Pt revision for

Fractures
By Majd
• According to etiology (cause)
1. Traumatic fractures : direct trauma - indirect – avulsion fracture {Common}
2. Fatigue (stress) fractures : repeated stresses (repeated minor trauma) common in metatarsals.
3. Pathological fractures : minor stress is placed upon a bone that is weakened by pre-existing disease cancer – ostéoporoses – Bone cyste
•PATTERN OF FRACTURE (line of fracture)
• Transverse fracture (most stable):caused by bending moment (angulation)
• Oblique fracture (less stable)
• Spiral fracture: more unstable, caused by torsion moment (twisting)
• Comminuted fracture: more than two pieces, cause by violent trauma.
•
•
Compression (impact) fracture: very stable, occurs in spongy bone.
Green stick fracture occurs in children, where the bone is soft like the stem of the plant.
Type of fractures
•FRACTURE STABILITY
• Stability of fracture depends on:
1. line of fracture :transverse fracture is usually stable- oblique fracture is usually unstable.
2. Muscle pull: unbalanced muscle pull tends to redisplace certain fracture e.g. fracture shaft of femure& forearm bones.
3. Integrity of the supporting ligaments: a wedge compression fracture of the spine is stable because spinal ligaments are intact. In contrast, fracture
dislocation of the spine is unstable because the spinal ligaments are torn
• FRACTURE DISPLACEMENT
• Displacement of a fracture is caused by: •Direction of trauma. •Muscle pull. •Gravity.
• The direction of fracture displacment is described according to the position of the distal fragment in relation to the proximal one
• Types of displacement include: Angulation. - Displacement. - Rotation. - Overriding.
• OPEN AND CLOSED FRACTURED
• Closed fracture (simple fracture): when there’s no communication between the site of fracture and the exterior of the body
• Open fracture (compound fracture): when there’s a wound leading down to the fracture site The wound must create a communication between the
fracture site and the wound , This type of fracture is subjected to contamination by micro-organism from the air.
Physical Therapy program during the immobilization period
in fractures

1- Prevention of general complicaitons (in bed ridden)

1-To prevent respiratory complication:-
• like chest infection and pneumonia
• Prevented by doing regular and daily breathing exercise.
2- To prevent circulatory complication:
• As DVT and thrombophlebitis.
• Prevented by circulatory exercises in the form of active free ex.
2- Prevent pressure ulcers : by changing position, early ambulation and using of alternating air mattress.
3-To prevent stiffness, weakness and atrophy of the free parts by ROM and strengthening exercises.
4- To prevent weakness of the immobilized part by active static exercises of the immobilized parts.
5- To maintain patient’s posture by strengthening of trunk muscles (abdominal and back exercises.
6- To prepare the patinet for gait training by ROM, strengthening, balance and co-ordination exercises.
 • Inflammatory phase
•Prevention of general complications: Rehabilitation after internal
•• Start ROM exercise as pain permits.
fixation
• • No strengthening exercise.
• • Ambulation according to fracture site and mode of fixation.
•From inflammatory phase to clinical union:
•• Active free joints to all joints
•• Static exercise to the joint above and below the fracture (minimal resistance may be used).
•• Strengthening exercise to distant joints.
•• In L.L. fractures:
• – Partial weight bearing in stress sharing devices
• – Non weight bearing or toe touch in stress shielding (bearing) devices.
•After clinical union (to radiological union):
•• Active exercise and passive exercises for ROM improvement.
• • Isometric exercises (submaximal then maximum resistance).
• • Weight bearing is started for stress shielding devices.
• • Weight bearing develops to weight bearing as tolerated in stress sharing devices.
• After radiological union:
• • Regian complete ROM by active, active assisted and passive exercise.
• • Vigorous strengthening through active resisted exercise (isotonic)
•• Gradual weaning form assistive devices.
• • The patient should be functional and preparing to return to activity.
Clinical union & radiographic union

• Clinical union:

Clinically, there is no pain, tenderness over fracture site.

X-ray shows the fracture line not completely oblitrated but there is a continuous bridge of external callus.
External fixation can safely be removed on clinical union of a fracture of the UL.
In the LL, the fracture may need to be protected by allowing partial and gradual wt. bearing.

