The principles of fracture fixation aim to ensure fractures heal properly and patients return to normal function. They include: 1) Restoring anatomical relationships through fracture reduction to realign displaced bone fragments. 2) Providing absolute or relative stability through fixation methods like plates or external fixators to hold the reduction. 3) Preserving blood supply by minimizing soft tissue and bone trauma during reduction and fixation to support healing. 4) Allowing early and safe mobilization through exercise to promote healing and prevent complications while the fracture mends.

1. AOTrauma Principles Course
PRINCIPLES OF FRACTURE FIXATION
Dr Ahmad Fadzli Sulong
IIUM Kuantan

2. LEARNING OUTCOME
• By the end of this lecture:
- Able to understand the 4 concepts of fracture fixation
based on the AO concept
- Understand the methods applied to achieve these
principles

3. The principles of fracture fixation

4. The principles of fracture fixation
Fracture reduction to restore
anatomical relationships

5. The principles of fracture fixation
Fracture fixation providing
absolute or relative stability

6. The principles of fracture fixation
Preservation of blood
supply

7. The principles of fracture fixation
Early and safe
mobilization

8. The principles of fracture fixation

9. FRACTURE REDUCTION

10. Fracture reduction
• What?
- The act of restoring a fracture or dislocation into its
normal position in the body
• When?
- Presence of displacement – 2 types

11. Fracture reduction – displacement
• Medial or lateral and
anterior or posterior
• Shortening or
lengthening

12. Fracture reduction – displacement
• Internal or external
rotational malalignment
• Valgus or varus
malalignment
• Flexion or extension
malalignment

13. Fracture reduction – WHY?
WHY?

14. Fracture reduction – aim
• ANATOMICAL REDUCTION
- To restore the bony anatomy and morphology
- Intra-articular fractures
‘Steps’ and ‘gaps’
must be avoided

15. Fracture reduction – aim
• FUNCTIONAL REDUCTION
- To restore the relationship
between the proximal and
distal main fragments of the
fracture
- To restore the length,
alignment and rotation
- Mechanical and anatomical
axis as reference
- Often in diaphyseal
fractures

16. Fracture reduction – aim

17. FRACTURE FIXATION

18. Fracture fixation
• What?
- The fracture is held through absolute or relative
stability as the personality of the fracture, the patient
and the injury requires
• Goals?
- To maintain the reduction
- To create sufficient stability:
• Allow early and optimal function of limb
• Minimizes pain

19. Fracture fixation
• ABSOLUTE STABILITY
- no movement at fracture site, rigid
- Achieved through interfragmentary compression; e.g
lag screws, compression plates
- Often in intra-articular fractures
- No callus forms, fracture heals through direct healing

20. Fracture fixation
• RELATIVE STABILITY
- Micro-movement at fracture
site
- No fragment compression,
splinting or bridging between
fragments
- Fracture heals through callus
formation
- Often in diaphyseal fractures

21. PRESERVATION OF BLOOD
SUPPLY

22. Preserving blood supply
• How?
- Care of soft tissue around fracture
- Maintaining bone blood supply

23. Preserving blood supply – soft tissue
• Ensure only devitalised and
dead tissues are removed
• Attempt to preserve a good
soft tissue envelope around
bone as long as risk of
infection NOT compromised
• Minimal and gentle soft
tissue handling
• Keep exposed tissues
moist
• MIPO technique

24. Preserving blood supply – bone
• Reducing periosteal stripping
• Attempt indirect reduction whenever possible
• Selection of implants that preserve blood supply e.g: low
contact DCP, lock plates, ring fixators
• Implants that leave the least ‘footprints’

25. EARLY AND SAFE
MOBILIZATION

26. Early and safe mobilization
• How early is early?
- Immediate post op – provided is safe enough and not
jeopardizes fixation
• Why?
- Promotes bone and soft tissue healing
- Helps to prevent immobilization problems, e.g: DVT,
pressure sores, disuse atrophy

27. • To restore function to injured part and patient as a
whole
• Objectives:
- Reduce oedema
- Preserve joint movement
- Restore muscle power
- Guide patient to normal activity
Early and safe mobilization – exercise

28. • Elevate and exercise
• Never dangle, never force
Prevent oedema

29. • Helps to:
- Pump away oedema
- Stimulate circulation
- Prevent soft tissue adhesion
- Promotes fracture healing
• On cast – static muscle contraction
• Off cast – mobilize joints and build muscle
Active exercise

30. • Especially in fractures around the joint
Assisted movement

31. • Once fracture healed enough, normal daily activity need
to be retaught:
- Walking
- Getting in and out of bed
- Bathing
- Dressing
• For hand injuries: role of occupational therapists
Functional activity

32. SUMMARY
• Why principles of fracture fixation important:
- To ensure fracture heals well and properly
- To ensure patient returns to normal function as quickly
as possible
- To reduce early and late complications of fracture

33. THANK YOU