Treatment of closed fractures

What is the preliminary treatment of closed fractures

-ABCs of resuscitation

-first aid, splintage, analgesics, broad spectrum antibiotics

Assessment - is it:

• closed or open

• Is there vascular ,nerve and visceral injury

On examination-pain

• A-abnormal mobility

• B-bruising and swelling

• C-crepters-when you shake limb

• D-disability

What investigations are done to confirm diagnosis in closed fractures

Plain digital X-ray is gold standard in the views anterio-posterior, lateral view

• special views- cone view

• If suspecting c7# -swimmers view

• Odontoid #- open mouth view

CT scan

MRI

PET scan

What are the 3Rs of closed fracture treatment

Reduction-if necessary

Retention/immobilization

Rehabilitation-physiotherapy,may be passive or active

What are the methods of reduction of closed fractures

Closed reduction-reduction/manipulation under anesthesia

Traction- can either be skin traction or skeletal traction, both are weight dependent

Open reduction-operative reduction under vision

What are the methods of immobilization of closed fractures

External splint-sling,pop,neighbor

Traction

Internal fixation- e.g open reduction with internal fixation

What are the methods applicable for open reduction with internal fixation

Suitable for tubular bones e.g tibia, fibulae, femur,radius , ulnar

• metal plate and screws-made up of special steel or titanium,minimum 3 screws before # and 3 screws after #

• Inter medullary nail -methods used open nailing,closed nailing .nails used are called kuntscher nails

• Intramedullary wire- suitable for upper limb # in children , usually done via open method using kirshner wires

• Circumferential wire-to reinforce repair of K-wire and k-nail-wrap the site and tighten

What fractures require rigid immobilization

# neck of femor

#shaft of ulna

# scaphoid

Rigid emobilization is not essential in…

#ribs

#clavicle-arm sling

#scalpula-arm sling

#phalanges- use buddy/neighbor/gaiter splint