management of long bone fractures

Question 1

initial management

Answer 1

• assessment of fracture
• IV analgesia
• splinting/ immobilisation of limb

Question 2

types of splinting immobilisation techniques

Answer 2

• temporary plaster called a backslap
• sling
• thomas splint (for femoral shaft fratures)

Question 3

what if a fracture is grossly displaced/ obvious fracture dislocation/ risk of skin damage from excessive pressure

Answer 3

you can reduce it before x-rays

Question 4

definitive management of fractures

Answer 4

is extremely variable

Question 5

generally

Answer 5

undisplayed/ minimally displaced or unangulated/ minimally angulated fractures which are stable can be managed non-surgically

Question 6

management of displaced or angulated fractures

Answer 6

which are deemed unacceptable require reduction under anaesthetic

Question 7

management of unstable injuries

Answer 7

surgical stabilisation which may involve the use of small percutaneous pin (K-wires) for small fragments, screws, plates and screws, intra- medullary nails or external fixation

Question 8

management of unstable extra-articular fractures of diaphysis

Answer 8

can be fixed with open reduction with internal fixation (ORIF) using plates and screws which will heal by primary bone healing

Question 9

when may ORIF be unsuitable

Answer 9

when soft tissues are too swollen or there will be extensive blood loss i.e. fracture of the shaft of the femur

Question 10

what is carried out if ORIF to be avoided

Answer 10

closed reduction and indirect internal fixation to allow micro motion allowing healing by secondary bone healing

Question 11

management of displaced intra-articular fractures

Answer 11

requires reduction and rigid fixation using ORIF