• Radiographic union:

fracture is clinically united and X-ray shows disappearance of fracture line and re-establishment of cortical
continuity, i.e., consolidation of fracture
 HEALING OF A FRACTURE The inflammatory phase
Healing of cortical bones •Lasts 1-2 weeks
•Healing of the fracture starts as soon as the •Takes from 2-3 months
fracture occurs. •Increased vascularity
•Stages of healing of cortical bones include:
•Rate of healing depends on •Formation of fracture haematoma
• Inflammatory phase.
1. The age of the patient • •Invaded by inflammatory cells e.g. neutrophils,
Proliferation phase:
2. The type of bone (cortical or macrophages, and phagocytes
• Subperiosteal and endosteal cellular
cancellous), may influence the
speed of union. proliferation. •Osteoclasts function to clear necrotic tissue,
3)Blood supply to the bone fragments • Callus formation. preparing the ground for the reparative phase.
4)Immobility. • Consolidation.
•Radiographically, the fracture line may become
• Remodeling phase more visible as the necrotic material is removed.

The Proliferation (reparative) phase
• Lasts several months
• Fracture hematoma is invaded by chondroblasts, and
fibroblasts which lay down the matrix for the callus
between the edges of the fracure from outside (at the
periosteum) and from the inside (at the endosteum.
• Soft callus is formed of fibrous tissue, cartilage, and
small amounts of bone.
The remodeling phase Prerequisites for healing
•Requires months to years. •Adequate blood supply
•Adequate fixation
•Osteoblastic + osteoclastic activity = replacement of •Opposition of the ends of the fracture
immature disorganized bone with mature organized bone. fragments
•Medullary canal gradually reforms
•With rigid fixation and absence of micro
•Trabecular continuation occurs. movement between fragments, primary bone
•Some correction of angular deformities may occur due to bone healing.
resorption from the convex surface and new formation on the •With less rigid fixation secondary healing
concave surface. occurs.
•Radiographically fracture is no longer visualized
Primary bone healing
• In the presence of a rigid fixation
• Rigid fixation requires direct cortical contact & intact intramedullary vasculature
• The new bone grows directly across the compressed bone ends to unite the fracture.
• Very slow
• Cannot bridge fracture gabs
• No radiographic evidence of a bridging callus
• Occurs 2 weeks from the time of injury.
• Healing process depends primarily on osteoclastic resorption of bone followed by osteoblastic
new bone formation.

Secondary bone healing

• In the absence of rigid fixation.
• Mineralization and bony replacement of a cartilage matrix with a characteristic radiographic
appearance of callus formation.
• The greater the motion at the fracture site, the greater will be the quantity of callus.
• This external bridging callus adds stability to the fracture site by increasing the bony width.
• Occurs with casting and external fixation and intramedullary rodding.
DIAGNOSIS OF A FRACTURE
•CLINICAL SIGNS:
• Visible of palpable deformity.

• Local swelling

• Visible bruising (ecchymosis)

• Marked local tenderness over the bone

• Marked impairment of function.

•Two signs that give unmistaken evidence of fractures but should not be tested voluntarily:
• Abnormal mobility
• Crepitation.
Additional clinical investigations
•Skin wound: and whether it’s continuous with the fracture (open Fracture)
•State of circulation: look at: color, temperature, arterial pulse, capillary return and nerve conductivity. Refer the patient to further testing when necessary (e.g
doppler)
•State of spinal cord and peripheral nerves.
•State of viscera.
Radiological Examination
•Two views (at least): anteroposterior and lateral
•Two joints: proximal and distal to the fracture (the film should include at least one joint).
•In some fractures more views are needed
•And in some fracture CT is required.
 TREATMENT OF A FRACTURE
•Fracture management steps:

• Reduction of the fracture.

• Immobilization for enough time.

•Rehabilitation of the soft tissues and joint.
Reduction is needed for displaced fractures
•May be:
• Closed reduction: without exposing the bone.
• Open reduction: most commonly associated with
internal fixation
•Reduction and fixation may be applied by:
• Traction
• External splints and braces.
• External fixation.
• Internal fixation.

For types of internal and external fixation return to introduction in fracture

dr.mona
 Stress-sharing devices
• Permit partial transmission of load across the fracture site.
• Micromotion at the fracture site induces 2ry bone healing with callus formation. • e.g. casts, rods,
intramedullary nails • Early weight bearing can be permitted because
• – Micromotion permitted by the device enhances healing
• – The compression stress of the weight is partially imposed on the bone protecting the device from
failure
Stress- shielding device
• Shields the fracture site from stress by transferring stress to the device.
• Fractured ends of the bone are held under compression and there is no motion at the fracture site.
• Stress shielding devices result in 1ry bone healing without callus formation.
• e.g. compression plating.
• Secondary bone healing is relatively fast.
• Primary bone healing is more slowly.

