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Approach To Fracture

The document outlines the approach to fracture management, which includes clinical assessment, analgesia, imaging, and definitive management. Definitive management involves reducing the fracture if closed reduction is possible, otherwise open reduction is required. The fracture is then held in place either externally with splints, casts or traction, or internally with pins, plates or rods. Finally, exercises are prescribed to regain function and prevent joint stiffness.

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Rebecca Wong
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271 views17 pages

Approach To Fracture

The document outlines the approach to fracture management, which includes clinical assessment, analgesia, imaging, and definitive management. Definitive management involves reducing the fracture if closed reduction is possible, otherwise open reduction is required. The fracture is then held in place either externally with splints, casts or traction, or internally with pins, plates or rods. Finally, exercises are prescribed to regain function and prevent joint stiffness.

Uploaded by

Rebecca Wong
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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APPROACH TO FRACTURE

1. Clinical Assessment
 Primary survey: Airway, Breathing, Circulation, Deformity & Disability, Exposure and
Environmental situation
 Secure airway and stop bleeding
 Rule out brain injuries/ increased ICP
 Rule out other fractures/ injuries
 Rule out open fractures
 Simple history including -SAMPLE history
o Symptoms
o Allergies
o Medications & drugs
o Past medical and surgical history
o Last meal
o Events leading to injury/ accident
 Physical examination
o Look – deformity, soft tissue integrity
o Feel – tenderness, neurovascular status
o AVOID move to prevent exacerbation
2. Analgesia
3. Imaging: Rule of 2s
 2 sides – bilateral
 2 views – AP + lateral view
 2 joints – one joint above & below
 2 times – before and after reduction

4. Definite management: Reduce, Hold, Exercise


(A) REDUCE
 Always recheck neurovascular status and obtain post-reduction X-ray after reduction

Closed Reduction
 IV sedation and muscle relaxation
 Types of block – hematoma block, sural block
 Reverse the mechanism that produced the fracture & realignment of bones
 Skeletal/ skin traction might be needed for fracture that is difficult to reduce due to powerful
muscle pull, eg. femur, tibia, supracondylar fractures [Buck’s traction for lower limb, lateral
traction for humeral fracture]

Open Reduction
 Failed closed reduction
 Not able to cast or apply traction due to site, eg. hip fracture
 Pathologic fractures
 Potential improvement with ORIF
 Indications: NO CAST
o Non-union
o Open Fracture
o Neurovascular Compromise
o Displaced intra-Articular Fracture
o Salter-Harris 3,4,5 [fracture passes through epiphysis and metaphysis of bone]
o PolyTrauma
(B) HOLD
 External stabilisation: splint, cast, traction, external fixator
1) Traction under gravity – only for upper limb
2) Skin Traction
- Buck’s skin traction [max 5kg]
3) Skeletal Traction
 Internal stabilisation: percutaneous pinning, extramedullary fixation (screws, plates, wires),
intramedullary rods

(C) EXERCISE – to regain function and avoid joint stiffness

Adhesive plaster – Holland strap


+ for young children and thin elderly
SKULL TONG – FOR cervical spine traction
https://www.slideshare.net/kywong5005/ortho-splinting-traction-pop
slide
PLASTER OF PARIS (POP)
Cast – whole circumference of limb
Slab – half circumference of limb and secured with cotton bandages
 8 inches for thigh, 6 inches for leg, 4 inches for arm
 use hot/ warm water will dry the plaster faster (but at the same time need to apply faster
before it dries out)
 apply 4-6 layers (up to 10-12 layers for lower limb)
 create oval ‘window’ if need to inspect wound; must put back the cut piece back to the area
to avoid ‘window edema’, where tissue herniates through the hole as it swells
 for lower limb: apply cast with leg flexed at 30o, as it is the physiological position when human
walk
+ Burns

COMPARTMENT SYNDROME: 6Ps


 Pain – out of proportion (not relieved by painkillers) [earliest sign]
 Paresthesia
 Paresis (partial paralysis)
 Pulselessness
 Pallor
 Poikilothermia [inability to regulate core temperature]

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