Disease - Fractures

From CambridgeNotes

Fracture defined as soft tissue injury complicated by break in a bone

History and Examination

  • Mechanism of injury (suspicious?)
  • Look, Feel, Move, Special tests; Neurovascular

Investigations

  • X-Ray: two orthogonal views; joints above and below; if difficult consider further X-ray or bone scan

Treatment: Resus → Reduce → Restrict → Rehab

  • Resuscitation: open fractures require urgent attention
    • Remove debris; take a photo; antiseptic-soaked dressing
    • Antibiotics and tetanus jab; urgent theatre to debride and examine under anaesthesia (EUA)
  • Reduction: closed (manipulation) < traction < open
  • Restriction: depends on stability of fracture
    • Non-operative: non-rigid e.g. slings; rigid e.g. plaster of Paris
    • Traction (not often used)
    • Operative: external-fixation e.g. pins; internal-fixation e.g. pins, plates, screws or nails
  • Rehab: early mobilization is best
  • Principles applied to hip fracture
    • Intracapsular: undisplaced fractures use cannulated screws; displaced fractures use hemiarthroplasty e.g. Austin-Moore
    • Extracapsular fractures use dynamic hip screw (DHS)

Complications

  • General: tissue damage e.g. rhabdomyolysis, fat emboli, respiratory distress syndrome; rest e.g. sores, deep vein thrombosis (DVT) and pulmonary embolism (PE); anaesthesia
  • Specific: immediate (bleeding, neurovascular damage); early (compartment syndrome, infection); late (problems with union, avascular necrosis, growth disturbance)

Prognosis

  • Children: upper limb 3 weeks; lower limb 6 weeks
  • Adults: upper limb 6 weeks; lower limb 12 weeks
  • Note times given for fractures to unite - double this for the length of time for fractures to fully heal
MediaWiki