Transcript 4-conservative treatment fx , casting

CONSERVATIVE
TREATMENT OF
FRACTURES
Dr. Muhammad ASIF
Orthopedic Surgeon
Department of Orthopaedics
College of Medicine
King Khalid University Hospital
Fracture management
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The ideal goal of fracture management is
anatomical reduction and function restoration
compatible with the severity of injury, age,
occupation and activity of daily living of injured
patient.
 Either
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Operative
Non operative (Conservative)
 Traction
 Splint (Cast / Slab)
Traction
 Traction
is the application of a pulling
force to a part of the body
 Purpose:
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to reduce, align, and immobilize fractures;
• Unstable and unfixable
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When reduction and/or proper length cannot
be maintained by static immobilization
to minimize muscle spasm
to prevent or reduce skeletal deformities or
muscle contractures.
Classification of Traction
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Skin Traction : is maintained by direct
application of a pulling force on the patient’s skin
. Generally temporary measure.
 To reduce muscle spasms
 To maintain immobilization before surgery
 In children
 Skeletal Traction : applied to bone by means of
a pin or wire surgically inserted into the bone,
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providing a strong steady, continuous pull, and
can be used for prolonged periods .
Complications of traction
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Neurovascular compromise.
Inadequate fracture alignment..
Skin breakdown .
Soft tissue injury
Pin tract infection .
Osteomyelitis can occur with skeletal traction.
Complications of traction
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complications from immobility especially with
long term traction and in elder pt.
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Pressure ulcer
Pneumonia
Constipation
Anorexia
Urinary stasis and infection
Venous stasis with DVT
General Indications for CAST
1. Most fractures in children:
a. Tremendous capacity of remodeling.
b. Non union and stiffness is unlikely.
2. Undisplaced fracture
3. Poor bone Quality: Osteoporosis.
4. Unfixable fracture e.g. severe comminuted.
5. Systemic contraindication.
6. Local contraindication.
7. Psychosocial problem.
Splint / Cast
 Principle:
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To stabilize joint above and joint below the
site of injury whenever and wherever is
possible
 Objectives:
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To hold broken bone anatomically to prevent
malunion.
To reduce excessive movements to prevent
non union.
To get early function
How to Preserve Function?
 Immobilize
only joint necessary,
 Range of motion of uninvolved joints.
 Isometric exercise.
 Physiotherapy after cast removal.
 Weight bearing whenever possible in case
of lower limb fracture.
What are casts made of ?
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The outside, or hard part of the cast,
two different kinds of casting materials.
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Plaster (POP) - white in color.
hemihydrated calcium sulphate.
On adding water it solidifies by an exothermic
reaction into hydrated calcium sulphate
fiberglass - variety of colors, patterns, and designs.
inside of the cast
Cotton and other synthetic materials are used to
line the inside of the cast to make it soft and to
provide padding around bony areas.
 Plaster
is usually used in the early stages
of treatment,
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Displaced Fracture that need manipulation
can be molded more precisely.
heavy
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must remain dry, water will distort the cast
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Fiberglass
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Can be used in Undisplaced Fx if swelling not
expected
healing process has already started.
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lighter weight, durable, require less maintenance.
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Different types of casts
Type of Cast/Slab
Location
Uses
Short arm
Applied below the elbow
to the hand.
Distal Forearm or wrist
Fx. Also used to hold the
forearm or wrist muscles
and tendons in place after
surgery.
Long arm
Applied from the upper
arm to the hand.
Distal humerus, elbow, or
proximal forearm
fractures. Also used to
hold the arm or elbow
muscles and tendons in
place after surgery.
Scaphoid cast/ thumb
spica
Below elbow to hand
including thumb
Scaphoid Fx, thumb FX
U slab
From shoulder to elbow
and then to armpit
Humerus shaft fx
Type of Cast / Slab
Location
Uses
Short leg cast:
Applied to the area below Distal T/F Fx,
the knee to the foot.
ankle Fx,
severe ankle
sprains/strains.
