Introduction to fractures and management

Question 1

Fracture-

Answer 1

break in the bone, either completely broken or cracked

Question 2

Causes of fractures

Answer 2

Direct
-break occurs at point of impact
-eg. knee breaks due to hitting the dash
Indirect
-force transmitted along bone
-injury occurs at some point distant to impact
-eg. femur, hip or pelvic fractures due to knees hitting the dash

Question 3

Mechanisms of injury

Answer 3

-Twisting- distal limb fixed, proximal part rotates eg. football or skiing accident
-Avulsion- muscle and tendon unit with attached fragment of bone ripped off bone shaft eg. athletics, dance
-Stress- occurs in legs/ feet secondary to prolonged running or walking
-Pathological- result of fracture with minimal force eg. patients with cancer or osteoporosis

Question 4

Types of fractures

Answer 4

-Transverse- horizontal fracture line, caused by direct injury
-Spiral- fracture coils through bone
-Comminuted- shatters into 3 or more pieces
-Oblique- fracture line on diagonal
-Impacted- compression, ends jammed together, no loss of function
-Greenstick (paediatric)- pliable bone splinters on 1 side but without complete break

Question 5

Closed fracture-

Answer 5

fractured bone doesn’t break or pierce the skin

Question 6

Open (compound) fracture

Answer 6

-fractured bone tears or pierces the skin
-check for wounds around injury site
-increases risk of infection

Question 7

Stable-
Unstable-

Answer 7

-ends of injury may remain in place (bone may not be completely broken)
-ends of fractured bones can easily be displaced (could damage blood vessels, nerves, organs)

Question 8

Limb fractures

Answer 8

Upper extremity- rarely life threatening, may result in long term impairment
Lower extremity- more severe, significant blood loss eg. femur or pelvis
-tend to realign long bones via traction
-splinting via box splint or vacuum splint

Question 9

Pelvic fractures

Answer 9

-direct or indirect force
-likely to break in 2 places
-fragments damage blood vessels, bladder, rectum, nerves
-use pelvic splint and treat as potentially critical

Question 10

Calcaneal fracture

Answer 10

-heel
-results from falls
-consider lumbar sacral compression (lower back)

Question 11

Femur fracture

Answer 11

Mid shaft of femur
-high speed deceleration with impact eg. car accident
-can cause hypovolaemia, use traction splint
Neck of femur
-leg tends to shorten and rotate outwards
-minimal blood loss due to joint capsule

Question 12

Fracture signs and symptoms

Answer 12

-holding/ supporting/ protecting affected area
-swelling near or at site of fracture
-loss of function
-irregularity of limb surface
-pain at or near injury when moved
-deformity
-unnatural mobility
-crepitus may be heard if bone ends grate
-tenderness (bony) when gentle pressure applied to bone

Question 13

Clinical examination

Answer 13

-look- deformity, swelling, bruising
-feel- deformity, bony tenderness
-move- assess range movement (stop if painful)
-examine- joints above and below
-special tests- motor function, sensation, circulation distally to injury

Question 14

Vascular compromise

Answer 14

-vascular injury should be suspected in all fractures and dislocations
Distal to injury assess for:
-pallor- discolouration
-pulselessness
-paraesthesia- pins and needles etc.
-paralysis

Question 15

Managing fracture

Answer 15

-immobilisation
-prevent further damage
-decrease bleeding and swelling
-reduce pain
-provide analgesia
-splint above and below injury
-dressing on open fractures
-neurovascular assessment
-maintain normal alignment

Question 16

Pain management

Answer 16

-pain score before and after intervention
-entonox, paracetamol, morphine