What are the 4 stages of fracture management?
What would you want to cover in a fracture assessment?
- Other injuries
- Neurovascular status
- Social and smoking history
What option are available to reduce a fracture?
- Open reduction
- Closed manipulation
What is involved in open reduction?
Surgical procedure where fracture is reduced
When is open reduction considered for a fracture?
- When anatomical reduction is required
- Associated neurovascular damage
What is involved in closed manipulation?
Manipulation of closed fracture in ED or under GA
When is closed manipulation considered for managing a fracture?
Extra-articular fractures where adequate and ecceptable reduction can be achieved
When is traction used to manage a fracture?
Aid reduction, analgesia and in patients who are unsuitable for anaesthesia
When is external fixation used to retain a fracture?
- Contaminated open wounds
- Severe open fractures
- Severe associated soft tissue injury
When is internal fixation used to retain a fracture?
- Comminuted or displaced fractures
- Intra-articular fractures
- Bones not able to be reduced by other methods
- Associated with joint incongruity
What are intramedullary methods of internal fixation?
- Intramedullary nail
When would you consider using an intramedullary nail to retain a fracture?
Long bone fractures - femur/tibia/humerus
When are K-wires used for internal fixation?
Fracture fragments or for intramedullary fixation of small bones
What are different methods of extramedullary internal fixation methods?
Plates and screws
Why are plates and screws used for internal fixation?
- Bridge comminuted fractures
- Compress simple fractures around joints
- Support areas of thin cortex
- Secure tension side of fracture
What are different methods for retaining a fracture?
- External fixations
- Internal fixations
- Conservative Immobilisation
What are examples of splint casts?
- PLaster/fibre-glass backslab
- Aluminium/wire/heat mouldable plastic splints
What is a splint?
Why should you use a splint/backslab in an acute fracture?
Allow for swelling
What are examples of sustained traction?
- Collar and cuff arm sling
- Skinng traction
- Traction splint
- Skeletal traction
If you managed an acute fracture with a backslab/splint, what would you do in terms of follow up?
1 week post injury - full circumferential cast
What are important aspects to consider for long-term management and rehabilitation?
- Weight bearing status
- Smoking status
- Antibiotic prophylaxis
- VTE prophylaxis
- Cause of fracture
What are immediate complications that can occur due to a fracture?
- Arterial damage
- Surrounding structure damage
- Fat embolus
What are early (within a few weeks) complications of a fracture?
- Wound/prosthesis infection
- Loss if position/fixation
- Chest infection
- Compartment syndrome
What are late complications (months-years) of fracture?
- Delayed union
- Avascular necrosis
What are features of compartment syndrome?
- Pain out of proportion with the injury
- Exacerbated by passive stretching of the limb
- Consider 6 P's
How long does it take for callus to form?
6 weeks - remove temporary fixations at this point
How long does it take for full fracture healing?
When are repeat X-ray performed?
- Post op
- After cast application
What fractures are at risk of avascular necrosis?
- Head of femur
- Scaphoid waist
- Neck of talus
How would you manage a clavicular fracture?
Broad arm sling or polysling
How would you manage a proximal humerus fracture?
Collar and cuff sling
How would you manage a distal humerus fracture?
Above elbow backslab/cast
How would you manage a mid-humerus fracture?
Collar and cuff sling and U-slab cast, or functional brace
How would you manage a colles fracture?
- Closed manipulation under haematoma block
- Colles backslab/cast
What is a colles backslab/cast?
Below elbow cast/backslab with wrist flexed and ulnar deviated
How would you manage a scaphoid fracture?
- Futuro splint +/- thumb extension
- Thumb spica/splint if definitive
How would you manage a displaced intracapsular NOF fracture in someone over the age of 60?
THR or hemiarthroplasty
How would you manage a displaced/undisplaced intracapsular fracture in someone < 60?
How would you manage an intertrachanteric extracapsular NOF fracture?
Dynamic hip screw/gamma nai
How would you manage a subtrochanteric extracapsular NOF fracture?
How would you manage a femur/tibial fracture?
How would you manage a lateral malleolar fracture?
Below knee backslab/cast or aircast boot or stirrup brace
How would you manage a bumalleolar/trimalleolar/lateral malleolar fracture which disrupts the syndesmosis?
What analgesia whould you avoid in fracture management?
NSAIDs - interfere with bone healing