Fracture and Dislocation Treatments
Fracture is the bone's injury due to overload or high-energy impacts and loss of integrity. Great forces are required for fracture of the bone, except for diseases that reduce endurance (Osteoporosis, Osteogenesis imperfecta, cancers and cysts). Fractures resulting from weakening of bone with diseases are defined as “pathological fractures.. Long and flat bones react differently to external forces and are injured differently. The load with which the long bones are most resistant is to resist forces in the longitudinal transport direction. Bending strength is relatively low but weak against shear forces. Flat bones are more resistant to shear forces, but do not exhibit the same strength as long bones during transport and bending.
Fractures; It can be simple (one-piece), segmentary and multi-part. It is defined as open fracture in case of contact of the fracture line with the external environment with skin injury. Open fractures are graded according to the size of the wound and the type of contamination. The most dirty and most difficult to treat injuries have been reported as open fractures associated with agri-fertilizer.
In penetrating-explosive injuries such as high-energy or firearms, sudden loads in all three directions cause fragmented fractures. The type of fracture is important for planning the treatment. Simple fractures can often be corrected by hand-fixing (closed reduction), with plaster-wrap fixation after the fracture ends face. In cases where the fracture ends cannot be confronted, the fracture ends are assembled and fixed in various ways. In open fractures, if the wound is dirty, surgical cleaning and surgical treatment may be at the forefront.
Types of Fracture Treatment with Outlines
Closed smoothing and plaster fixation: Broken ends are manually corrected and brought together. It is followed by a maximum angulation of 15 degrees in the direction of movement without contact and rotation of at least 50%. While this angulation is accepted at the upper limits in children, high angulations in adults are directed to surgery since there is no chance of reshaping.
Traction correction: Segmented fractures, large bone fractures that cannot be controlled by strong muscles, or fractures of the spine with dislocation are tractioned to provide alignment. Traction is the principle of placing the fracture directly with the weights hanging over the wire passed to the bones. In traction, the broken ends should be balanced and the muscles should be brought up to face for 72 hours. If the procedure is successful, it can be continued until boiling tissue is achieved or gypsum and other external fixations (external fixator) can be passed.
Surgical Methods
Closed correction and percutaneous screw-wire-nail fixation: Today's most preferred surgical treatment method. Fractures in the muscle-ligament joints, fractures of the joint, which cannot be stabilized after fixation, can be planned in case of necessity of movement.
Open correction and internal-external fixation: If soft tissue interferes with the contact between the fracture ends, open surgical treatment and fixations are applied in cases where the joint fractures, growth cartilage fractures, intra-articular fractures and vascular-nerve lesions are accompanied in order to remove foreign bodies in open fractures. In dirty wounds, metal fixations are not applied in such a way that external fixations are preferred.
Dislocation; is the disruption of the relationship between the surfaces forming the joint. Joints can be harmonious, interlocking sphere-bowl relationships (hip), often incompatible or not enough bone coverage. The joint thus becomes more mobile but prone to protrusion and is vulnerable to external forces. Joint limits are limited by ligament structures, and compliance is achieved through meniscus structures and cartilage-like structures surrounding the joint called labrum. But the most important support, the joint capsule provides what we call structure. While providing lubricity with fluid in the joint, the capsule approaches the surface like a suction cup due to the negative pressure effect of the closed airtight structure of the capsule and shows resistance to exit.
As a result of joint dislocation, the articulation of the joint capsule ruptures, ligament rupture and joint alignment are broken. It may break the bones that form the joint as it exits. In this case, fracture-dislocation is mentioned.
Joint dislocations should be placed within the first 24 hours. It is placed closed joint by special maneuvers and fixed with bandage-bandage-plaster. Fixation of at least 3 weeks is planned according to the characteristics of the joint.
Fracture-dislocations, dislocations with joint fractures, dislocated dislocations, dislocations with vascular-nerve lesions and interfering structures are treated surgically.
The main goal in modern orthopedic surgery, whether fracture or dislocation, should be immediate detection and early movement. The sociocultural structure of the patient may change the treatment.
The main goal of treatment is painless, fully mobile joint and healthy limb.
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