Fracture Principles

Talking about indications for ORIF

  • Failure to obtain & maintain adequate closed reduction
  • Fractures that unite poorly
  • Pathological fractures
    • NOF fractures
    • Multi-trauma
  • Nursing difficulties

Reduction Principles

  • Apply traction in the long axis of the limb
  • Reverse the mechanism that produced the fracture
  • Align the fragment that can be controlled with the one that cannot
  • Maintaining the soft tissue linkage
    • Ie. soft tissue hinge between fragments is very important
  • Blocks to reduction include
    • Soft tissue
    • Haematoma

Plaster

  • Roll of muslin stiffened by dextrose or starch
  • Impregnated with the Hemi-hydrate of Calcium Sulfate
    • AKA Dehydrated Gypsum
  • When water is added, Calcium Sulfate takes up its water of crystallization
    • CaSO4 + H2O + H2O » CaSO4-2H2O + heat
    • Exothermic

Fiberglass

  • Knitted fiberglass
    • 45% Polyurethane Resin
    • 55% Fiberglass
  • Pre-polymer is Methylene Bisphenyl Di-isocyanate (MDI), which converts to a nontoxic Polymeric Urea Substance
  • MDI molecules have Isocyanate end-groups that react with any molecule containing an active hydrogen
  • Exothermic reaction
  • Use smaller rolls as tendency to “ridge” at curves
  • More elastic, so apply tighter