Fracture Management

Question 1

What are the 4 fracture management stages

Answer 1

1. Resuscitate
2. Reduce (if displaced)
3. Retain (to maintain position while healing occurs)
4. Rehabilitate

Question 2

What to do in resuscitation of fracture mx

Answer 2

ATLS in life-threatening wounds

Look for other injuries - does c-spine need immobilised

Question 3

Options to reduce a fracture

Answer 3

Open reduction
- where anatomical (perfect) reduction is required - i.e. intra-articular fracture or associated NV damage

Closed manipulation
- for extra-articular fractures where adequate reduction can be achieved

Traction
- to aid reduction, analgesia and in patients who are unsuitable for GA

Question 4

Options for retaining a fracture

Answer 4

External Fixation - required for:

• contaminated open wounds
• severe open fractures
• severe associated soft tissue injury

Internal Fixation - required for:

• comminuted or displaced fractures
• intra-articular fractures
• bones not able to be reduced by other methods
• associated joint incongruity
• INTRAMEDULLARY - IM nail or k-wires
• EXTRAMEDULLARY - plates and screws

Conservative Immobilisation

• can be used for most fractures without the above properties and to stabilise fractures temporarily before fixation
• splints and casts
• brace (allows continued function)
• sustained traction