Fractures Part 1

Types
Closed.
Open, e.g. open to air, bowel, body cavity.
Which observations may indicate an open fracture?
Is infection a problem in bone?
What is osteomyelitis?
Are closed fractures at risk from infection?
In what ways can bad management cause harm?

Descriptions of fractures
Simple
Transverse
Oblique
Spiral
Comminuted
Impacted
Displaced
Hairline
Crush
Avulsion
Depressed
Greenstick
Stellate
A history of the type of trauma is important

Clinical features
Local pain
Pain on stressing a limb
Impaired function
Swelling
Haematoma
Limb deformity
Abnormal positions or movement
Altered length of limb
Crepitus

Priorities
Whole patient management

Principles of management
Systemic stabilization.
Prevent / treat shock.
Pain management, local and systemic.
Prevent infection
Reduction.
Alignment of bones.
Surgical, external or internal fixation.
Conservative.

First aid and basic management
Systemic stabilization.
Immobilization.
Traction.
Cover open fractures and keep moist.
First aid measure to allow movement to hospital.
Back slab immobilisation technique.
Collar and cuff, sling.

Haemorrhage
Bones have a copious blood supply.
Normal blood volume and how much can be lost.
IVT, warmed crystalloid, 3 for 1.
Observations in haemorrhage.

Local complications
Secondary neurological injury
Vessels may be torn or compressed.
Observations for vascular damage / embarrassment.
Muscle, tendon, ligament injury.
Muscular damage – e.g. compartment syndrome, pain, fibrosis, loss of function.
Where is compartment syndrome most common?
Complications to rib fractures — pneumothorax.
Complications of skull fracture.
Bone grinding.
Skin.
PNS, e.g. brachial plexus, radial nerve.

Systemic complications
Shock.
CNS.
ARDS – shock lung, 24-48 hours after fracture, fat embolism, petechial rash
Rhabdomyolysis with myoglobinaemia and myoglobinuria.