Long leg cast
From above knee to foot
Proximal T/F Fx,
trauma around knee
Hip spica
From lower chest to one
or both feet
Femur fracture in children
PTB cast
From knee to foot
For weight bearing in
healing Fx T/F
Closed Reduction Method
Closed Reduction Method
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Adequate analgesia / anaesthesia
Traction – countertraction
Increase the deformity if needed, to reduce / lock
on fragments
Correct rotational deformity as well.
Remove any rings from fingers or affected limbs
All acute injuries (<48 hours post injury)
fully padded well molded plaster,
full casts may be splittted.
After Closed Reduction and
Casting
 must
have circulation check
 Plaster takes 48 hours to become fully dry
and harden so take care.
 Weekly radiographs for 3 weeks to confirm
acceptable reduction.
 Can re-manipulate within 3 weeks after
injury if displaced.
Excellent Reduction with Well
Molded Cast
Colles’ Fracture
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Displaced
dorsolaterrally
 Treatment:
Cast +/- surgery,
depending on
shortening and
displacement
Scaphoid Bone FX
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Retrograde blood
supply
 Total healing time of
10-12 weeks or more
Boxer’s Fracture
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Classically neck of
the fifth metacarpal
 bump over the back
of palm just below the
small finger knuckle
 Treatment: casting or
surgery (pins)
Patellar Fracture

Fall onto kneecap or
when quadriceps is
contracting
 Attempt “straight leg
raise”
If Extensor mechanism
intact / undisplaced Fx
Cast / Slab
Fracture of 5th Metatarsal
 Avulsion
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base of 5th metatarsal from pull of attached
tendon;
heal well in cast
 Jones
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Fracture
Fracture
Transverse fracture through base of 5th
metatarsal, about 1-2 cm from tip;
cast for 6-8 wks if undisplaced
Fracture of 5th Metatarsal
Avulsion Fx
Jones’ fracture
30 year old patient
Torus Fracture
“Buckle
fracture”
 mostly in
children;
metaphysis
 cast for 2-4
weeks
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Type 1 S/C Fx humerus:
non-displaced
conservative
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Note the nondisplaced fracture
(Red Arrow)
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Note the posterior fat
pad (Yellow Arrows)
Type 2: Angulated/displaced fracture with intact
posterior cortex;
close reduction and K-wires fixation
Type 3: Complete displacement, with no contact
between fragments;
close / open reduction and K-Wire fixation
UNDISPLACED FRCTURE
LATERAL CONDYLE
Fracture surgical neck humerus,
10 year old
Post Cast instructions
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Keep your limb elevated to prevent swelling.
Apply an ice bag to injured area.
Keep the cast clean and dry.
Check for cracks or breaks in the cast.
Rough edges should be padded to protect the skin
from scratches.
Do not scratch the skin under the cast by inserting
sticks.
Encourage patient to move his/her fingers or toes to
promote circulation
Contd
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Prevent small toys or objects from being put inside
the cast.
Do not put powders or lotion inside the cast.
Cover the cast while your child is eating to prevent
food spills and crumbs from entering the cast.
Do not use the abduction bar on the cast to lift or
carry the child.
Use a diaper or sanitary napkin around the genital
area to prevent leakage or splashing of urine.
How To Know if Something Is
Wrong With Your Cast
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Pain that is not adequately controlled with
medication prescribed by your doctor.
Increasing swelling
Numbness or tingling in the extremity (hand or foot).
Inability to move your fingers or toes beyond the
cast.
Circulation problems in your hand or foot.
Loosening, splitting or breaking of the cast.
Unusual odors, sensations, or wounds beneath the
cast.
If you develop a fever or generalized illness
Complications of cast
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Compartment syndrome, tight cast that restricts
swelling.
Impaired distal neurovascular.
most serious is deep venous thrombosis leading
to pulmonary embolism----calf pain.
Re displacement of fracture.
stiff joints, muscle wasting.
Plaster Sores.
Malunion, Nonunion, Delayed union
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Cast Burns- can
occur during cast
removal if blade dull
or improper technique
used.
Fracture distal Radius & ulna
Close reduction and casting
Fracture Healed
Fx distal Radius ulna in a Child
After Close reduction and casting
One week follow up; Angulated
Surgery; close reduction and fixation
Healed
21 year old patient
THANKS