Conservative Fracture management

Question 1

What are the 4 stages of fracture management?

Answer 1

• Resuscitate
• Reduce
• Retain
• Rehabilitate

Question 2

What are the main forms of reduction of a fracture?

Answer 2

• Open reduction
• Closed manipulation
• Traction

Question 3

When may open reduction be required?

Answer 3

When anatomical reduction is necessary - e.g. inta-articular fractures) or associated neurovascular damage

Question 4

When may closed reduction be regarded as the best option?

Answer 4

For extra-articular fractures where accurate reduction can be achieved

Question 5

What are methods for retaining a fracture in its reduced position?

Answer 5

• External fixation
• Internal fixation
• Conservative immobilisation

Question 6

When would external fixation be used to retain a fracture in its reduced position?

Answer 6

• Contaminated open wound
• Severe open fractures
• Severe associated soft tissue injury

Question 7

When would internal fixation be used to retain the position of a fracture following reduction?

Answer 7

• Comminuted or displaced fractures
• Intra-articular fractures
• Bones not able to be reduced by other methods
• Associated joint incongruity

Question 8

What are the main forms of intramedullary internal fixation?

Answer 8

• K-wires
• Intramedullary nails

Question 9

What are the main forms of extramedullary internal fixation?

Answer 9

Plates and screws

Question 10

How would you conservatively manage a C-spine fracture?

Answer 10

Cervical collar/traction

Question 11

How would you conservatively manage a pelvic fracture?

Answer 11

• If stable - none necessary
• Immediate management - pelvic binder

Question 12

How would you conservatively manage a proximal humerus fracture?

Answer 12

Collar and cuff

Question 13

How would you conservatively manage a midshaft humeral fracture?

Answer 13

Collar and cuff, and U-slab/functional humeral brace

Question 14

How would you conservatively manage a distal/olecranon/epicondylar humeral fracture?

Answer 14

Above elbow backslab/cast

Question 15

How would you conservatively manage a colles fracture?

Answer 15

Colles backslab - below elbow backslab with wrist flexed and ulnar deviated

Question 16

How would you manage a Smith’s fracture?

Answer 16

Below Elbow backslab/cast with wrist extended

Question 17

How would you conservatively manage manage a volar Barton’s fracture?

Answer 17

Above elbow backslab/cast

Question 18

How would you conservatively manage an ulnar fracture?

Answer 18

Above elbow backslab/cast

Question 19

How would you conservatively manage a fracture of the scaphoid?

Answer 19

• Futuro splint +/- thumb extension
• Tumb spica splint/cast - If definite fracture

Question 20

How would you conservatively manage a fracture of any other carpal of the hand except the scaphoid?

Answer 20

• Below elbow backslab/cast
• Volar/dorsal forearm splint

Question 21

How would you conservatively manage a bennet’s fracture?

Answer 21

Bennet’s Cast

Question 22

How would conservatively manage a fracture of 4th/5th metacarpals?

Answer 22

• Ulnar gutter splint
• Volar/dorsal forerarm slab/splint

Question 23

How would you conservatively manage a fracture/fractures of the 2nd/3rd metacarpals?

Answer 23

• Radial gutter splint
• Volar/dorsal forearm slab/splint

Question 24

How would you conservatively manage a patella fracture?

Answer 24

• Above knee backslab
• Leg cylinder cast
• Hinge brace
• Cricket brace

Question 25

How would you conservatively manage a tibial plateau fracture?

Answer 25

* **Hinge brace** * **Above knee back-slab/cast** - non-weight bearing

Question 26

How would you conservatively manage a tib/fib fracture?

Answer 26

Above knee back slab/cast

Question 27

How would you conservatively manage a bi/trimalleolar fracture?

Answer 27

Non weight bearing * **Below knee backslab/cast**

Question 28

How would you conservatively manage a metatarsal fracture?

Answer 28

Weight bear as tolerated * **Stiff soled shoes** * **Walking boot**

Question 29

How would you conservatively manage fractures of the proximal or mid palages of the hand?

Answer 29

* **Buddy tape** * **Ulnar/radial gutter splint** * **Dorsal/volar finger splints**

Question 30

How would you conservatively manage someone with a distal phalanx fracture?

Answer 30

* **U-shaped splint** * **Mallet finger splint** - if mallet fracture