fractures bio med 4

7/27/2019 Fractures Bio Med 4

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Fracture Management

Bio Medicine Emergency MedDr. Spencer Shimabukuro


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Fracture Management

Introduction

Rarely life-threateningProper handling can reduce the amount of

pain

Future function may depend on how the fracture

was handled
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Life or Limb

Threatening Emergencies

ConditionOpen fracture

Fracture/dislocation

with major vasculardisruption

Major pelvic fracture

Hip dislocation

Compartmentsyndrome

Possible outcomeOsteomyelitis

Amputation

Exsanguination

Avascular necrosis ofthe femoral head

Ischemiccontracture, renal


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Compartment Syndrome


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Compartment Syndrome

A potential emergency condition where excesspressure builds up in an enclosed part of the body(or compartment)

The pressure may cut off blood to affected tissues

May kill organs and tissues leading to amputation andeven death

May lead to irreversible muscle and nerve damage

Legs, arms, and abdomen are most prone to

compartment syndrome

Usually due to injury/wound such as a brokenbone

May take just several hours to develop


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Fractures & Dislocations

Fracture: A break in a bone produced by

excessive strain or force on the bone.

Causes include a blow, a fall, a twistingmovement, or even no apparent cause

(spontaneous fracture).
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Types of Fracture

Open Fracture (compound): has penetration ofthe skin and bleeding.

Closed Fracture (simple): has the skin intact.

Stress Fracture: is a small fracture usually in aweight bearing bone It is an overuse injury that is caused when

muscles fatigue and excess physical stress istransferred to a bone.

Tibia - runners Tarsals, calcaneus, and toes of the feet runners

Vertebrae osteoporosis and cancer


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CLASSIFICATION OF

FRACTURES

Types of Fractures Transverse - fracture runs

perpendicular to the axis ofthe bone

Greenstick in youth, bonebends and breaks

Oblique fracture runs atan angle to the axis of thebone

Comminuted bone isbroken into several pieces(at least 3 different pieces)

Stress bones fracturesdue to pressure or stressput on it

Spiral due to twistingmotion


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DISLOCATION

Dislocation: is a separation or displacement ofjoint, with a structural loss of joint stability.

It may or may not be accompanied by a fracture(fracture-dislocation).

It is usually caused by an injury such as a hardblow or fall.

Treat a dislocation as a fracture, and seek

medical attention immediately. You can cause a lot of damage by trying to re-

inserting a dislocation yourself


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PERIPHERAL FRACTURES

Mechanisms of Injuries

Variety of Forces

If biomechanics is known it may be possible to

predict.

Direct blow: injury at the point of impact.

Indirect blow: injury caused did not occur at the

point of impact, but rather at a point somedistance away, due to forces transmitted along

the bone.


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Mechanisms of Injury

Twisting Forces: typically the distal part of the

extremity remains fixed while torsion develops in

a more proximal part of the limb. Commonly occurs in football or skiing.

Violent muscle contractions

Avulsion fractures Fatigue/stress fractures

Pathologic conditions


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Signs and Symptoms

(General)

Pain at fracture site

Patient heard the bonesnap or pop.

Deformity or unnaturalmovement

SHORTENING of theextremity.

Swelling/bruising Guarding/loss of use

Crepitus

Exposed bone ends


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Initial Treatment

Keep the patient still

ABCDS

Call 911

Observe for signs of hypovolemic shock due to

internal bleeding

Immobilize broken bones and joints Prevent further injury

Minimize pain and discomfort

Reduce swelling and bleeding


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How to Test for Fractures

A 128 Hz tuning fork canbe used to test forfractures

Hit the tuning fork to

cause it to vibrate Place on potential fracture

The vibrations will vibratethe bones and cause it to

hurt About 80% accurate Mostly accurate on long

bone and ribs

May miss the toes the

most


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Splinting

Splints are applied to suspected fractures,dislocations and severe sprains.

The objective is to immobilize the joints aboveand below the injury.

Applying a splint reduces the movement ofinjured muscles and bones, and allows the

patient to be transported with less pain and riskof further injury.

It also reduces the risk of shock by decreasinginternal bleeding.


