FRACTURES and

DISLOCATION

ARNADI

DEPARTMENT OF ORTHOPAEDIC AND

TRAUMATOLOGY
ARIFIN AHMAD GENERAL HOSPITAL
PEKAN BARU
 INTODUCTION

General Incidence :
 Age of injury  competitive & recreational
sports
 Industrial accidents, traffics accident
 North America  - No.1 killer of young people
- Annual cost > $ 160 billion
- 2/3 involve musculoskeletal
(fractures and dislocations)
 INTODUCTION
Definition :
 Fracture  Disruption in the structural continuity of
- bone
- epiphyseal plate
- cartilagoneus
 Dislocation (Out of Joint) 
A complete loss of contact between the
articular surface of joint
Description fracture

1. Site:
• Diaphyseal
• Metaphyseal
• Epiphyseal / intra
articulair
2. Extent:
• Complete
• Incomplete
• Hairline
• Buckle
• greenstick
Description fracture

3. Configuration
– Transverse
– Oblique
– Spiral
– Comminuted
– Interarticular
4. Relation of the Fracture
Fragments to each
other:
– Shifted sideways
– Angulated
– Rotated
– Distracted
– Overriding
– Impacted
Description fracture

5. Relationship of the fracture to

the external environment
open (compound) X closed
fractures
• From within
• From without

6. Complication
The Diagnosis of Fractures
1. History : - Injury
- Pain
- Can’t move/ stand
2. Assesment of the patient’s :
- General conditions (ATLS)
- Local physical examination :

Look : - Swelling
- Bruising
- Deformity
- Fracture (Open)
- Distal extremity
The Diagnosis of Fractures

- Local physical
examination :

Feel :
- Localized tenderness
- Crepitus

Move :
- Abnormal movement
The Diagnosis of Fractures

3. Radiographic examination 
Rule of twos :
– Two views (AP and Lateral)
– Two joints (Proximal and Distal)
– Two limbs (R and L )
– Two injuries
– Two occasion

4. CT Scan , MRI
COMPLICATION

1. Initial
2. Early
3. Late
Initial and Early Complication
1. Local :
1. Skin complications
2. Vascular complication :
a. Arterial spasm/ compression/
thrombosis
b. Compartment syndrome (pain,
pallor, puffy swelling, paresthesia)
c. Gangrene, Intermittent claudication,
Volkmann’s ischemic contracture,
Gas gangrene (clostridium welchii)
Initial and Early Complication
3. Neurological complication
4. Visceral complication
5. Joint complication
2. Remote Complication :
1. Multiple injuries
2. Hemorrhagic shock
3. Fat embolism
4. Pulmonary embolism
5. Pneumonia
6. Tetanus
Late Complication
1. Local Complication :
- Joint stiffness
- Bony complication
- Muscular complication

2. Remote Complication :
- Renal calculi
- Accident neurosis
Special Types of Fractures:

1. Stress fractures
2. Pathological
fractures
3. Birth fractures
4. Epiphyseal plate
fractures
The General Principles of Fracture
Treatment

1. Firstly do no harm.
2. Select treatment with specific aims
3. Cooperate with the laws of nature
4. Be realistic and practical in your
treatment
5. Select treatment for patients as an
individual
Specific Methods of Treatment
for Closed Fractures

1. Protection alone
(without reduction /
immobilization)
2. Immobilization by
external splinting
(without reduction)
3. Closed reduction by
manipulation followed
by immobilization:
Plaster of paris cast
 Specific Methods of Treatment
for Closed Fractures:

4. Closed reduction by continuous

traction followed by
immobilization :
- Skin traction
- Skeletal traction
5. Closed reduction followed by
functional fracture bracing.

6. Closed reduction by manipulation

followed by external skeletal
fixation.
Specific Methods of Treatment
for Closed Fractures:

7. Open reduction followed

by internal fixation.
8. Closed reduction by
manipulation followed
by internal skeletal
fixation.
Specific Methods of Treatment
for Closed Fractures:

9. Excision of a fracture
fragment and replacement by
an endoprosthesis.

Moore’s prosthesis
 Treatment for Open Fractures:

Gustilo and Anderson

• Type 1: < 1 cm
low energy
• Type 2: >2 cm,< 10 cm
moderate energy
• Type 3: A, B, C: > 10 cm
high energy, high velocity
gunshot, segmental fracture,
neurovascular injury
Treatment for Open Fractures:
1. Cleansing of the
wound
2. Excision of
devitalized tissue
(debridement)
3. Treatment of the
fracture
4. Closure of the
wound
5. Antibacterial drugs
6. Prevention of
tetanus
 Healing of a fracture:

1. Stage Hematoma
2. Stage Inflammation
3. Stage Callus
4. Stage Consolidation
5. Stage Remodeling
Abnormal Healing of Fractures

1. Mal union

2. Delayed union

3. Non-union =
pseudoarthrosis
DISLOCATION

• Out of Joint
• Definition  A complete loss of contact
between the articular surface
of joint.

Emergency case in orthopaedic

DISLOCATION

Shoulder Dislocations :
• Anterior dislocation > 50 %
• Posterior dislocation
DISLOCATION

Hip Dislocations :
• Posterior dislocation > 80 %
• Anterior dislocation
DISLOCATION

Dislocation of the Elbow :

• Posterior >>
• Anterior
• Divergen
• Lateral
• Medial
DISLOCATION

Knee Dislocations :
• Anterior
• Posterior
• Lateral
• Medial
• Rotatory
References :
• Louis Solomon, David Warwick, Selvadurai N : Apley’s
System of Orthopaedics and Fractures.
• Robert B. Salter, MD : Textbook of Disorders and
Injuries of the Musculoskeletal System.
THANK YOU