FRACTURES

Eugene Sherry, MD, MPH, FRACS.

Senior Lecturer,
 Dept. of Orthopaedic Surgery,  
University of Sydney, Australia.

  3 Minute Fracture Talk

Reduce fracture with traction and hold with Plaster Of Paris.

What is it

A fracture is a break in a bone

Fracture in an infant

It can be open (to air) or closed

It can be transverse, oblique or comminuted

It can be at the end or the middle of a bone

Describe displacement as tilt (angulation), shift (% loss of end

Closed reduction in a co-operative
to end contact) or twist (rotation, too difficult).
child. Most fractures in

children can be treated by

The patient may be young (< 14 years), co-operative or unwell,
closed reduction
the bone maybe abnormal (pathological).

Why treat it

To prevent muscle spasm (pain) and malunion.

Fracture blisters

Fracture blisters Supracondylar fracture humerus in child - the most difficult

fracture - requires traction and expert judgement.

How to treat it

Save patient. Save limb. Debride and later (closure) soft

tissues. Reduce (closed, manipulation, or open, surgery) and
hold (externally with POP or external fixateur or internally with
screw, plates, rods).

Fracture Healing 5 phases ( See Man. Sp. Med. chapter 2).

Haemorrhage (minutes), granulation tissue (hours), forget days,

immature callus (weeks, clinical union), mature callus (months,
x-ray union) and re-modelling (years).

Complications

Late is secondary osteoarthritis. Early is: general (death, fat

embolism, DVT, pneumonia) or local (skin: blisters, pressure
areas, necrosis, RSD; nerves: - neuro proxia/axonotmesis/
neurotmesis; tendons torn or trapped;, blood vessels blocked
with ischaemia, no pulse, or venous swelling; muscles:
compartment syndrome with pain at rest / paraesthesia / pain
on movement; bone healing. Bone healing be slow to heal
(delayed union), won’t heal (non-union), can’t heal (necrosis) or
heal crooked (malunion).

Fractures just about always operated on

Multiple trauma, pathological fractures, fractures of femur,

displaced fractures into joints or of forearm.

Fractures just about never operated on

Children’s fractures (except of hip), tibial shaft fractures,

clavicle fractures.

Try not to operate on

The disturbed, drug addicts, and unreliable people.

Quick review of all fractures

Orthopaedics starts at tip of odontoid process. Cervical spine

reduce: hold in traction/collar, exclude neuro loss; thoracic
spine: high neuro loss; lumbar spine: seldom operate. Pelvis
maybe life threatening (give blood). Fractures of hip and femur
need ORIF, most foot fractures need reduction with K-wire
fixation. Fractures clavicle need sling, shoulder and humerus
are forgiving, elbow fractures often need ORIF, forearm
fractures often need ORIF, colles fractures closed reduction,
most hand fractures closed reduction with K-wire fixation.
Growth plate (end of bones) injuries in children may result in
growth arrest and shortening or angulation of limb (use Salter
Harris classification).

Never apply a full POP to a new fracture; always follow up all

fractures.

Know how to reduce a Colles fracture and a shoulder

dislocation before finishing medical school.