Fracture management Flashcards
What is the typical management of a clavicular fracture?
Broad arm sling or polysling
What is the typical management of a proximal humerus fracture?
Collar and cuff sling (applies traction)
What is the typical management of a mid-humerus fracture?
Collar and cuff sling + U-slab cast, or functional brace
What is the typical management of a distal humerus fracture?
Above elbow backslab/cast
What is the typical management of a Colles’ fracture?
- Close manipulation under haematoma block
- Colles’ backslab/cast (below elbow)
(wrist flexed and ulnar deviated)
What is the typical management of a scaphoid fracture?
- Futuro splint ± thumb extension
- Thumb spica splint cast if definite fracture
What is the typical management of a NOF (intracapsular) fracture?
Displaced >60 years:
- THR
- Hemiarthroplasty
Undisplaced/displaced <60 years:
- cannulated screws
What is the typical management of a NOF (extracapsular) fracture?
Intertrochanteric:
- dynamic hip screw
- gamma nail
Subtrochanteric:
- intramedullary nail
What is the typical management of a femur/tibia shaft fracture?
Intramedullary nail
What is the typical management of a lateral malleolus (Weber A) fracture?
- Below knee backslab/cast
- Aircast boot (CAM boot) or stirrup brace (full-weight bearing)
What is the typical management of a bimalleolar/trimalleolar/lateral malleolar fractures that disrupt the syndesmosis (Weber C and some Weber B)?
Surgical fixation
What are the 4 Rs of fracture management?
- Resuscitate
- Reduce (if displaced)
- Retain (maintain position whilst healing occurs)
- Rehabilitate
Why is fixation required?
To maintain reduced position while callus forms in ~6 weeks
When is external fixation indicated?
- Contaminated open wounds
- Severe open fractures
- Severe associated soft tissue injury
When is internal fixation indicated?
- Comminuted or displaced fractures
- Intra-articular fractures
- Bones not able to be reduced by other methods
- Associated joint incongruity
What are the different methods of intramedullary internal fixation?
- Intramedullary nail (long bone fractures)
- K wires (fracture fragments or small bones)
What are the different methods of extramedullary internal fixation?
- Plates and screws (bridge comminuted fractures, compress single fractures, support areas of thin cortex)
How long does full fracture healing usually take?
12 weeks
Generally, lower limb bones take twice as long to fully heal as upper limb bones
Children’s bones heal twice as fast as adult’s bones
Why are some fracture fragments at risk of avascular necrosis?
Retrograde blood supply
Which type of fractures are at highest risk of avascular necrosis?
- Head of femur
- Waist of scaphoid
- Neck of talus
