2.3 Long Bone Fractures

Question 1

What are the long bones?

Answer 1

1. Humerus
2. Radius and Ulna
3. Femur
4. Tibia and Fibula
   Most often in RTA or in sports under age of 40, peak teenage boys.

Question 2

Initial management of a long bone fracture?

Answer 2

ATLS principles

• Pain relief.
• Immobilise fracture in a vacuum splint can help during transfer. (comfort, reduce neurovasc injuries, can be xrayed)
• Manipulate fracture into anatomic position and hold with plaster of Paris (POP).

Question 3

Management options for long bone fractures

Answer 3

1. Conservative management
   (if good position from reduction or too unwell for surgery)
2. Surgical management:
   - open reduction and internal fixation (plate and screws, allows inter fragmentary compression, precontoured plates are good for close to knee or ankle joints, soft tissue damage from plate can disrupt healing)
   - intramedullary nailing (for mid shaft fractures, harder if close to metaphysis)
   - external fixation (good in high energy injuries where soft tissue damage precludes safe surgical insition, also used in open fractures where there was contamination at the fracture site, difficult to gain compression yet the construct is rigid can lead to nonunion, pins can be entry point for infection and osteomyelitis)

Question 4

When do stress fractures occur?

Answer 4

Repetitive loading: athletes, military recruits

Weakened bone: osteoporosis, Paget’s disease.

Question 5

Ix to Dx a stress fracture?

Answer 5

Insidious onset, exercise pain.
Xray may just show periosteal reaction 1 month after fracture.
No xray findings then MRI or Technetium-99m scans.
Rest 4-6weeks