Displaced fractures
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Types of displacement

1. Width 2.
Length 3.
Angled 4.
Rotary
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Factors Determining
Fracture Severity
ÿ Injury localization ÿ Direction
of the damaging force ÿ Value of the
damaging force (high speed / low
speed) ÿ Age of the
patient
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Examination of the patient

1. Determining the mechanism of injury
(history): fall from a height, fall on an
outstretched arm, fall on an adducted
arm, knee blow 2. Clinical examination
(complaints,
examination, palpation, measurement of the
length and volume of the limb,
determination of joint
mobility) 3. X-ray examination
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Fracture symptoms
ÿ Absolute fracture symptoms: 1.
Characteristic deformity 2.
Pathological mobility 3. Bone
crepitus ÿ Relative
symptoms:
1. Local pain
2. Swelling 3.
Dysfunction
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Types of deformation
ÿ thickening and enlargement
circles - with transverse displacement

ÿ violation of the axis, curvature - with axial

displacement
ÿ shortening or lengthening - when offset along the
length
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Conditions that determine

the fusion of bone fragments 1.
General factors (age, chronic
diseases, metabolic
disorders , malnutrition)
2. Anatomical and physiological
features (flat and
tubular bones) 3. Local factors
(injury severity, circulatory
disorders, impaired
innervation, intra-articular
fractures , incomplete reposition
and fixation, infectious
complications, soft tissue interposition
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Principles of fracture treatment

1. Anesthesia (local, conductive, general) 2.
Reposition of bone fragments -
manipulation of the peripheral fragment and its
establishment in relation to the central one in an
anatomically correct position

3. Immobilization - retention and

creation of immobility of the matched
fragments

4. Therapeutic exercise 5.
The use of stimulants
regeneration process
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REPOSITION

Closed open

gradual Simultaneous

Hardware Manual
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Types of immobilization
1. Plaster cast (longet or circular) 2.
Permanent
traction (skeletal, cutaneous)

3. Osteosynthesis
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First aid for fractures

1. Stop bleeding 2. Prevention
and treatment of shock 3. Transport
immobilization 4. Application of aseptic

bandages
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Fracture treatment methods

1. Conservative treatment - closed reposition
and immobilization with a plaster cast

2. Skeletal traction
3. Surgical treatment (focal osteosynthesis):
• Intromedullary
• Extramedullary 4.
Extrafocal osteosynthesis
(compression - distraction)
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plaster overlay rule

bandages

1. Physiological (functionally advantageous)

position of the limb 2. The bandage
must cover at least 2 adjacent joints

3. The bandage is not twisted, but cut 4. Good

reposition of bone fragments 5. The distal parts
of the limb should remain open 6. The
bandage should fit, but not

compress the underlying part of the body

(prevention of bedsores)
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Principles of permanent
traction
1. Traction is carried out in the
average physiological
position

2. Reposition is carried out along the axis

central bone fragment
3. Pulling load
increases gradually
4. It is necessary to create
countertraction
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indications for skeletal

traction
1. Diaphyseal fractures of the femur 2.
Diaphyseal fractures of the leg bones 3. Lateral
fractures of the femoral neck 4. Compound
fractures in the region
ankle joint 5. Humerus
fractures 6. Failures of
simultaneous closed
manual reposition with a pronounced
displacement of fragments
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Indications for surgery

treatment
1. Absolute
ÿ Open fractures ÿ Damage
to internal organs ÿ Interposition of soft
tissues ÿ False joint ÿ Pyoinflammatory
complications

ÿ Ill-healed fractures with gross impairment of

function 2. Relative ÿ
Unsuccessful attempts at
closed reduction ÿ Transverse fractures of long
tubular
bones
ÿ Delayed consolidation ÿ Improperly
healed fractures with
minor impairment of function
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Indications for extrafocal

osteosynthesis
1. Closed and open complex
fractures of long tubular bones 2. Intra-
articular fractures 3. Pronounced
displacement of bone
fragments

4. Multiple fractures 5. False joints,

delayed consolidation 6. Fractures
complicated by
infection 7. Severe deformity, shortening

limbs
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dislocation -

complete displacement of the articular

ends of the bones that articulate
with each other in relation to each other,
which is accompanied by a rupture
of the capsule and ligamentous apparatus
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dislocations

Congenital Acquired Habitual

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Acquired dislocations 1.
Depending on the origin • Traumatic
- due to the action of trauma
• Pathological
- due to joint disease with
destruction of the
articular surface
2. Downstream
• Complicated
• Uncomplicated

3. In relation to the external environment

• Open •
Closed
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Dislocation Clinic
1. The mechanism of injury is a fall on
limb, sharp overextension of the limb in
the joint, direct blow to the joint area 2.
Sharp pain in the
joint area, palpation soreness, finding
the head of the bone in an unusual
place, springy resistance 3.
Impossibility of active and passive
movements 4.
Deformity in the joint area

(forced position of the limb, shortening,

lengthening, changing the axis of the limb)
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Treatment of dislocations

1. Conservative treatment: •
reduction of dislocation
• Immobilization with a plaster bandage
or splint
2. Surgical treatment (indications)
• Open dislocations •
Irreducible fresh dislocations • Chronic
dislocations • Habitual
dislocations
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