Đại cương gãy xương CLB Y Khoa Trẻ ĐH Y Khoa Vinh

• An orthopaedic surgeon dealing with trauma must combine the knowledge of the systemic effects of trauma, including immunological impair-ment, malnutrition, pulmonary and gastrointestin

Bs CKI.CTCH.Trần Văn Thuyên

Đại cương gãy xương

11/29/18

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• An orthopaedic surgeon dealing with trauma must combine the knowledge of the systemic effects of trauma, including immunological impair-ment, malnutrition, pulmonary and gastrointestinal dysfunc-tion, and neurological injury in planning both the timing and the type of surgical intervention required.

• The goal of fracture treatment is to obtain union of the fracture in the most

anatomical position compatible with maximal functional return of the extremity

CLASSIFICATION OF FRACTURES

• Name: such as Judet, Judet, and Letournel’s classification of acetabular fractures and Neer’s classification of proximal humeral injuries

• The latest 2007 update of the OTA classification includes the AO classification

Linear

Comminuted

Segmental

Bone Loss

Modes of bone healing

• primary bone healing (strain is < 2%)

– intramembranous healing

• occurs via Haversian remodeling  

– occurs with absolute stability constructs

• secondary bone healing (strain is between 2%-10%)

– involves responses in the periosteum and external sof tissues. 

• enchondral healing

– occurs with non-rigid fixation , as fracture braces, external fixation, bridge plating, intramedullary nailing, etc

stability throughout the construct

Type of Fracture Healing with Treatment Technique

Cast treatment Secondary: enchondral ossification

External fixation Secondary: enchondral ossification

IM nailing Secondary: enchondral ossification 

Compression plate Primary: Haversian remodeling

CLASSIFICATION OF SOFT TISSUE INJURIES

Gustilo and Ander-son in 1976

• In type II wounds the laceration is more than 1 cm long but is without extensive sof tissue damage, skin flaps, or avulsions

• Type IIIA open fractures have extensive sof tissue lacera-tions or flaps but

maintain adequate sof tissue coverage of bone, or they result from high-energy trauma regardless of the size of the wound This group includes segmental or severely comminuted fractures, even those with 1-cm lacerations

• Type IIIB open fractures have extensive sof tissue loss with periosteal stripping and bone exposure They usually are massively contaminated.

• Type IIIC open fractures include open fractures with an arterial injury that

requires repair regardless of the size of the sof tissue wound

• Other classifications include that of Tscherne and Gotzen, which is widely used in Europe Closed fractures are divided into grades 0 through 3 (Fig 53-3) Open fractures are divided into grades 1 through 4 (Table 53-2)

Open Fractures (OTA 2010)

Evaluation is based on the mnemonic ABCDE

• Airway, which should be free and unobstructed

• Breathing, which should be as normal as possible under the circumstances with

normal oxygenation

• Circulation both central and peripheral; the goal is good capillary filling of all

extremities and maintenance of a normal blood pressure

• Disability, which includes neurological, musculoskeletal, uro-logical, and reproductive injuries These injuries, although rarely life threatening, can result in serious long-term disability

• Environment Many of these injuries do not occur in an iso-lated situation and may result in contamination that can expose caregivers to disease

• Life- and limb-threatening musculoskeletal problems include hemor-rhage from wounds and fractures,

• infections from open frac-tures,

• limb loss from vascular damage and compartment syndrome, and

• loss of function from spinal or peripheral neurological injuries

OPEN FRACTURES

• Tscherne described four eras of open fracture treatment: life preservation, limbpreservation, infection avoidance, and functional preserva-tion

permitted the development of techniques that result in salvaged but nonfunctional extremities There is concern, however, about “technique over reason” and not only the end result of a useless limb but also the physical, psychological, financial, and social effects on the individual

Mangled Extremity Severity Score

The Mangled Extremity Severity Score

(MESS)

• Some studies have found that limbs with scores of 7 to 12 ultimately required amputation, whereas scores of 3 to 6 resulted in viable limbs

GENERAL INDICATIONS FOR SURGICAL REDUCTION AND STABILIZATION

and traction tech-niques, were referred to as proponents of “conservative treatment.”

• The second school of thought included proponents of surgical treatment of all fractures

a listing of absolute indications for surgical reduction and

stabilization

CONTRAINDICATIONS TO

SURGICAL REDUCTION AND

STABILIZATION

DISADVANTAGES OF SURGICAL REDUCTION AND STABILIZATION

TIMING OF SURGICAL TREATMENT

three categories: emergency, urgent,and elective

LAMBOTTE’S PRINCIPLES OF SURGICAL

TREATMENT OF FRACTURES

• (1) anatomical reduction of the fracture fragments, especially in joint fractures,

• (2) stable internal fixation to fulfill the local biomechanical demands,

• (3) preservation of blood supply to the injured area of the extremity, and

• (4) active, pain-free mobilization of adjacent

muscles and joints to prevent the development of fracture disease

TREATMENT OF COMPLICATIONS FROM SURGICAL TREATMENT OF