General management of fractures

Outline

Treatment of closed fractures Treatment of open fractures

Closed fracture

Reduce fracture

Hold reduction

Exercise

Closed # m(x)

Adequate apposition

Normal alignment

Reduce fracture

Reduce fracture

Extra articular fracture – relative stability

Reduce fracture

Intra articular fractures – MUST obtain absolute stability

Preferably 3 people

Adequate sedation essential

Continuous monitoring

Closed reduction

Closed reduction

Open reduction

Hold reduction

Traction

Hold reduction

Casts

Hold reduction

Functional bracing

Hold reduction

Internal fixation

Hold reduction

External fixation

To restore function to injured part and patient as a whole

Objectives:

Reduce oedema

Preserve joint movement

Restore muscle power

Guide patient to normal activity

Exercise

Elevate and exercise

Never dangle, never force

Prevent oedema

Helps to:

Pump away oedema

Stimulate circulation

Prevent soft tissue adhesion

Promotes fracture healing

On cast – static muscle contraction

Off cast – mobilize joints and build muscle

Active exercise

Especially in fractures around the joint

Assisted movement

Once fracture healed enough, normal daily activity

need to be retaught:

Walking

Getting in and out of bed

Bathing

Dressing

For hand injuries: role of occupational therapists

Functional activity

Open fracture

Fracture communicates with external environment

High risk of infection

Definition

Grading

Antibiotic prophylaxis

Adequate debridement

Fracture stabilization

Wound coverage

Principles

Antibiotics

Remove all dead/dying tissue

Dilute any contaminants

Debridement

Usually with

external fixation

To facilitate wound management

Fracture stabilization

To convert open fracture to close fracture

Wound coverage

15 minute break!

Questions

What is Malaysia’s pre-hospital concept in managing trauma?

Question 1

Fill in this colour coded system used in A&E

Question 2

Describe the methods of clearing an airway

of a trauma victim from the simplest to the most complex

Question 3

Describe the clinical features of the condition

demonstrated by the following x-ray

Question 4

Describe how would you stop a profusely bleeding

upper limb wound

Question 5

Describe the method for performing a closed

manipulative reduction

Question 6

Describe this method of holding a fracture reduction and its benefits

Question 7

Describe how to prevent oedema in a post-traumatic limb

Question 8

Describe the benefits of active exercise in post-

traumatic limb and how to perform this in a patient on cast

Question 9

Name this machine and describe its benefits

Question 10