powerpoin fracture

8/14/2019 Powerpoin Fracture

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FRACTUREFRACTURE


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Goals Pri mary care general approach to fractu remanagement including maximizingoutcomes and minimizing risks Management of common upper and lowerex tremi ty fractu res Pedi atri c speci fi c concerns Splinting and castingtechniques


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First aid of fracturesOnce the following signs and symptoms have disappeared, administer first aid forthe fracture.(1) Touching or moving causes severe pain(2) Severe swelling or transformations(3) Crooking of the limb in the oppositedirection.(4) The sound that the bone touches(5) A pale complexion, cold sweat.


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First aid of fracturesAp p l y a he mo sta t.I f the b o ne i s p ro tru d i ng f ro m the w o u nd , d o no ti rri g a te . Ap p l y a thi c k sa ni ta ry g a u z e a nd b i nd thef ra c tu re d a re a w i th a b a nd a g e , o r a sl i ng i f ahe mo sta t ha s b e e n u se d .S p l i nti ng w i th a sl i ng o r a c l o th f o r f i x a ti o n i n ano n-p a i nf u l p o si ti o n.

P a ssi ve re w a rmi ng a nd a d mi ni ste ri ng me d i c a ltre a tme nt a s so o n a s p o ssi b l e .

Figure from Editorial Supervisor Dr. OSAWA Seiji, Sugunidekiruoukyuteate


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Substitute splintsplint C ardboard Cushion Blanket Newspaper Magazine Pencil chopsti cks Board Measu re Umbrella B amboo sword (cane)

Figure from Editorial Supervisor Dr. OSAWA Seiji, Sugunidekiru oukyuteatemedemirukyukyujiten, POPLAR Publishing Co.,Ltd., 1995


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Equipment(1) General equipment desk, chair, bed, washbowl,

health education inf ormation, etc.(1)(2) For phy sical examination/health counseling

stature meter, scales, tape measure, ey e char t(Landolt C hart) , blood pressure gauge, etc.


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Equipment(3) For f irst aid/implementation of inf ection anddisease prevention clinical thermometer,

scissors, f orceps, nail clippers, cotton buds, bottlesof water, disinfectant (80% ethanol and 10%povidone- iodine), sanitary gauze, medical tape,bandages, sticking plasters, sanitary napkins,plastic gloves, and penlight.


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Equipment(4) For protection and transport blanket , sling, splint ,

stretcher, etc.(5) Medicine O RS or sugar and salt , bottles of water, eye

lotion, anti- inf lammatory analgesic plasters, digestivemedicine, antibiotics, analgesics, antihistamines,antibiotic ointment, and adrenocorticotrophic hormoneointment, etc.

Figure from Editorial Supervisor Dr. OSAWA Seiji, Sugunidekiru oukyuteate medemirukyukyujiten , POPLAR

Publishing Co.,Ltd., 1995


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Equipment(6) For environmental hygiene inspection: thermometer,hygrometer, illuminan ce meter, noi se level meter,water quality test , etc.

(7) Necessary items for a first-aid carrying case

Scissors, forceps, nail clippers, cotton buds, sling, bandages,

plastic gloves, clinical thermometer, sanitary gauze, splint,sticking plasters, ORS or sugar and salt,(bottles of water),

disinfectant, anti-inflammatory analgesic plasters, digestive

medicine, analgesics, eye lotion, antihistamines, sanitary

napkins, memo pad, ballpoint pen, penlight, and plastic bags.


