12/31/2023 0 Comments Comminuted open fracture pictures![]() ![]() Appropriate evaluation at first presentation, as well as during their management, can significantly prevent both morbidity and disability to a patient. Hand fractures are the most common fractures presenting at both accident and emergency and within orthopaedic clinics. Allowing the ability to grasp, and differentiated from other animals by an opposing thumb, the main functions include both fine and gross motor skills as well as being a key tool for sensing and understanding the immediate surroundings of their owner. Callus forms in 6 weeks – temporary fixations (e.g.The hand is essential in humans for physical manipulation of their surrounding environment.Treat the cause of the fracture if necessary, e.g.Antibiotic prophylaxis for open fractures.Analgesia (but avoid NSAIDs – they interfere with bone healing).Smoking cessation – delays bone healing.For swelling, RIE: Rest, Ice, Elevation.Non-weight-bearing (leg must not touch floor) – for ~ 6 weeks in conservatively managed unstable fractures and after fixation with plates.Consider weight-bearing status of affected lower limb.Learn how to apply a backslab and cast here! Slings, splints and braces are also covered here. NB: femur and tibia/fibula shaft fractures can be managed conservatively but are usually managed with intramedullary nailing to reduce time non-weight-bearing. Skeletal traction (pins passed through bone to provide point of traction).Skin traction (adhesive strappings around parts of limb distil and proximal to fracture, and weight traction applied to each in opposite directions).Brace (supportive device that allows continued function).Cast (circumferential immobiliser), e.g.plaster backslab, fibreglass backslab, aluminium/wire/heat-mouldable plastic splints Splint (non-circumferential immobiliser), e.g.Conservative immobilisation – can be used for most fractures without above properties, and also to stabilise fractures temporarily in case of delay before reduction/fixation.Plates and screws – to bridge comminuted fractures, compress simple fractures around joints, support areas of thin cortex or secure tension side of fracture.K-wires (stainless steel pins which can be inserted percutaneously to hold bone fragments together can be used as temporary fixation for ~4 weeks) – for fracture fragments or for intramedullary fixation of small bones.Intramedullary nail – for long bone fractures (femur/tibia/humerus).Internal fixation – required for: comminuted or displaced fractures, intra-articular fractures, bones not able to be reduced by other methods, associated joint incongruity.External fixation – required for: contaminated open wounds, severe open fractures, severe associated soft tissue injury.(to maintain reduced position while callus forms in ~ 6 weeks) Learn about closed fracture manipulation here! REtain Traction (to aid reduction, analgesia and in patients who are unsuitable for anaesthesia).Closed manipulation (may be done in emergency department or require general anaesthesia) – for extra-articular fractures where adequate and acceptable reduction can be achieved.for intra-articular fractures) or associated neurovascular damage Open reduction – when anatomical ( perfect) reduction is required ( e.g.Look for other injuries (don’t get distracted by one obvious injury!) – does the cervical spine need to be immobilised?.Advanced trauma life support in life-threatening wounds (see ATLS).Retain (to maintain position while healing occurs) – by internal fixation, external fixation or conservative methods.Reduce (if displaced) – may be done by open reduction, closed manipulation or traction.Include social history and smoking (delays bone healing)įracture management stages include ( 4 R’s):.When/where/why it happened (was it the result of another problem, e.g.Who – age, job, hobbies, hand dominance (if hand/arm involved). ![]()
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