General Management of Fractures

Question 1

What is the general management of closed long bone fractures?

Answer 1

A-E resus
Pain relief
Image length of bone and joint above/below
Manipulation and stabilisation in plaster of paris
-ankle at 90 degrees to prevent damage

Re-image to check position

Check for complications- neurovascular status

Further management depends on positioning post manipulation

If fracture well reduced- long term immobilisation and follow up

If not= surgery

Question 2

What is the general management of open long bone fractures?

Answer 2

A-E resus
Pain relief
Check distal neurovascular status and assess degree of soft tissue injury

IV abx immediately +/- tetanus prophylaxis

Leg imaged and taken to theatre within 6hrs

Plastic surgery may be needed?

Question 3

What is the Gustillo and Anderson criteria for managing open long bone fractures?

Answer 3

1- simple fracture, wound <1cm

2- simple fracture, wound >2cm

3- multi fragmented fracture
3A- adequate soft tissue cover
3B- require plastics input
3C- vascular injury