Relation between device and healing mode

• Stress-sharing devices, e.g. casts,
•intramedullary nail and external fixators do not provide rigid fixation → 2ry bone healing & callus formation.
• Stress shielding devices e.g. compression plates provide rigid fixation →1ry bone healing
 COMPLICATIONS OF A FRACTURS
Early complications
•Wound infection;
•Can be classified in two ways; • From an open fracture.
• Immediate: within few hours. • Can lead ot septicaemia, tetanus or gas gangrene
• Early: within the first week. •Fat embolism:
• Late: months or years later • An embolus of fat globule (most probably from the fracture site)
•Or reaches the lung leading to hypoxia.
• General: as chest infection. • Treated by oxygen when diagnosed.
• Local: in the site of fracture: as malunion •Chest infection:
• Due to prolonged recumbuncy.
• Especially dangerous in old-aged patients.
Immediate complications • Diffused intravascular coagulation:
•Haemorrhage: • Due to defect in the clotting mechanism
• From the site of fracture
• May lead to shock (hypovolaemic( •Compartment syndrome:
•Damage to arteries: Increasing the pressure inside a closed sheath (fascia).
• By the fracture fragments • Causes impairment of venus rtrurn and occlusion of
• e.g. brachial artery in fracture of the humerus, femur
artries.
•Damage to surrounding soft tissues
• This finally leads to fibrosis of muscles and nerve
• Can lead to serious problems
• Examples: injury of the brain by fracture skull, injury of the lung
injury.
by fracture of the ribs • Presented by signs of ischemia (pain, pallor, pulslessness,
coldness) and lack and painful movement.
• Treated by fasciotomy
 Late complications Aseptic necrosis (avascular necrosis):
•Deformity (malunion(: •Death and collapse of the bone due to lack of blood supply.
• Mild deformity (less than 5⁰) is acceptable, esp.: •The most commonly affected bones are:
• In children • The femoral head (most commonly after femoral neck fracture)
• In the movement plane • Scaphoid bone: the proximal pole.
• If unacceptable, treated by:
• The head of the talus: when the talar neck is broken.
• Osteotomy
• External fixator •Shows in x ray:
• Bone lengthening techniques • The affected bone appears denser than the surrounded bone.
• Later on the bone appears collapsed.
Delayed union and Non-union:
•When the union of the fracture takes more than Reflex sympathetic dystrophy: (Sudeck'satrophy)
three to four months (the fracture is still mobile) •Occurs after any injury specially fractures.
•Caused by: •Characterized by:
• Lack of blood supply • Cold thin and shiny skin.
• Infection or tumors • Persistent edema
• Inability to move the limb
• Interposition of soft tissue between the fragments.
• X ray shows patchy osteoporosis
• Excessive movement between the fragments
•Explained by sympathetic over activity
•Treatment:
• Bone grafting Post-traumatic heterotropic ossification
• Joint replacement •New bone formation outside the skeleton (in a muscle or joint capsule) nearby a fracture.
•Prevention is the mainstay of treating this complication.
Osteoarthritis: may occure in
•Common in
• Intra-articular fracture to the fractured joint.
• Adjacent joint(s) in extra-articular fracture. This is due to either • brachialis after supracondylar fracture of the humerous.

• Elbow joint cavity after fracture dislocation.

• Mal distribution of stress on the joint surface. •Passive movement and massage are prevented to avoid heterotropic ossification.
• Increase load on the joint due to shortening of the limb.
Clavicular Injuries
One of the most common fractures
Includes:
Fracture of the midshaft of the clavicle.
Fracture of the outer end of the clavicle.

Acromioclavicular separation.

