Principles of fracture management

Question 1

What are the 3 core components of fracture management?

Answer 1

Reduce

Hold

Rehabilitate

Question 2

What does reduction entail?

Answer 2

Restoring the anatomical alignment of a fracture or dislocation of the deformed limb

Main principle = correct deforming forces that caused the injury

Usually requires 2 people → 1 does reduction, the other provides counter-traction (3rd person plasters)

Question 3

What does reduction enable?

Answer 3

Tamponade of bleeding at fracture site

↓ traction on surrounding tissues = ↓swelling

↓ pressures on BV = restores any affected blood supply

Question 4

How and where is reduction normally done?

Answer 4

Closed in ED

Sometimes open (direct visualisation of fracture and reducing it with instruments) in surgery

Question 5

What clinical consideration should you bear in mind when doing reduction?

Answer 5

It’s painful → needs analgesia

Method of choice = regional/local blockade

Next line = short period of conscious sedation

Question 6

What does “hold” entail?

Answer 6

Immobilise fracture

Done via simple splints or plaster casts

Question 7

When applying a plaster cast what are the most important things to remember?

Answer 7

Must have an area which is only covered by the underlying dressing

Allows the fracture to swell

Question 8

What can happen if the plaster is not applied correctly?

Answer 8

Becomes too tight + painful

↑ rsk of compartment syndrome

Question 9

How should the plaster be applied when there is axial instability?

Answer 9

It should cross the joint above and below

Question 10

What is axial instability?

Answer 10

Fracture is able to rotate along it’s axis e.g., in a combined tibia-fibula metaphyseal fracture

Question 11

What 3 things should you think about when immobilising a fracture?

Answer 11

1. Can the patient weight bear? - varies depending on fracture but always inform patient of this
2. Do they need thromboprophylaxis? - if the patient is immobilised in a cast and not weight bearing, it’s common to provide thromboprophylaxis
3. Have you provide advice about symptoms of compartment syndrome? - tell patients about symptoms and importance of coming to A&E for further assessment if they get them

Question 12

What does “rehabilitate” entail?

Answer 12

Intensive period of physiotherapy after fracture Mx

Patients get stiff after immobilisation hence therapists and important for a successful recovery + ensuring that they have adequate adaptations at home if they need it (due to things like reduce ability to weight bear or use an arm)

Advice patients to move non-immobilised unaffected joints from the outset

Question 13

Source

Answer 13

https://teachmesurgery.com/orthopaedic/principles/fracture-management/