Fracture management

Question 1

What are the general principles for fracture management

Answer 1

1. Control the haemorrhage
2. Support the injured area
3. Immobilise the join above and below the fracture
4. Assess neurovascular status distal to the fracture before and after splinting
5. Provide pain relief

Question 2

what are the actions before and after splinting a fracture

Answer 2

1. realign long bone fractures as close to normal position before splinting
2. Open fractures with exposed bone should be irrigated prior to realignment and splinting
3. If joints are involved there is an increased possibility of neurovascular impairment and reduction is not recommended
4. Manage middle third femur fracture and upper 2/3 tib/fib fracture with traction splint

Question 3

What are the types of fractures?

Answer 3

1. Comminuted - 2 + bone fragments
2. Segmented - 2 + fracture lines and 1 free floating
3. Transverse - Right angle to long axis
4. Oblique - obliquely to long axis (diagonal)
5. Fracture dislocation - 1+1=2
   Greenstick - bone is bent but fractured on outer arch.

Question 4

Explain Grade 1, 2, & 3 fractures

Answer 4

G1 = <1cm long, clean w/ minimal soft tissue damage
G2= <5cm long, mid-mod contamination + ST damage
G3 = (a) contamination + sever ST damage
(b) Penosteal stripping, requires ST reconstruction
(c) Major vascular injury + contamination