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Articular Fractures

  1. Intraarticular Fractures
    1. Principles
      1. Immobilization (prolonged) of intraarticular fractures result in joint stiffness.
      2. Major articular depression & fragment displacements do not fill with fibrocartilage and so the resulting instability is permanent.
      3. Anatomical reduction and stable fixation of articular fragments is necessary to restore joint congruity
      4. Immediate motion is necessary to prevent joint stiffness and to ensure articular healing & recovery.
      5. Lambotte’s principles of surgical treatment of fractures include: anatomical reduction of fracture fragments stable internal fixation, preservation of blood supply and active pain free mobilization of adjacent muscle & joints
  2. Management
    1. The main aim of treatment is to restore the congruity of the joint surface, to prevent further joint damage which may lead to secondary osteoarthritis. It can be done by:
    2. Aspiration of intraarticular hematorna
    3. Excision of loose articular fragments
  3. In undisplaced fractures where only immobiizaton is necessary
    1. POP Slab / Cast
    2. Skeletal traction
  4. Internal fixation / Arthroplasty
    In displaced fracture depending on age & site
  5. Arthrodesis
    When other measures fail or stable painless joint is required in young active labourer

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