Management of fractures

Question 1

What 3 initial clinical examinations must be carried out?

3

Answer 1

1. Associated injuries
2. Assess above and below the joint
3. Assess for distal neurovascular compromise

Question 2

Initial management steps of a fracture

Answer 2

1. Pain relief
2. Splinatage
3. X ray and photographs

Question 3

Initial mx of an ‘Open fracture’ (3)

Answer 3

• Infection prevention*
  1. Wound is swabbed, photographed and covered with Abx dressing
  2. Tetanus prophylaxis
  3. Start IV antibiotics

Question 4

What is the main principle of fracture management?

Answer 4

1. Reduction
2. Immobilisation
3. Rehabilitiation

Question 5

What is reduction?

Answer 5

Reduction is carried out if fracture if the position of the fracture is significantly displaced, to prevent healing in an abnormal angle.

• if fracture is not displaced –> hold until healed
• If fracture is displaced –> Reduce and then hold until healed

Question 6

What is closed reduction?

Answer 6

When fracture is reduced by traction or manipulation under anaesthesia
( non surgically )

Question 7

What is open reduction?

Answer 7

Typically done when displacement is too severe for closed reduction

1. Formal surgical exposure and reduced under direct vision
2. Followed by internal fixation

Question 8

What is immobilisation?

Answer 8

In order for fracture to heal, it must be fixed in one place.
Fractures can be fixed either;

• Internal fixation
• External fixation

Question 9

Mx of low intensity fracture?

3

Answer 9

non operative immobilisation

1. Casts - Plaster of paris / Backslabs
2. Splint
3. Traction - mainly used in children, prolonged bed rest required.

Question 10

Mx of high intensity fracture?

2

Answer 10

1. External fixation

2. Internal fixation - follows open reduction

Question 11

Name methods of internal fixation? (3)

Answer 11

1. K wires - wires are inserted percutaneously
   - minimally invasive
2. Intramedullary nails
   - fracture of long bones
   (femur/tibia and humerus)
3. Plates and screws - v invasive
   - used for articular fractures
   - e.g. Ankle fractures