Fracture management

Question 1

What are the important three points to remember for traumatic orthopaedic complaints?

Answer 1

Reduce
Hold
Rehabilitate

Question 2

What is reduction?

Answer 2

Restoring the anatomical alignment of a fracture or dislocation of the deformed limb

Question 3

What does reduction of a fracture allow?

Answer 3

Stopping of bleeding, reduction in the traction on surrounding soft tissue so reduces swelling, reduction of traction on nerves so reduces risk of neuropraxia, reduction of pressures on transversing blood vessels so restore blood supply

Question 4

How is reduction usually done?

Answer 4

Usually closed in the emergency setting but can be done open by visualising the fracture and reducing it with instruments or intra-operatively

Question 5

What is needed for reduction to be done?

Answer 5

Analgesia- regional or local blockade, conscious sedation

Question 6

How many people are required to do a specific manoeuvre?

Answer 6

3- 1 to preform the reduction and 1 to provide counter-traction, 3rd applies the plaster

Question 7

What is hold?

Answer 7

hold is the generic term to describe immobilising a fracture

Question 8

When is traction usually needed with hold?

Answer 8

subtrochanteric neck of femur fractures, femoral shaft fractures, displaced acetabular fractures and some pelvic fractures

Question 9

Why is traction needed with hold for some types of fractures?

Answer 9

the muscular pull across the fracture site is strong and the fracture is inherently unstable

Question 10

What can be used to immobilise a fracture?

Answer 10

simple splints or plaster casts

Question 11

Why are plaster casts not circumferential for the first 2 weeks?

Answer 11

To allow the fracture to swell, otherwise the cast will become tight overnight, and compartment syndrome may occur

Question 12

What is axial instability?

Answer 12

where the fracture is able to rotate along its long axis

Question 13

What fractures usually have axial instability?

Answer 13

combined Tibia/fibula metaphysical fractures or combined radius/ulna metaphysical fractures

Question 14

How should plaster be applied for axial instability?

Answer 14

cross both the joint above and below- above the knee or above the elbow, so prevents the limb from rotating on its long axis

Question 15

What questions need to be asked for patients with casts?

Answer 15

Can the patient weight bear? Do they need thrombophylaxis? Does the patient know about compartment syndrome?

Question 16

What is rehabilitation in regards to fractures?

Answer 16

The need for most patients to undergo an intensive period of physiotherapy, due to the feeling of stiffness after immobilisation, also therapy may be needed if affects the quality of life