Coupon Accepted Successfully!


Timing of Operative Treatment

  1. Emergency (Immediate)
    1. Emergency procedures include
      1. Open fractures
      2. Irreducible dislocation of major joints
      3. Fracture with lacerations or deep excoriations in operative field
      4. Spinal injuries with deteriorating neurological defecits
      5. Fracture- dislocations that impair the vascularity of limb or overlying soft tissue.
      6. Fractures with compartment syndromes.
      7. In these situation, delays in surgery can lead to infection, neurological damage, amputation and possibly death.
  2. Urgent
    These are done within 24 to 72 hours of injury, such as
    1. Repeat debridement of severe open fractures
    2. Long bone stabilization in poly trauma patients
    3. Hip fractures
    4. Unstable fracture dislocations
  3. Elective
    These can be delayed 3-4 days to 3-4 weeks. Injuries that can be treated with elective surgery include isolated skeletal injuries that have been initially reduced & stabilized with non-operative techniques but would have a better out come with surgery such as
    1. Both bones forearm #
    2. Fractures with damaged soft tissues
    3. Fracture blisters at planned operative site
    4. Intra articular fractures that require further radiographic evaluation for adequate preoperative planning.
  4. Long Bone Fracture
    1. General Managment of Fractures
      1. Of Short Bones
        1. Screws
        2. K- wire
        3. Tension band wiring
      2. Of Long Bones
        1. Intramedullary nailing eg K nail, interlocking nail, Rush nail, reconstruction nail etc)
        2. Plating eg. DCP
        3. External fixator
        4. Dynamic hip screw (DHS) & Dynamic condylar screw (DCS)
        5. Plaster cast
  5. Kuntscher Cloverleaf Intramodullary (KIM) Nail
    It is mainly useful for transverse or short oblique fractures around isthmus of femur. It provides stability by
  6. Three point fixation
    Due to elastic deformation it provides three point bony fixation.
    1. at both ends
    2. at isthmus
  7. Elastic deformation or Elastic locking
    To increase the elasticity of nail, it is hollow, has a cloverleaf cross section and a longitudinal slot, When a straight nail passes through a curved medullary canal it is deformed (elastic deformation), and gets locked.
Lambotte/AO principle
  1. Restore anatomy
  2. Stable fixation(Internal/external)
  3. Soft tissue handling gentle/preserve vascularity
  4. Earle and safe mobilization
  1. Due to high remodeling potential most of the pediatric factures are managed by close reduction as a variable amount of malalignment is acceptable.
  2. But physeal fractures (all type II, IV; and failed closed reduction with residual displacement in type I & III Salter Harris fractures) are managed with operative treatment. (open reduction & internal fixation).
  3. Fracture patella & olecranon are usualy managed by TBW (tension band wiring)
  4. Fracture lateral condyle humerus is usually managed by K-wire fixation
  5. Colle’s fractures are usually managed by conservative (cast) trea tment.
Description: Description: C:\Users\RAMKINKAR JHA\Downloads\sm.v02.fig07.jpgDescription: Description: C:\Users\RAMKINKAR JHA\Downloads\7-0-mm-6-5-mm-cannulated-screw-thread-length-16mm-250x250.jpg
Screws are implants that can be used alone or with other implants like plates. it is implant of choice in young patients of Fracture neck of femur(Closed reduction and internal fixation ie CRIF)
Description: Description: C:\Users\RAMKINKAR JHA\Downloads\Mini-Straight-Plate-DCP-2.0-mm-DCP-2.0-mm.jpgDescription: Description: C:\Users\RAMKINKAR JHA\Downloads\download (51).jpgDescription: Description: C:\Users\RAMKINKAR JHA\Downloads\IndianJOrthop_2011_45_5_417_83762_f5.jpg
Plates like dynamic compression plate is used in few diaphysial fracture like radius, ulna,humerus. Newer plates like locking plates are best suitable for periarticular and osteoporotic fractures.
Description: iln68lgDescription: iLocImg2
Inter locking nails are generally implant of choice in long bone diaphyseal fracture like shaft of femur and tibia in adults.
Description: 334Description: JSciSoc_2013_40_3_135_120055_f4 
Titanium Elastic Nail system (Also called TENS, is flexible nail like Ender’s nail, used in pediatric shaft femur fracture)
Description: 3d9ee43dc9c73d4508b9eb4852aacaef Description: index_clip_image042 Description: bank7
Tension band wiring based on the principle of converting the tensile strength into compressive that promotes fracture healing eg shown above (Fracture patella, olecranon, medial malleolus)

Test Your Skills Now!
Take a Quiz now
Reviewer Name