Types Of Fracture Long Essays

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Fractures General Principles Long Essays

Question 1. Lefort’s classification of fractures of the maxilla

Answer:

Lefort 1

Maxilla Clinical Features:

  • Oedema of lower part of face
  • Ecchymosis in buccal vestibule
  • Bilateral epitaxis
  • Mobility of upper teeth
  • Disturbed occlusion
  • Pain
  • Upward displacement of fragment- telescopic fracture H ‘Cracked cup’ sound on percussion of upper teeth
  • ‘Guerin sign- ecchymosis in the greater palatine region

Maxilla Management:

  1. Reduction
    • Reduction of the impacted fragment with the help of disimpaction forceps (Rowe’s and William’s forceps)
    • Placement of Rowe’s forceps:
      • A straight blade is placed into the nostrils
      • A curved blade is placed over the palate
    • Placement of William’s forceps
      • Placed over the buccal aspect
      • Displaces maxilla in mesiodistal direction
  2. Fixation:
    • Zygomatic suspension fixation is done
    • Holes are drilled over the zygomatic arch
    • Pass the wire through it
    • Bring it up to the arches
    • Twisted over are arch bars
  3. Inter Maxillary Fixation
    • IMF done for 3-4 weeks

Types of bone fractures long essay

Lefort 2 Clinical Features:

  • Cross edema of the middle third of the face.
  • Ballooning of face
  • Black eye
  • Lengthening of face
  • Bilateral subconjunctival hemorrhage
  • Depressed nasal bridge.
  • Anterior open bite
  • Bilateral epistaxis
  • Loss of occlusion
  • Difficulty in mastication and speech
  • Airway obstruction
  • CSF leak
  • Paraesthesia of cheek
  • Step deformity

Read And Learn More: General Surgery Question and Answers

Lefort 2 Management:

    • Reduction – reduction of the fragments through disimpaction forceps.
    • Fixation Zygomatic suspension fixation is done,
    • Inter – maxillary fixation
      • It is done for 3-4 weeks.

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Lefort’s 3 Clinical Features:

  • Ballooning of face
  • Panda facies
  • Racoon eyes
  • Bilateral subconjunctival hemorrhage
  • Lengthening of face
  • Separation of sutures
  • ‘Dish face’ deformity
  • Enophthalmus
  • Diplopia
  • Deviation of the nasal bridge
  • Epitaxis
  • CSF rhinorrhoea

Lefort’s 3 Management:

Bilateral frontomalar suspension
↓
Application of arch bars
↓
Intraosseous wiring

Classification of fractures in orthopedics

Question 2. Discuss the management of maxillofacial injuries

Answer:

Management Of Maxillofacial Injuries:

1. Primary assessment

  • Check for airway
  • Bilateral anterior mandibular fractures have the risk of the tongue falling back, check for it
  • Orotracheal intubation is carried out
  • Hemorrhage is controlled
  • Anterior and posterior nasal packing is used

2. Secondary assessment

Fractures General Principles Secondary Assessment

3. Radiography

Fractures General Principles Radiology

Principles Of Management:

  1. Reduction
    • Restoration of fractured fragments to their original position
    • Brought by
      • Closed reduction
      • Open reduction
  2. Fixation
    • Fractured fragments are fixed
    • This prevents displacement of the fragments
    • Consists of
      • Direct fixation
      • Indirect fixation
  3. Immobilization
    • The fixation device is retained in position till a bony union is obtained
    • Immobilization depends on the type of fracture and bone involved.

Question 3. Classify fractures of the face and discuss the management of each type of fracture

Answer:

Definition: Fracture is defined as a sudden break in the continuity of bone and it may be complete/incomplete

Fracture Classification:

  1. Lefort’s classification
    • Lefort 1
    • Lefort 2
    • Lefort 3
  2. Erich’s classification
    • Horizontal fracture
    • Pyramidal fracture
    • Transverse fracture
  3. Depending on the zygomatic bone
    • Sub zygomatic
    • Supra zygomatic
  4. Depending on level
    • Low level
    • Mid-level
    • High level

Fracture Management:

  • Open reduction
    • In it, the fractured fragments are surgically exposed and visualized
    • Indications
      • Dislocation of the condyle into the middle cranial fossa
      • Dislocation of condyle into the external auditory canal
      • Lateral extracapsular displacement
      • Inability to obtain the desired occlusion
      • Bilateral subcondylar fractures in edentulous
      • Bilateral subcondylar fractures associated with comminuted fractures
      • Consists of
        • Exposure of the site
        • Detachment of the bone from all muscle attachments
        • Reinserting
        • Fixation of the segment
  • Closed reduction
    • In it, the fractured fragments are not openly visualized for anatomical alignment
    • Consists of
      • Manipulation of joint
      • Intermaxillary fixation for 10 days
      • Mobilization of the jaw
    • Indications
      • Fractures of the condylar neck that are not displaced
      • Fractures of the condyle in children
      • Intracapsular fractures
  • Fixation
    • The anatomically aligned fragments are then held in place by devices to fix it in that position
    • It is divided into
      • Nonrigid
      • Semi-rigid
      • Rigid
  • Immobilization
    • The fragments are retained without any movement for at least 4-6 weeks
    • It enables callus formation and healing of fragments

Types of Fracture Types of fracture

Essay on types of fractures

Question 4. Classify fractures. Describe the treatment of fractured mandible and clinical features.

Answer:

Fractured Mandible General Classification:

  1. Simple/ closed
    • Doesn’t communicate with the exterior
  2. Compound
    • It communicates with the exterior
  3. Comminuted
    • Bone is crushed into pieces
  4. Complex
    • Involvement of vital structures
  5. Impacted
    • One fragment is driven into other
  6. Greenstick
    • Fracture of one fragment and bending of other
  7. Pathological
    • Superimposition of disease

Management Of Fractured Mandible:

  • Closed Reduction And Indirect Fixation:

1. Wiring:

  1. Essig’s wiring
    • Used to stabilize dentoalveolar structures
    • Steps:
      • Move the luxated teeth back to the position
      • Adapt wire to the teeth
      • Pass the wire’s one end buccally and the other lingually
      • Join both ends
      • Pass small wires interdentally and fix it
      • Twist it, cut it, and adjust it interdentally
  2. Gilmer’s wiring
    • The pre-stretched wire is passed around the individual tooth
    • Both ends are brought together and twisted
    • Repeat for each tooth
    • Repeat for both the arches
    • Final twisting of mandibular and maxillary wires
    • Twist cut it, and adapt interdentally
  3. Risdon’s wiring
    • Pass the wire around both the 2nd molar
    • Both ends are twisted together
    • Repeat for each tooth
    • Both the base wires are bought to the midline
    • Twisted together
    • Cut it
    • Adapt it to the neck of the teeth
  4. Eyelet wiring
    • Prepare loops in the center of wire
    • Two tails of the wire are passed interdentally
    • One end is passed around the distal tooth from lingually to buccally
    • Another end is passed around the mesial tooth lingually to buccally
    • Twist both ends
    • Cut it short
  5. Multiloop wiring
    • Adapt solder wire around the buccal surface of the tooth
    • Adapt wire buccally from the last molar to the midline
    • Pass the other end distal to the 2nd molar over the lingual side
    • Pass interdentally bring it to the buccal side by passing under the wire
    • Now pass it from buccal to lingual
    • Round it around the tooth
    • Repeat the same procedure

2. Arch Bar Fixation:

  • Arch Bar Fixation is a method of indirect fixation used in the management of mandibular fractures
    • Open Reduction And Direct Fixation:
      • Transosseous wiring or osteosynthesis
      • Plating using compression plates
      • Lag screw fixation
      • Titanium or stainless steel mesh fixation

Fractured Mandible Clinical Features:

  • Change in the contour of the face
  • Lacerations
  • Ecchymosis of the floor of the mouth
  • Occlusal disturbances
  • Step deformity of the mandible
  • Pain and tenderness rismus
  • Deviated mouth opening
  • Anesthesia and paraesthesia of the lower lip and chin

Long answer on bone fractures and types

Question 5. Clinical signs, symptoms, and general principles of treatment of fractures.

Answer:

Treatment Of Fractures Clinical Features:

  • Pain at or near the site of fracture
  • Tenderness or discomfort on gentle pressure over the area
  • Swelling
  • Loss of sensation
  • The injured part cannot move normally
  • The contracting muscles may cause the broken ends of the bone to override
  • Irregularity of the bone
  • Crepitus may be heard or felt
  • Unnatural movement at the site of fracture

Principles Of Fracture Management:

  1. Reduction
    • Restoration of fractured fragments to their original position
    • Brought by
      • Closed reduction
      • Open reduction
  2. Fixation
    • Fractured fragments are fixed
    • This prevents displacement of the fragments
    • Consists of
      • Direct fixation
      • Indirect fixation
  3. Immobilization
    • The fixation device is retained in position till a bony union is obtained.
    • It depends on the type of fracture and bone involved.

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