Sternoclavicular separation.
 Fracture of the midshaft of the clavicle
 Trauma: .
 Falling (landing) on an outstretched hand.
 Direct blow to the point of the shoulder.
 Displacement: the broken clavicle usually overlap because of the weight of the upper limb
normally transmitted through the clavicle
 Duration of healing:  In adults: 6 weeks  In children: 2-3 weeks
 Treatment:
 Sling: to support the arm, for 10 days if pain permits
 Must not rub against the fracture
 Figure of 8 bandage: to pull the shoulder backwards
 Internal fixation: rare
 Complications:
 Malunion: unavoidable but doesn’t interfere with function.
 Non-union: unusual.
 Both can be avoided by internal fixation, but the surgery is risky to the vessels.
 Deformity: due to malunion and callus.
 Damage to vessels: the vessels of the lung.
Fractures of the scapula
Trauma: usually direct blow.
Sites:
Acromion
Blade (body) of the scapula
Glenoid
Treatment:
Immobilization in a sling and early mobility.
 Shoulder dislocation
The shoulder is mechanically unstable
It can be dislocated
Anteriorly
Posteriorly
Inferiorly
 in association with a fracture (fracture dislocation(
multidirectional
 Anterior shoulder dislocation
 The most common type of dislocation.
 Trauma:
 Forceful abduction and external rotation.
 Grand mal attacks or electroconvulsive therapy.
 Pathomechanics:
 The head of the humerus slips off the front of the glenoid cavity.

 It moves medially and the elbow points outwards.

 Clinical picture:
 The head of the humerus appears in the subclavicular triangle and the contour of
the shoulder is lost (the shoulder looks flattened(
 The patient has to carry his injured limb.
 Radiographic examination:
 X ray Shows the head out of the glenoid cavity.
 Fractures of the humeral head should be looked for The lateral scapular view is the
best
 Treatment:
 Before reduction:
 Check the x ray , associated fracture needs Special attention
 Examine the function of the axillary nerve Closed reduction of the dislocation.
 Immobilization of the upper limb across the Body with a bandage for three weeks.
 Anterior shoulder dislocation

Complications of ant. Shoulder dislocation:

Damage of the circumflex artery)axillary artery) as it passes around the
neck of the humerus.
Joint stiffness: due to adhesions.
Prevention: physiotherapy.
Recurrent dislocation.
Irreducibility: due to invation of the subscapularis by the
humeral head.
 Fractures of the upper end of the humerus
Avulsion fracture of the greater tuberosity:
Due to avulsion by violent contraction of the supraspinatus
tendon, or a fall on the shoulder.
Treatment:
If stable: shoulder support for 3 weeks
If jammed in the shoulder: internal fixaion by a screw.
Fracture of the surgical neck of the humerus
 Trauma: fall on an outstretched arm
 Types:
 Impacted: stable and appears as a line of dense line in xray.
 Displaced: more dangerous due to risk of damaging nerves or vessels.
 Treatment:
 Impacted fracture: shoulder support in a sling or collar for 2 weeks.
 Undisplaced or minimally displaced fractures:
 Shoulder support or sling for 4-6 weeks
 Severely displaced fractures:
 ORIF: in young adults

 Hemiarthroplasty: in elderly, esp. 4 parts fracture.

 Humeral shaft fracture
 Trauma and subsequent type of fracture:
 May be: Spiral, transverse, segmented or pathological.
 Spiral fracture: caused by twisting injury.
 Transverse fracture: caused by direct trauma or fall on The arm
 Pathological fracture: the humerus is a common site for pathological fracture.

 Treatment
 Conservative treatment: by u slab, hanging cast or collar and cuff. To protect the humerus.
 Some degree of mal-alignment is acceptable.
 ORIF: in cases of failure of conservative treatment, mal-alignment or pathological fracture.

 Intramedullary nail or plate and screw is used

 Complications:
 Neurovascular damage: to the radial nerve or brachial vessels by the sharp ends.

 Malunion

 Non-union: esp. when soft tissue is caught between the fracture fragments.
 Fractures around the elbow
Supracondylar fracture of the humerus:
Trauma:
 Falling on an outstretched arm.
 Common in children

Treatment:
 Undisplaced fractures: backslab with the elbow fl exed for 3 weeks
 Displaced fracture
 Closed reduction and immobilization in a backslab with the elbow fl exed beyond 90 or suspension in a
dunlop traction
 Internal fixation with K wiring: percutaneous or open.

