1. Depending on whether the fracture is connected to the outside world

2. According to the degree and shape of the fracture

1 Angular shift

2 side shift

3 Shortening and shifting (overlapping or interpolation)

4 separation shift

5 rotational shift

Factors affecting displacement: external violence, muscle pulling, weight of the distal limb of the fracture, improper handling and treatment

(1) Deformity: After the fracture segment is displaced, the shape of the injured part changes;

(2) Abnormal activities: In parts of the limbs without joints, there may be abnormal activities after fracture;

(3) Bone friction or bone friction feeling: When the fracture ends rub against each other, you can hear bone friction or feel bone friction. The diagnosis can be confirmed when one of the above three manifestations is found. If the above special clinical manifestations are not found, fracture cannot be excluded.

Early complications: shock, fat embolism syndrome, visceral injury (liver, spleen, lung, kidney, rectum, urethra and bladder), important artery injury, spinal cord injury, peripheral nerve injury. Compartment syndrome (paresthesia, passive stretch, active flexion pain and tenderness) (on the verge of ischemic muscle contracture-ischemic muscle contracture-gangrene). Early blood and fluid transfusions, timely debridement, and proper on-site first aid can prevent the occurrence of complications.

Late complications: septic pneumonia, bedsores, deep vein thrombosis of the lower limbs, infection, traumatic ossification (myositis ossificans), traumatic arthritis, joint stiffness, acute bone atrophy (painful osteoporosis near joints) , reflex sympathetic osteodystrophy), ischemic osteonecrosis, ischemic muscle contracture, etc.

(1) There is no local tenderness or longitudinal percussion pain;

(2) There is no abnormal local activity;

(3) X-ray films show that the fracture line is blurred and there is continuous callus passing through the fracture line;

(4) After the external fixation is released, the injured limb meets the following requirements: the upper limb can lift 1kg forward for 1 minute, and the lower limb can walk continuously for 3 minutes on level ground without crutches, and no less than 30 steps;

(5) Observe that the fracture is not deformed for two consecutive weeks.

Systemic factors (1) Patient’s age: children heal faster than adults; (2) Health conditions affect fracture healing;

local factors (1) Blood supply to the fracture: Those with good blood supply heal faster; (2) Type and number of fractures; (3) Infection affects fracture healing; (4) Degree of soft tissue damage: severe injuries heal slowly; (5) Soft tissue embedding will cause fractures to not heal;

Treatment affects fracture healing. Repeated manual reduction, open reduction, open fracture debridement to remove excessive bone fragments, and traction separation. Insecure fixation, inappropriate exercise, and other factors include the effect of drugs, the influence of pulse current, etc.

reset standard

Reset method

Advantages and Disadvantages of Open Reduction

External fixation: small splint, plaster bandage, head and neck and abduction frame, continuous traction, external fixator.

Internal fixation: Kirschner wires, bone plates, screws, steel plates, intramedullary pins, locking intramedullary nails (common type, reconstruction nails, PFN, PFNA)

Small splint fixation Advantages: The upper and lower joints are not fixed, early exercise is possible, and there are few complications. Disadvantages: easy redisplacement of fractures, skin pressure sores, ischemic contracture

Indications for cast immobilization 1. After open fracture debridement and before wound healing. 2. Auxiliary fixation after open reduction and fixation of fractures in certain parts. 3. Maintenance of deformity correction position and post-operative fixation of bone and joints. 4. Fixation of limbs affected by septic arthritis and osteomyelitis.

Precautions after plaster immobilization 1. Elevate the affected limb to help reduce swelling Avoid local compression during fixation 2. Avoid changing your body position before the plaster has solidified. 3. Indicate the fracture status and date on the plaster. 4. Observation window to observe distal blood supply 5. After the swelling of the limb subsides, replace the cast with a fitted cast 6. Muscle relaxation and contraction exercises during the fixation process, and timely movement of unfixed joints 7. During the plaster immobilization process, active muscle contraction should be performed to exercise the unfixed joints and move them as early as possible.

Early exercise (1-2 weeks), mid-term exercise (two weeks - clinical healing), late exercise (after clinical healing)