A fracture is when a bone is injured by overload or high-energy impacts and loses its integrity. Great forces are required to break the bone except for reasons such as diseases that reduce its strength (Osteoporosis, Osteogenesis imperfecta, cancers and cysts). Fractures caused by the weakening of the bone with diseases are defined as “pathological fractures”. Long and flat bones respond differently to external forces and are injured differently. Long bones are most resistant to loads in the longitudinal direction of transport. Its bending strength is relatively low, but it is weak against shear forces. Although flat bones are more resistant to shear forces, they do not show resistance like long bones during carrying and bending.
Fractures; It can be simple (one-piece), segmental and multi-part. If the fracture line comes into contact with the external environment together with skin injury, it is defined as an open fracture. Open fractures are graded according to the size of the wound and the type of contamination. The dirtiest and most difficult-to-treat injuries were reported as agro-manure-related open fractures.
In penetrating-explosive injuries such as high-energy or firearms, sudden loads in all three directions cause comminuted fractures. The type of fracture is important in planning the treatment. Simple fractures can be corrected mostly by manual correction (closed reduction) and with plaster-wrap fixation after the fracture ends meet. In cases where the fracture ends cannot be brought together, which prevents the union, the fracture ends are surgically combined and fixed in various ways. If there is a dirty wound in open fractures, surgical cleaning and surgical treatment may come to the fore.
Types of Fracture Treatment with Outlines
Closed correction and Plaster fixation: Broken ends are manually corrected and brought face to face. It is followed with a maximum angulation of 15 degrees from the direction of movement without at least 50% contact and rotation. While this angulation is considered to be in the upper limits in children, high angulations in adults are directed to surgery since they do not have a chance to reshape.
Traction correction: Segmented closed fractures, large bone fractures that cannot be controlled with strong muscles, or spine fractures with dislocation are placed under traction for alignment. Traction is the principle of directly seating the fracture with weights suspended over the wire inserted into the bones. In traction, the ends of the fractures should be brought face to face for up to 72 hours by balancing the muscles. If the procedure is successful, it can be continued until the union is achieved or plaster and other external fixations (external fixator) can be passed.
Surgical Methods
Closed correction and percutaneous screw-wire-nail fixation: It is the most preferred surgical treatment method today. It can be planned in cases of unstable after fixation, fractures in the muscle-ligament attachment sites, fractures involving the joint, and in cases where movement is required.
Open correction and internal-external fixation: If soft tissue enters between the fracture ends and prevents contact, open surgical treatment and fixations are applied in cases of joint-related fractures, growth cartilage fractures, intra-articular fractures and vascular-nerve lesion, in order to remove foreign bodies in open fractures. Metal fixations are not applied in dirty wounds, external methods (fixators) are preferred.
Dislocation; It is the deterioration of the relationship of the surfaces forming the joint with each other. Joints are compatible, intertwined sphere-bowl relationship (hip), as well as mostly incompatible structures or structures that do not have sufficient bone coverage. In this way, the joint becomes more mobile but prone to dislocation and vulnerable to external forces. Joint limits are limited by ligament structures, harmony is ensured by meniscus structures and cartilage-like structures surrounding the joint, which we call the labrum. But the most important support is provided by the structure we call the joint capsule. While it provides lubricity with liquid in the joint, it approaches the surface like a suction cup with the negative pressure effect of the closed airtight structure of the capsule and resists extrusion.
As a result of dislocation of the joint, forcing the boundaries of the joint, the rupture of the joint capsule, rupture of the ligaments and the structures that provide the joint harmony are destroyed. When the joint is dislocated, it can break the bones that make up the joint. In this case, fracture-dislocation is mentioned.
Joint dislocations should be placed in the first 24 hours. It is placed on the joint with special maneuvers closed and fixed with dressing-bandage-plaster. At least 3 weeks of fixation is planned according to the characteristics of the joint.
Fractured dislocations, dislocations associated with joint fractures, late-intervented dislocations, dislocations with vascular-nerve lesions and structures that interfere with placement are treated surgically.
Whether for fracture or dislocation, the primary goal in modern orthopedic surgery should be prompt detection and early movement. The socio-cultural structure of the patient can also change the way of treatment.
Painless, fully mobile joint and healthy limb are the main goals in treatment.