5. Management of a Fracture or Dislocation

What is a dislocation

no articulation between two bones where there normally is one

What history should you always take if there’s a fracture/dislocation and why

AMPLE history because they’ll need treatment and stuff in AMPLE may affect that

what’s AMPLE stand for

Allergies

Medications

Past medical history

Last meal

Events

If time allows at the emergency, what should you do

A full history. But get ample down at least

What 3 things do you do when examining

look

feel

move

What nerves are related to the shoulder and why

Auxillary, radial, median- they’re close to the humeral head of the shoulder

Where does the auxiliary nerve supply

The area where the regimental band would be

Where does the ulnar nerve supply

the thumb and half of the ring finger

how to test ulnar nerve works

ask patient to spread hands then push them together

Where does the auxiliary nerve go w the shoulder

loops around the shoulder

What does the radial nerve supply

posterior muscles or the nerve and forearm

how to test the motor supply of the radial nerve

push down on the index finger while patient keeps it up

how does loss of sensation for a radial nerve present itself

best seen in the bit between the thumb and index finger

what does the median nerve supply

skin on the palm side of the arm, & the fingers that the ulnar doesn’t

how to test motor work of the thumb

make patient keep their thumb up as I try pushing it down

What to use to investigate a dislocation

X-ray, & CT scan

when specifically are you using a CT scan

If you’re uncertain abt what caused the underlying problem

How to manage the patient’s pains

Ensure the patient’s well cared after

talk to patiet abt how to reduce the dislocation if the dislocation’s the problem

reassess the neurovascular state before and after anything done to the area

why’re we reassessing the neurovascular area sm?

a nerve may have gotten worse afterwards

there may be no improvement, implying an operation (further treatment) may be requried

How to assess vascular status in the wrist/arm

press down on fingers and see if the blood runs back

interpretation of vascular status

if colour returns, the capillary refill is good in the arm

What do most fracture cases need

a reduction of the fracture

how to reduce the fracture in a wrist

Haematoma block to numb the wrist and align it better (yh a needle’s inserted)

Work done to reposition the fracture

(after anaethetic’’s injected into the blood clot forming around the fracture), the fracture’s realigned

steps to realign mechanically (w hands)

1. disimpaction (hyperextending the deformity a little bit here)

2. establish length (turning it)

3. establish alignment (aligning it)

How long is there a plastercast for

4-6 week afterwards

what if the position isn’t regained

an operation’s done

What’s put in an elbow fracture to keep everything in place

K-wires

Manovure to realign an elbow fracture

that

How to potentially realign the ankle bone rly easily

lifting the anle off the bed and raising the big toe. gravity may do its thing

How to realign a dislocation in a hip

• downward pressure on the pelvis

• external & internal rotation & upward pull on the femur

• reduction

What may an intertrochanteric fracture look like on surface

externally rotated, shortened

what may an interscapular fracture look like

Internally rotated