Fracture long bones

Closed -
Open bone has interrupted the tissue
o Wound is adjacent to the fracture
Impacted has underlying pathologic cause
Spiral secondary to indirect force
Dislocation discontinuity of joint; congruity of joint is shattered; joint knee
ankle
Subluxation assoc with strain
Strain muscle; usually at the back
Sprain ligaments, ankle sprain- most commonly sprained in the body
Mechanism
o Direct force
o Indirect force
Signs and symptoms of fractures
o Pain
o Deformity
Length shortening
Angulation
Rotation
o Swelling/ecchymosis
o Loss of function
o Grating
o Exposed bone ends
Hip is externally rotated most common position of hip fracture
Dislocation cannot manipulate in contrast with sprain
Potential complications of fractures
o Bleeding
o Compartment syndrome increased pressure within an enclosed
space
Pain out of proportion
Pallor
Pulselessness
Paresthesia
Paralysis
Management
o Primary survey ABC
Control of external hemorrhage apply pressure
A patient with multiple fractures require immediate transport,
immobilize the whole patient on a long backboard
o Best resting position
Flexed elbow and internally rotated shoulder
Extended hip and knee?
o Secondary Survey
Determine the mechanism of injury
 Identify chief complaint
Head-to-toe survey
Assess the neurovascular status of the injured extremity
Expose the entire extremity
Dress wounds before splinting the fractures
Check distal pulses, motor function and sensation
Upper extremity- check radial pulse
Lower
o dorsalis pedis near thalus, navus
o Posteror tibial posterior to medial malleolus
Straighten severely angulated fractures
Do not use force if there is resistance
Do not try to straighten deformities involving joints
Splint them in the position which they are found
o Purpose of splinting
Alleviates pain
Prevent further injuries
Prevent a closed fracture from becoming an open
Prevent further damage to surrounding tissues
Helps control bleeding
Facilitate transport
Acquire adequate radio evaluation
o For open fractures
Do not attempt to push exposed bones ends back beneath the
skin
Immobilize the joint above and below the fracture
Re-check the neurovascular status. Free the hands and feet
from the splint to access periodic evaluation of the distal
pulses
o Pad rigid splints generously
o Be sure to immobilize all the fractures before moving the patient
o Elevate the injured extremity once it splinted
o When in doubt, splint
Gustilo open fracture classification
o Based on size of wound, degree of contamination, degree of sot tissue
injury
Type III injuries
o Farm injuries
o High velocity gunshot wounds
o Shot gun wounds
o Open fractures more than 8 hours post injury
o Mass casualties
o Open segmental fractures
o Traumatic amputations
Management of open fractures
 Treat open fractures as emergency
Give antitetanus
Abx
Do debridement of wound
o Color
o Contractility
o Ability to bleed
Stabilize the fracture
Plan for wound coverage
Plan for rehab

Internal fixation
o nails,
o interlocking screw (torsion)
o Rod angulation
o Transverse length
Segmental fractures- nails and interlocking screw
2-3 months for bones to heal
mangled extremity severity score
o six or less consistent of salvaged limb
Segmental with comminuted plating or nail