Types Of Fracture Long Essays

Fractures General Principles Long Essays

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


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

Lefort 2 Clinical Features:

  • Cross edema of 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

Question 2. Discuss the management of maxillofacial injuries


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
    • It 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


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

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


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:

  • It 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

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


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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