Complications
 Vascular damage to the brachial artery.
 Compartment syndrome.
 Volkmann’s ischemic contracture.
 Median nerve damage.
 Malunion: cubitus varus or gunstock deformity: treated by osteotomy.
 Myositis ossificans
Elbow dislocation
 Trauma: falling on an outstretched arm in almost full extension ➞ant. Dislocation with coroniod .
 Treatment
 Reduction
 Immobilization in a caller and cuff for 2 weeks

 Complications
 Joint stiffness.
 Ectopic ossification (post-traumatic ossification).
Olecranon fracture
Trauma:
direct fall on the elbow point
Avulsion injury by triceps violence.
Pathomechanics: the fracture may be:
Stable
Displaced
comminuted
Treatment:
conservative treatment: splintage in extension.
Internal fixation: screw or tension band wiring.
Excision of the olecranon.
 Fracture of the radius and ulna
“fracture both bones upper limb”
Trauma:
Twisting injury of the forearm.
Pathomechanics:
Displacement of the bones and rotation is common.
Radiographs should be checked carefully.
Treatment:
Internal fixation is the treatment of choice because the fracture is
unstable.
Conservative treatment may be successful in children )above elbow cast(
External fixation in cases of open fracture.
 Single forearm fracture
Galleazzi fracture:
Single fracture of the RADIUS with dislocation of the DISTAL radioulnar
joint.

Monteggia fracture:
Fracture of the ULNA with dislocaiton of the SUPERIOR radioulnar joint.

Treated by internal fixation and they are highly dispalacable

Fracture of the distal end of the radius (Colles’ fracture(
 Trauma:
Treatment
 Falling on an outstretched arm.  The fracture may interfere with the joint line.
 Most commonly in older female.  Closed reduction and external fixation by a below
 Pahtomechaincs: elbow cast for 4 weeks.
 The famous dinner fork deformity that involves:  Check x rays should be done to ensure positioning.
 Backward angulation.  Internal fixation if the reduction cannot be
 Backward displacement. maintained
 Radial deviation.  External fixation in comminuted fracture.
 Supination.
 Proximal impaction.

 Complications
 Malunion.
 Sudeck’s atrophy.
 Rupture of the extensor pollicis longus
 Median nerve injury
FRACTURES OF THE LOWER LIMB
Trauma
FRMORAL NECK FRACTURE
 Trivial trauma (due to osteoporotic femoral neck)
 Pathomechanics
 The fracture displaces in external rotation and shortened, so the leg appears shortened and
externally rotated
 Types of fracture:
 Displaced fracture:
Subcapital: worst prognosis. Why?  TREATMENT
Transcervical
Undisplaced fracture:
Basal  Internal fixation OR rest in bed with frequent
 Undisplaced impacted fracture
radiographs
Blood supply to the femoral head: Displaced fracture:
 Capsule
 Internal fixation with several pins, crossed
 Medullary cavity
 Ligamentum teres nails,cannulated screw, or compression screw plate.
 Complications:  Prosthetic replacement: hemiarthroplasty
 Avuscular necrosis
Tompson (cemented) or Austin Moore (non-
 malunion
cemented)
FRMORAL NECK FRACTURE
FRMORAL NECK FRACTURE
 TROCHANTERIC FRACTURE
•  An extra-articular fracture between the greater and the lesser trochanters.
•  Classification:
•  Pertrochanteric: through the trochanters
•  Intertrochanteric: between the trochanters
•  Subtrochanteric: below the trochanters
•  Avulsion of the greater trochanter
 Trauma: a considerable trauma, that may be:
•  Falling on the trochanter

•  Twisting injury

•  The fracture is usually displaced due to attachment of strong muscles.

•  There’s usually ecchymosis as the fracture

•  As the fracture is extra-articular, blood supply to the head of the femur is not compromised.
TREATMENT TROCHANTERIC FRACTURE
 Inter-trauchanteric or pertrochanteric fractures
• Internal fixation with dynamic hip screw (compression screw plate)
• If internal fixation is not possible, skin traction is applied for 4-6 weeks.

 Subtrochanteric fracture:
 Internal fixation with dynamic hip screw or intramedullary nail.
 FRACTURES OF THE FEMORAL
• Trauma:
SHAFT
• Direct trauma
• Twisting injury
• Trauma from the front of the knee (weep lash accident).
• The fracture is usually displaced by the pull of the strong muscles of the thigh.
• Pathological fractures and compound fractures are common in the femoral shaft.

