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Complete or incomplete break in


the continuity of a bone
á   
  
÷islocation

A total loss of contact between the two ends of


bones

Subluxation

Partial loss of contact between the two ends of


bones
Vypes of dislocation
 Congenital
e.g: C÷

 Acquired
- Vraumatic
- Pathology
- Paralysis
Clinical Features
- Shock (severe injury)
- Pain
- Edema
- Bruising
- Local tenderness
- Muscle spasm
- Loss of function
  

Can be classified in 3 ways:

1) Vhe cause of fracture


2) Relation to surrounding tissues
3) Vhe pattern of the fracture

1) Vraumatic
- caused by
- direct violence
- indirect violence

2) Stress

3) Pathological

4) Avulsion
 !
a) Closed fracture / Simple fracture
No communication between the fracture bone and the
body surface

b) Open fracture / Compound fracture

÷irect communication exists between the body surface


and the fractured bone ends

c) Complicated fracture

In association with the fracture other important


structures have been damaged. E.g: nerves, vessels,
viscera organ etc.-
etc.-
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a) Complete

- Vhe bone is completely divided into 2 separate


fragments.
- Vhe fracture line itself maybe transverse,
oblique and spiral.

b) Incomplete

- It involves only one surface of the bone


- In children ƛ greenstick fracture
`
c) Comminuted
- More than two fragments.

d) Compression or crush
- Usually occur in cancellous bone

e) Segmental
- proximal, middle and distal third

f) ÷isplacement
- undisplaced
- displaced
- Impacted
- Stable
`
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ealing of fracture

 Stage of haematoma
 Stage of subperiosteal & endosteal cellular
 Stage of callus formation
 Stage of consolidation
 Stage of remodelling
ealing time of fracture

2 most stages of fracture healing


1. Union
2. Consolidation
Factors affecting the rate of fracture healing

- Vype of bone
- Pattern of fracture
- Blood supply
- Fixation
- Age
ealing time of fracture
Union
- Usually take 3-3-10 weeks after fracture occurred
ƛ partial repair of the bone
- Initial callus formation (not reach full bone maturity)
- Minimal movement of the fracture site
- Painful with pressure or weight bearing
- FWB is contraindicated
- Encourage PWB
- X Ray ƛ fracture line still visible
ealing time of fracture
Consolidation

- Usually take approximately double the union time & full


remodelling double the consolidation time
ƛ full repair and maturity of the bone
- No movement at the fracture site
- X Ray ƛ no fracture lines
- Start full function
Approximate healing time

Fracture Union (wks) Consolidation (wks)

Prox 3 rd humerus 7-10 days 3-4


÷istal 3 rd radius ulna 4-6 8-10
Scaphoid 3-4 6-8
Prox 3 rd Femur 4-6 8-12
÷istal 3 rd Femur 6 12
Prox 3 rd tibia 6-8 12-
12-16
÷istal 3 rd tibia 8-10 16-
16-20
"`  

1) Complications related to the fracture itself


a) Non union d) Infection
b) ÷elayed union e) Shortening
C) Mal union f) Avascular necrosis

2) Complication caused by associated injury


Injury to : major blood vessels, nerves, viscera, tendon,
Fat embolism and injuries and post traumatic affection
of joints
"`  

Non union
- Fracture failed to unite.
- Vhe gap between the bones is filled with fibrous tissue &
form pseudoarthrosis
- X ray : sclerotic or dense and rounded
- Causes:
- Infection
- Poor blood supply
- Poor fixation
- Vreatment:
- Bone grafting with internal fixation
"`  

# 
Fracture take longer time to heal than expected time
Causes & treatment: same as non union

"

- Union of the fracture fragment in an imperfect position


- Can be prevented by competent initial treatment

Causes:
- Poor initial treatment

Vreatment:
- Osteotomy with internal fixation
"`  

Infection
- Occur in open fracture
- contaminated wound leads osteomyelitis
Vreatment:
÷ressing & antibiotic

Shortening
Caused by mal union or crush fracture

Avascular necrosis
Necrosis of the bone as a result of lack of blood supply
References
 Adams(1986). Outline of fracture
 Ann Vhompson, Alison Skinner, Joan Piercy (1991) Vidyƞs
Physiotherapist, 12 edit
 ÷avid F. Paton (1992) Fractures and Orthopaedics
 Marian Vidswell(1998) Orthopaedic Physiotherapy
 Ronald Mc Rae (2001) Pocket Book Of Orthopaedics and
Fractures
 John Ebnezar (2003) Essentials Orthopaedics for
Physiotherapist. 1 st edit
 Karen Atkinson (2005) Physiotherapy In Orthopaedic : A
Problem Solving Approach. 2 edit