Principles of Fracture Management Flashcards
Most important principles.
Reduce
Hold
Rehabilitate
What is done before RHR in high-energy injuries?
Resuscitation following ATLS principles
What is reduction?
Restoring the anatomical alignment of a fracture or dislocation of the deformed limb
Why is reduction important?
Tamponade of bleeding at fracture site
Reduction in the traction of surrounding soft tissues
Reduction in the traction on the traversing nerves
Reduction of pressure on traversing blood vessels
How is fracture reduction typically done?
Performed closed in the emergency setting.
Some need open reduction by directly visualising the fracture or intra-operatively.
What does reduction require?
Analgesia either regional or local blockade
E.g. fascia iliaca blockade.
Patients usually require a short period of conscious sedation as well, provided A&E has access to anaesthetic agents, airway adjuncts and monitoring.
Specific manoeuvres usually requires two people
Usually also requires a third person to apply the plaster
What does hold involve?
Immobilising a fracture, this also involves traction if required (especially where the muscular pull across the fracture site is strong and makes the fracture unstable).
Most common way to immobilise a fracture
Simple splints or plaster casts.
Most important principles when applying a plaster cast.
First 2 weeks plasters are not circumferential
This is to allow the fracture to swell.
If there is axial instability the plaster should cross both the joint above and below
Usually termed as “above knee” or “above elbow”
Clinical requirements of immobilisation.
Can the patient bear weight? -> Let them know
Do they need thromboprophylaxis? -> If immobilised higher risk of DVT
Have you provided advice about symptoms of compartment syndrome and how to recognise it?
Explain rehabilitation
Intensive physiotherapy following fracture management.
Essential to successful recovery and is important to ensure patient to move non-immobilised unaffected joints from the outset.
Be mindful that immobility and inability to weight bear can have a profound effect on ability to cope at home.
Occupational therapist needs to be involved here.