•COMPLICATIONS OF FEMORAL SHAFT FRACTRE

• Hemorrhage.
• Mal-union.
• Delayed or non- union
• Infection.
•Vascular / nerve injury.
• Post-traumatic ossification.
 TREATMENT of FEMORAL SHAFT FRACTURE
•  Treatment is according to the patient’s age and the shape of the fracture.
•  Methods of treatment include:  INTERNAL FIXATION
•  Traction (skeletal). Intranmedullary nail (stress sharing):
•  Internal fixation.  Realigns the fracture
• External fixation.  To correct rotation, screws are used to lock the nails
•  Cast bracing. (make it interlocking nail: a stress shielding device).
 locking nails may be used for comminuted #s
•  Skeletal traction is used when
 Plate and screws (stress shielding) are used in selected cases,
•  Surgery is contraindicated. e.g. pathological fractures.
•  In children (gallow’s splint).  Disadvantage: extensive exposure and mechanical failure
•  Weight is modulated according to check x rays
•  Cast brace is used after the traction duration to begin rehabilitation
•  External fixation is used in cases of open (compound) fractures
•  Stress shielding device.
 SUPRACONDYLAR FRACTURE
 Trauma:
 Forced
flexion or extension.
 Common in older patients with porotic bone.

 Treatement.
 Internal fixation with dynamic compression screw.
 CONDYLAR FRACTURES
 One condyle may be separated
 The two condyles may be fractured in a T or Y manner
 Perfect reduction is essential for the function of the knee.
 Complications:
 Avascular (aseptic) necrosis.
 Early osteoarthritis.

 TREATMENT
Traction: in non-diplaced or minimally displaced fractures.
 Internal fixation:
 Essential if the fracture is displaced.
 Screws are used in unicondylar .
 Condylar plate for T or Y shaped fractures
 PATELLAR FRACTURES
•  Treauma:
•  Direct blow: leads to:
•  Transverse undisplaced fracture (stellate #).
•  Comminuted fracture.
•  Avulsion by violent contraction of the quadriceps: causes transverse displaced fracture.

• TREATMENT
• Long leg cast for stellate fracture:
• Internal fixation with tension band: for
• transverse displaced fractures
• Excision of the patella: for comminuted fracture
 FRACTURES OF THE TIBIAL PLATEAU
•  Trauma: lateral strock to the knee (may 6alternatively cause medial
collateral lig. Tear).
•  Patterns of fracture:

•  Vertical split of the lateral plateau

•  Depression fracture: rnaging form slight to depression of the

whole plateau.

•  Mix of the two

• TREATMENT
•  Split fracurtes are treated by Internal fixation with screw.
•  Depressed fractures are treated by: Internal fixation with elevation
of the bone surface and filling of the gap with cancellus bone graft
 FRACTURE OF THE ANKLE (POTT’S FRACTURE)

 Pott’s fracture may be caused by 4 types of injury:

• Adduction injury
• Abduction injury
• External rotation injury. STRUCTURES THAT MAY BE INJURED:
• Vertical compression injury • Medial maleolus of the tibia.
• Lateral maleolus of the fibula.
• Posterior margin of the tibia (posterior maleolus).
GRADES • Medial collateral ligament.
Five grades of severity: • Lateral collateral ligament.
1. Ligament injury alone • Inferior tibiofibular ligament.
2. Ligament injury + one maleolus
3. Ligament injury + two maleoli
4. Ligament injury + three maleoli
5. Ligament injury + diastasis of the inferior tibiofibular joint + fracture.
 FRACTURE OF THE ANKLE
(POTT’S FRACTURE)

MANAGEMETN
 Conservative treatment:
 If the stability of the fracture is good Below
knee plaster cast for 8 weeks
 Check x ray should be done every 10 days.
Weight bearing is permitted after 4 weeks
• INTERNAL FIXATION:
•  Indications:
•  If the fracture is unstable.
•  If the joint surface of the ankle is disturbed.
•  Types of fixation that may be used
•  Screws: for maleoli and diastasis
•  Plates and screws
•  Joint replacement if the ankle is damaged.

 COMPLIACTIONS
• Mal-union
• Osteoarthritis
FRACTURE OF THE ANKLE
(POTT’S FRACTURE)
FRACTURE OF THE ANKLE
(POTT’S FRACTURE)
FRACTURE OF THE ANKLE
(POTT’S FRACTURE)
For spine fracture return to spine fractures of
dr.mona