Principles of fracture management

Question 1

What should be the approach to fracture management ?

Answer 1

• Follow ATLS guidelines ABCD to rule out threat to life.
• Always check neurovascular status before and after interventions
• Fracture dislocations need to be reduced ASAP
• Open wounds will need cleaning and Antibiotics
• Open wounds will need a Tetanus
• Reduction promotes healing and reduces pain
• Provide Good Analgesia
• Unstable fractures/poorly reduced fractures nearly always require
  operative intervention

Question 2

What are the basic principles of fracture management?

Answer 2

• Reduction of fracture
• Immobilization / maintenance of reduction
  (cast/splints/surgery)
• Relative stability/ absolute stability
• Rehabilitation (mobilize and exercise)

Question 3

What are the stages of fracture healing ?

Answer 3

• Tissue destruction and haematoma formation
  (immediate)
• Inflammation and cellular proliferation (acute)
• Soft Callus formation (few days to weeks)
• hard callus formation or Consolidation (few weeks to months)
• Remodelling (months up to more than 1 year)

Question 4

What are the adverse factors to fracture healing?

Answer 4

• Degree of local trauma
• Inadequate reduction and immobilization.
• Infection.
• Location of fracture.
• Disturbances of ossification,
• Age, poor nutrition, smoking, drugs (especially NSAIDs), and
  diabetes

Question 5

What are the rule of 2’s in fracture management ?

Answer 5

• Two planes (AP and Lateral)
• Two joints (above and below)
• Two occasions
• Two limbs (compare with normal side)
• Two opinions