Fracture Fixation and Arthroplasty

 Fracture is a break in the structural continuity of
bone or periosteum.
 Fracture healing starts as soon as bone breaks

and continues modeling for many years.
Depends on Magnitude and direction of force
 Closed
– Bone fragments do not pierce skin

 Open/compound
– Bone fragments pierce skin

 Displaced or undisplaced
 Usually caused by directly applied force to
fracture site
 Caused by violence transmitted through limb
from a distance (twisting movements)
 Occurs in children: bones soft and bend
without fracturing completely
 Fracture in result of compression (osteoporosis)
 Caused by traction, bony fragment usually torn off by a
tendon or ligament.
 Bone fragments are impacted into each other.
 Two or more bone pieces - high energy trauma
 Abnormal stress on normal bone (fatigue
fracture) or normal stress on abnormal bone
(insufficiency fracture).
 Localises fracture and number of fragments
 Indicates degree of displacement
 Evidence of pre-existing disease in bone
 Foreign bodies or air in tissues
 May show other fractures
 MRI, CT or ultrasound to reveal soft tissue
damage
 Used for fractures that are too unstable for a
cast. You can shower and use the hand gently
with the external fixator in place.
 During a surgical procedure to set a fracture, the bone
fragments are first repositioned (reduced) into their
normal alignment. They are held together with special
implants, such as plates, screws, nails and wires.
 Plates are like internal splints that hold the broken
pieces of bone together. They are attached to the
bone with screws. Plates may be left in place after
healing is complete, or they may be removed (in
select cases).
 Screws are used for internal fixation more often
than any other type of implant. Screws come in
different sizes for use with bones of different sizes.
Screws can be used alone to hold a fracture, as well
as with plates, rods, or nails. After the bone heals,
screws may be either left in place or removed.
 In some fractures of the long bones the best way to
hold the bone pieces together is by inserting a rod or
nail through the hollow center of the bone that
normally contains some marrow.
 Wires are often used to pin the bones back together.
They are often used to hold together pieces of bone that
are too small to be fixed with screws. they can be used
alone to treat fractures of small bones, such as those
found in the hand or foot. Wires are usually removed
after a certain amount of time, but may be left in
permanently for some fractures.
1. Fracture hematoma
– blood from broken
vessels forms a clot.
– 6-8 hours after injury
– swelling and
inflammation to dead
bone cells at fracture
site
 lasts about 3 weeks
– new capillaries
organize fracture
hematoma into
granulation tissue -
‘procallus’
– Fibroblasts and
osteogenic cells invade
– Make collagen fibres
which connect ends
together
– Chondroblasts begin
to produce fibrocatilage,
 after 3 weeks and
lasts about 3-4
months)
– osteoblasts make
woven bone.
 Osteoclasts
remodel woven
bone into
compact bone
– Often no trace
of fracture line on
X-rays.
 Restore the patient to optimal functional state
 Prevent fracture and soft-tissue complications
 Rehabilitate the patient as early as possible

– Emergency orthopaedic management (Day
1)
– Monitoring of fracture (Days to weeks)
– Rehabilitation + treatment of complications

(weeks to months)
– A Airway and cervical spine immobilisation
– B Breathing
– C Circulation (treatment and diagnosis of cause)
– D Disability (head injury)
– E Exposure (musculo-skeletal injury)

 Arthroplasty is a
operative treatment of
orthropaedic disorder .
 Arthroplasty is the
operation for
reconstruction of a new
movable joint .
1. Osteoarthritis (OA)
2. Rheumatoid arthritis (RA)
3. Avascular necrosis (AVN) or osteonecrosis (ON)
4. Congenital dislocation of the hip joint (CDH) Hip
dysplasia
5. Frozen shoulder, loose shoulder
6. Traumatized and mal-aligned joint
7. Joint stiffness
 ABSOLUTE contra indication
1. Active joint infection.
2. Systemic infection or sepsis.
3. Chronic osteomyelitis.
4. Neuropathic of hip joint.
5. Severe paralysis of the muscles surrounding the
joint.
1. Localized infection such as bladder or skin.
2. Insufficient function of the gluteus medius
muscles.
3. Progressive neurological disorder.
4. Insufficient femoral or acetabular bone stock
associated with progressive bone disease.
 HEMI REPLACEMENT-in this type, only one
of the articulating surfaces is remove and is
replaced by a prosthesis of a similar type.
 TOTAL JOINT REPLACEMENT-in this type,
both of the opposed articulating surfaces are
removed. and replaced by prosthetic
compounds.

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 Fracture is a break in the structural continuity of

 Fracture healing starts as soon as bone breaks

– Bone fragments do not pierce skin

– Bone fragments pierce skin

 Prevent fracture and soft-tissue complications

 Rehabilitate the patient as early as possible

– Monitoring of fracture (Days to weeks)

– Rehabilitation + treatment of complications

– C Circulation (treatment and diagnosis of cause)

– D Disability (head injury)

– E Exposure (musculo-skeletal injury)

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