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Splinting

Splints can be made from a variety of rigid or

firm materials, including cardboard, a tree

branch, a broom handle, or a tightly rolledblanket or magazine.

An injured limb can also be protected by

Buddy Taping it to another part of the body.


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Splinting Procedure1. Explain the procedure to the patient.

2. Check PMSC (pulse, motor, sensory & capillary refill) before & aftersplinting.

3. Control any bleeding, expose the fracture site by cutting clothing &removing shoes & socks (except for ankle/foot injuries). If you are

splinting an upper extremity injury, remove rings, watches or otherjewelry.

Swelling may make it difficult to remove jewelry at a later time.

4. Control bleeding

5. Select an appropriate splint that is longer than the bone it will need tosupport.

Measure the splint against the uninjured limb to obtain anapproximation of the correct splint size.

6. Pad the splint with soft materials to relieve local pressure.

7. Apply the splint Use tape or binding to secure the splint in place above & below

the injury site


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Treatment

Record status ofdistal pulse


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Treatment

Record status ofcapillary refill time


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Treatment

Record status ofdistal sensation


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Treatment

Record status ofdistal motion

Record status of

distal strength


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Treatment

Splint joints as found

Do not try to realign a broken bone or reduce a dislocationyourself. You may damage the joint, muscles, nerves orblood vessels or even fracture a bone.

Do not push bone ends back beneath the skin.

Immobilize the joints above and below the injury. Try not to move a victim unless absolutely

necessary. Immobilize all fractures before moving the patient.


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Treatment/Splinting

Pad rigid splints

generously

Leave distal pulses

and fracture siteaccessible


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Splinting


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Treatment/Splinting

Reassess distalpulse


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Treatment/Splinting

Reassess distalsensation


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Treatment/Splinting

Reassessmotor/strength


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Treatment

Elevate the injured extremity if possible

Apply cold pack

When in doubt, splint

Continue to reassess vascular and neurologic

status after splinting

DO NOT give the victim food or fluids.

This may delay any necessary surgery.


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Specific Fractures:Assessment and Treatment

Shoulder

Clavicle fracture

Scapula fracture

Acromioclavicular separation

Signs and Symptoms Dropped shoulder

Holding arm across the chest

Inability to raise arm

Point tenderness

Distal numbness


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Specific Fractures:

Assessment and Treatment

Shoulder

Treatment

Have the patient sit or lie down

Support arm

Sling and swath; position of comfort; pad or pillow

under upper arm.


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Specific Fractures:


Humerus

Signs & Symptoms

Same as general fracturePossible wrist drop

Numbness or tingling

Treatment

Same as general splinting and

shoulder

Specific Fractures:


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Elbow

Signs & Symptoms (same as general)

Treatment

If arm is bent

DO NOT STRAIGHTENSling and swath

If arm is straight

Do not bend

Place pad under armpitSplint elbow

Lay patient down and elevate alarm


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Specific Fractures:


Forearm and Wrist

Signs & Symptoms

Same as general

Treatment

Same as general


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Specific Fractures:


Hand

Signs & SymptomsSame as general

TreatmentCrush Injury

Do not cleanse woundPut ball of soft cloth in patients hand

Split in bandage and imposition of functionSupport with slingObserve circulation

Closed Fracture: same as general


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Hip

Signs & Symptoms

Pain at sight and proximal groin

Pain and tenderness pressing on a greatertrochanter

Injured side foot turns out

Affected limb shortened

Treatment

Assess CSM

Place folded blanket between the legs

S ifi F t


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Specific Fractures:


Femur Signs & Symptoms

Severe pain

Loss of distal pulseShortened leg

Hypovolumic shock

Treatment

Control bleeding

Traction splint

High flow oxygen


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Specific Fractures:


Knee, Tibia/Fibula, Ankle and Foot

Signs & Symptoms

Same as general

Treatment

Same as general


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FRACTURE MANAGEMENT

Summary

Rarely an immediate threat to life.

A fracture can wait, the airway or severebleeding cannot.

If you do not check for neurological deficit, you

will not find it. When in doubt, treat the injury as a fracture.


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fractures bio med 4

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