Fracture and Dislocation Management

Question 1

What are the principles of good pre-hospital management of fracture/dislocation?

Answer 1

1. Control external haemorrhage
2. Apply good splinting practices
3. Resolve neurological or vascular compromise
4. Use judicious analgesia

Question 2

If there is suspicion of a pelvic injury, what is the benefit of prioritising application?

Answer 2

Pelvic splint is a major haemorrhage control device.

Question 3

Following a mechanism that may cause a pelvic injury, what might imply a need for priority application of a pelvic splint?

Answer 3

Inadequate perfusion and/or an altered conscious state.

Question 4

Can you apply a CT-6 and a pelvic splint? Which should be prioritised?

Answer 4

Yes, prioritise pelvic splint.

Question 5

Why should patients with a ?pelvic injury not be log rolled?

Answer 5

May mobilise the pelvis and disrupt clots.

Question 6

What are indicators of neurological or vascular compromise? Is this a time critical emergency?

Answer 6

1. Altered sensation
2. Loss of pulse
3. Cold/dusky skin in a limb distal to fracture/dislocation

Constitutes a limb threatening injury and is time critical.

Question 7

How should a neurologically/vascularly compromised fracture be managed?

Answer 7

Early realignment as a priority.

Question 8

How should a neurologically/vascularly compromised dislocation be managed?

Answer 8

Urgent transport if hospital is within 15 mins Tx time. If >15 mins, consult with receiving hospital and consider relocation at scene.

Question 9

What should be taken into consideration prior to attempting a relocation?

Answer 9

1. Pt analgised

2. Likelihood of success of the procedure

Question 10

What are the general principles of reducing a fracture?

Answer 10

1. Procedural analgesia
2. Irrigate with 500mL-1L if compound fracture
3. Apply traction & counter-traction in the line of the limb
   - This should reduce most fractures
4. Further manipulate limb while under traction as required
5. Splint the limb post-reduction

Question 11

What are the general principles of dislocation relocation?

Answer 11

1. Procedural analgesia
2. Apply sustained traction in the longitudinal direction away from the joint
3. Have an assistant provide counter-traction above the site of injury

Question 12

Is further analgesia likely to be required post-reduction?

Answer 12

Yes. Opioids are indicated for most fractures.

Question 13

What is the STOP note in the Fractures guideline?

Answer 13

Prioritise pelvic splinting if ?pelvic injury or if reduction in PSA/GCS with an MOI that may cause pelvic injury.

Question 14

How should rib fractures be treated in the Fractures guideline?

Answer 14

Not for use with Fractures guideline - treat as per chest injuries guideline.

Question 15

If a limb is injured, assess for?

Answer 15

Neurological or vascular compromise distal to the injury.

Question 16

What are the 5 management points as per the Fractures/Dislocations guideline?

Answer 16

1. If neuro/vasc. compromise - reduce w/ analgesia
2. Apply appropriate splinting post-reduction
3. If a joint dislocated with neuro/vasc compromise, consider immediate Tx w/ notification and consult Clinician for reduction advice
4. Consider ketamine/aggressive analgesia for extremely painful dislocations (eg. hip)
5. Reassess NV status post-manipulation/splinting/sling application