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Bone Description In growing bones

Metaphysis=end or neck

of bones

Diaphysis=shaft

In immature bones,

above definitions plusPhysis=growth plate

Epiphysis=outside of the

physis


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Fracture Description Transverse

Oblique

Spiral Comminuted


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Common Upper Extremity

Fractures-Distal Radius

Fall on outstretched with wrist in extension

Understand normal anatomy of 10 degrees of

volar tilt and radial length of 1cm


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Distal Radius Fracture

Management

For minimally displaced (less than 10-15

degrees dorsal angulation) initial splint-to

control suppination-pronation for 2-4 days

until swelling decreases Short arm cast for 4-6 wks or until fx is non

tender

ALWAYS EVALUATE NEUROVASCULAR in

all fractures


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Distal Radius Fracture (colles) Significantly displaced

fractures require reduction

after anesthesia (Bier block,

axillary or hematoma block

and will need more frequent

follow up to assure stability of

fracture

Orthopedic referral for more

complicated potentially

unstable fractures which may

require internal fixation


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Distal Radius Torus Fractures

Torus (buckle) in children

with minimal angulation

may be managed byshort arm casting for 3-4

wks then volar splint for

at risk activities for

another 3-4 wks3

Use of volar splinting

rather than casting has

also been shown to be

effective


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Common Hand Fractures

Mallet finger

Mechanism-Forced flexionif DIP joint while in

extension

X-Rays important to assess

boney avulsion and

possible displacement

Treatment is Stack splint inhyper extension for 8-10

wks and see every 2 wks


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Middle Phalanx Fracture

Oblique fractures of the

middle phalanx are

often unstable Always check for

rotation

Non displaced fractures

can be buddy taped for

3-4 wks and seen every

1-2 wks to assessstability


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Boxers Fracture

Mechanism: Fist striking a hard object

X-ray shows a 5th metacarpal neck fx with

flexion.

Up to 40 degrees of flexion deformity or more

(measured on lateral) can be tolerated with

goodeventual function. Closed reduction required

with

greater angulation.

Immobilization with an ulnar gutter splint in

90

degrees flexion at the MCP and 30 degrees

extension at the wrist


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Management of Scaphoid

Fractures (high risk)

Displaced fx.- refer to orthopedic surgery.

Suspected- Thumb spica splint and re xray in 10 to 14 days.

Non displaced fxa

Distal=4-6wks short arm thumb spica cast, middle=6wks long arm

thumb spica and 4-6 short thumb spica cast, proximal=refer.


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Clavicle Fractures

Middle Third Most common is middle

third fractures and

especially in children, can

be treated with a sling

rather than a figure of 8

Immobilization is 4-8

weeks or until fracture site

is non tender Nonunion is less than 1%

of mid 3rd fxs


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Clavicle Fracture

Distal Third

Distal third fractures are more rare and displacement

may be indicative of instability due to significant

ligament injury requiring surgical repair Non displaced can be treated with sling for 3-6 weeks


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Clavicle Fracture

Proximal Third

Less than 5% (less than 1% in children) of

clavicle fractures Can be associated with vital neuro vascular

injury with posterior displacement which

could

necessitate emergent treatment

Difficult to image


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Lower Extremity Fractures

Distal fibular or Tibial Maleolar

With stable mortice,

may be managed with4-6 wks in short leg

walking cast or walking

fracture boot in 90

degrees of flexion

(neutral)

Appropriate rehab isessential

Distal fibular shaft

immobilize 6-8 wks


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General Pediatric Considerations

Good news

Healing is usually faster

Excellent callus formation and remodeling

Caution

Injury to the area if the physis can cause

disrupted growth and need longer follow

up and possible referral


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Salter-Harris

Classification Types of fractures by

frequency:II, I, III, IV,V (crush injury)

Type I may not be visible on

x-ray and is suspected when

tenderness is at the site of

the physis

Suggest referral of alldisplaced type I and all Type

III and above due to high

complication rates


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Other Pediatric Fractures

Torus (buckle) is

due to a

compressive force

Greenstick is a long

bone shaft fracture

with involvement of

only one cortex

(>15 degrees angulationrequires closed

reduction)


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Stress Fractures

Hx of significant increase in intensity orfrequency of exercise/use

Must review underlying risk!

(ie, bone metabolism, diet deficiency)

Concept of bone stress reaction to overt

stress fracture


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.THE END.THE END

powerpoin fracture

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