An Introduction to

FRACTURES and DISLOCATIONS

Professor C.G.Iwegbu
MD, MChOrth, FRCSEdin, FRCSGlasg
FWACS, FICS
 DEFINITIONS
• FRACTURE • DISLOCATION
A fracture is a break in A dislocation is a
the continuity of bone, disruption of a joint,
caused by trauma characterised by a
complete loss of
apposition of the
component parts of the
joint. A partial
dislocation is termed a
subluxation
A FRACTURE
A DISLOCATION
Mechanisms of fractures
 Mechanisms of Dislocations
These are similar to those of fractures:
• Direct injuring force
• Indirect injuring force
Description of fractures
 When you are presented with a fracture
patient:
Remember that:
• Injuries to the body tend to be multiple in nature
• A patient with an obvious upper or lower limb fracture may
also have sustained life-threatening injuries to the brain, face,
chest or abdomen
• Such a patient requires TRAUMA LIFE SUPPORT, which secures
a patent AIRWAY, BREATHING and INTACT CIRCULATION. You
will learn more about this as you climb the ladder of surgical
expertise
• Preoccupation with the diagnosis of fractures /dislocations
comes only after your patient’s general condition has been
stabilised.
 Diagnosis of fractures I
1. Obtain a good history: complaints, history of
complaints, past medical history, medication,
occupational and social history
2. Carry out a good physical examination:
• LOOK
• FEEL
• MOVE
 Diagnosis of fractures II
3. INVESTIGATIONS:
• Conventional X-rays are a basic and compulsory
requirement
• CT scan will give details of a complex fracture,
esp. intra-articular
• MRI scan is helpful in defining the relationship
of a fracture to neighbouring soft tissues e.g.
the spinal cord or peripheral nerves
• Others imaging modalities may be indicated
TREATMENT OF FRACTURES AND
DISLOCATIONS
 Principles of Treatment of Fractures and
Dislocations
1. Reduce the dislocation or fracture (if it is displaced)
2. Immobilise the fracture/dislocation:
• Externally e.g. POP or other form of casting
• Internally e.g. with screws, metal plates,
metal rods or nails or prosthesis
• External fixator is indicated in open fractures
3. Rehabilitate patient with exercises and other
supportive measures
 Reduction of Fractures
• Closed reduction - by applying traction against
counter-traction
• Open reduction by exposing the fracture site
and carrying out reduction under direct vision
• Closed/Open reduction using an external
fixator
Reduction of fractures
 Immobilisation of fractures
• External immobilisation using a cast e.g. POP,
various splints: immobilise one joint above
and one joint below the fracture
• External immobilisation using an external
fixator
• Internal immobilisation using wires. Nails,
rods, prostheses
Methods of fracture immobilisation -
traction
The IWOT frame
The IWOT frame
The IWOT Double frame
Setting up the IWOT frame
The IWOT frame in use
Cast immobilisation of fractures of the
upper limb
Cast immobilisation of fractures of the
lower limb
Cast immobilisation of a femoral shaft
fracture in a 5-yr-old boy
Immobilisation of fractures
External fixation using an external fixator
 Treatment of fractures:
Internal fixation using an intramedullary nail/rod
Intramedullary interlocking nailing of a
tibial shaft fracture
DISLOCATIONS
Principles of Treatment of Dislocations

These are the same as those of fracture

treatment:
• REDUCE
• IMMOBILISE
• RHABILITATE
Treatment of dislocations
 Rehabilitation following fractures and
dislocations
• Rehabilitation is at least as important as the
specific treatment of these injuries themselves
• It is the sum total of all measures directed at
restoring full function to the affected bone of
joint
• So, we are talking of all the physiotherapist and
occupational therapist can contribute to the
restoration of function and normal life of the
patient: splintage, hot/cold compress; exercises; home modification, etc.
Queen’s Hospital, Romford, Essex, England