Managing fractures

46 Managing fractures





Questions



image How is an open fracture managed?

image What are the methods of reduction?

image How can a fracture be immobilized?

A fracture is defined as soft tissue injury with a disruption in the continuity of a bone. This is an important definition, as the soft tissue injury is just as important as the fracture; open fractures, neurovascular damage or compartment syndrome all require special management.


The rate at which fractures heal depends upon a number of factors: the patient (increasing age and adverse health factors slow healing), the fracture (closed fractures heal faster than diaphyseal) and the treatment (good blood supply and immobilization). On average, fractures of lower limbs take 6 weeks in children and 12 weeks in adults, and those of upper limbs take 3 and 6 weeks, respectively.




Imaging


Plain radiographs following the rule of 2s:


image 2 views, A-P and lateral: to assess displacement; some areas require specific views

image 2 joints: joint above and below to identify joint extension

image 2 times: one film prereduction and one film postreduction, to assess the effectiveness of reduction

image 2 sides: to compare normal and abnormal.

MRI is used to assess spinal injury and CT is used to assess visceral injury in pelvic and lower rib fractures.



Interpretation of an orthopaedic radiograph


The ABCS system is used.




Adequacy and alignment

The radiograph should include the joint above and below to identify fully the features of the injury including the alignment of the bones with each other (e.g. when looking at the aligment of one cervical vertebrae with the vertebrae below).



Bone margin and density

The bone margins are followed to note any disruptions indicating fractures. The fracture pattern and deformity (Ch. 45) should be noted and the radiographs examined closely for other fractures and in other bones. The general density and architecture should be noted and any suspicious lesions, which might suggest the possibility of pathological fractures.



Cartilage and joints

Any widening/disruption of joint spaces and surfaces may indicate intra-articular involvement or dislocation, which may alter management.



Soft tissues

Air in the tissues may indicate an open wound, fracture, visceral injury or synergistic infection; gross swelling of the soft tissues may produce local complications.

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Managing fractures

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