Management of Fractures

ABCs, primary survey and secondary survey (ATLS protocol)

• rule out other #’s/injuries
• rule out open #
• AMPLE Hx: Allergies, Medications, Past MHx, Last meal, Events surrounding injury
• Analgesia
• Imaging

1) Obtain the reduction

• closed reduction: apply traction in the long axis of the limb & reverse # mechanism
• indications for open reduction – NOCAST
• other indications include:
  
  
  a) failed closed reduction
  
  
  b) cannot cast or apply traction due to site (e.g. hip #)
  
  
  c) pathological #’s
  
  
  d) potential for improved function with open reduction and internal fixation (ORIF) potential complications of reductions
  
  
  e) infection
  
  
  f) non-union
  
  
  g) implant failure
  
  
  h) new #
• re-check neurovascular status after the reduction and obtain post-reduction XR

2) Maintain the reduction

• external stabilization – splints, casts, traction, external fixator
• internal stabilization – percutaneous pinning, extramedullary fixation (screws, plates, wires); intramedullary fixation (rods)
• post-reduction imaging
• follow-up – evaluate bone healing

3) Rehabilitate to regain functioning and avoid joint stiffness