Fractures and dislocations

By
Dr. Khalil Abdulqawi El-Aajam
PhD. M.Sc. B.Sc

Dr. Khalil El-Aajam

Fractures
• A fracture is a break in the continuity of bone.

Dr. Khalil El-Aajam

Types of Fractures
1. Complete fracture involves a break across the entire cross-section
of the bone and is frequently displaced (removed from normal
position).
2. Incomplete fracture (eg, greenstick fracture), the break occurs
through only part of the cross-section of the bone.
3. Comminuted fracture is one that produces several bone fragments.
4. Closed fracture(simple fracture) is one that does not cause a break
in the skin.
5. Open fracture (compound, or complex, fracture) is one in which the
skin or mucous membrane wound extends to the fractured bone.

Dr. Khalil El-Aajam

Dr. Khalil El-Aajam
Dr. Khalil El-Aajam
Clinical Manifestations
a. Pain
b. loss of function
c. Deformity
d. shortening of the extremity
e. local swelling
f. discoloration

Dr. Khalil El-Aajam

Diagnosis
The diagnosis of a fracture is based on the patient’s symptoms, the
physical signs, and the x-ray.

Dr. Khalil El-Aajam

Urgent Management of Fractures
1. Immediately immobilize affected limb. If movement is required
before splinting, support limb above and below fracture.
2. Unless there is bleeding apply splints and padding (above and
below fracture site) directly over the clothing. If bleeding is
present visualization may be necessary before pressure can
be applied where bleeding is originating. Keep patient
covered to preserve body heat.
3. If the fractured extremity is a leg bone, the unaffected
extremity can be used as a splint by bandaging both legs
together. An arm can be bandaged to the chest or put into a
sling to minimize further tissue damage.

Dr. Khalil El-Aajam

4. Assess color, warmth, circulation, and movement (CWCM) of the
limb distal to the fracture.
5. Open fractures require the protruding bone be covered with a
clean (sterile preferred) dressing.
6. Do not attempt to “straighten” the fractured extremity. Move
the affected limb as little as necessary.
7. Transport to an emergency department as soon as possible.

Dr. Khalil El-Aajam

• Medical Management of Fractures
1. Reduction
a. Closed reduction
b. Open reduction
2. Immobilization
3. Regaining of normal function
4. Strength through rehabilitation

Dr. Khalil El-Aajam

Splints and Bandages

• Bandage:- is strip or roll of material that is wrapped around a body

part to support or immobilize a body part, or to secure a dressing.

Dr. Khalil El-Aajam

Kinds of bandages:
• Gauze is use for bandages because it is light and porous and
conforms to body parts, inexpensive and can be discarded after one
use.
• Elastic bandages adhere to the skin providing support and pressure
and conforms to body parts.

Dr. Khalil El-Aajam

Principles of Application of Bandages
1. Elevate extremity for several seconds prior to application to reduce
venous congestion.
2. Always wrap from distal to proximal direction (towards the heart to
promote venous return)
3. Each rotation should overlap previous lap by one half
4. Use an equal amount of tension for each turn
5. Following application, check distal body parts (hands, fingers, feet &
toes) for numbness, pale or cyanotic color, absence of pulse to
determine if bandage is too tight)

Dr. Khalil El-Aajam

Dr. Khalil El-Aajam
Dr. Khalil El-Aajam
Dr. Khalil El-Aajam
Dr. Khalil El-Aajam
Dr. Khalil El-Aajam
Dr. Khalil El-Aajam
Dr. Khalil El-Aajam
Dr. Khalil El-Aajam
Dr. Khalil El-Aajam
Dr. Khalil El-Aajam
Dr. Khalil El-Aajam
Complications
• Complications of fractures fall into two categories—
a) Early complications include shock, fat embolism, compartment
syndrome, deep vein thrombosis, thromboembolism (pulmonary
embolism), and infection.
b) Delayed complications include delayed union and nonunion,
necrosis of bone.

Dr. Khalil El-Aajam

Dislocations
• Dislocations are a common injury in which the ends of the bones are
forced from their normal position.
• They are usually caused by trauma as in falls or contact sports or a
disease such as rheumatoid arthritis. Any joint large or small may
become dislocated.
• Severe pain along with lost range of motion of the joint and joint
deformity occurs.

Dr. Khalil El-Aajam

Medical intervention
• Immediate medical treatment is required to preserve function.
• Splint the extremity as it is found, apply ice, and seek help.
• Do not move the extremity as blood vessels, muscles, and nerves
could be damaged..

Dr. Khalil El-Aajam