conservative management of simple fractures

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Dr. Abdullah-Al-Mamun …

Dr. Abdullah-Al-Mamun
Resident, Department of Orthopaedics and Traumatology
Dhaka Medical College
01716135120

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  • 1. Prof. Md Shahiduzzaman Head, Department of Orthopaedics and Traumatology Dhaka Medical college Hospital
  • 2.
    • Recognise the fracture….always
    • Reduce the fracture…..If possible
    • Maintain reduction…..always
    • Reahabilitation….always
  • 3.
    • Clinical
      • LOOK, ASK, FEEL.
      • Look for nerve damage.
      • Look for impaired circulation
  • 4.
    • X-ray: (Rongentogram)
      • At least two views
      • See joints above and below the affected limb.
      • Define the type of the fracture…
        • Displacement, Angulation, Shortening, Rotation.
        • Number of fragments.
        • Joint involvements.
  • 5.
    • Not all fractures need reduction
    • Fracture needs Reduction
      • Fracture involving joints.
      • Angulation more than 15 degree
      • With any rotation deformities.
    • Aim to get correct alignment.
      • Before manipulation—study x-ray carefully
      • Manipulate gently, firmly and purposefully.
      • Check reduction with x-ray
    • If dislocation, check stability after reduction
  • 6.  
  • 7.
    • BANDAGE
    • BACK SLAB
    • TRACTION
    • EXTERNAL FIXATION
    • INTERNAL FIXATION
  • 8.
    • It begins soon after injury.
    • Speak to the patient gently, tenderly and confidently.
    • Remove anxiety and fear.
    • Do not cause pain by handling the limb carelessly.
  • 9.
    • Plaster of Paris is prepared from Gypsum, which is a crystalline form of calcium sulphate, by heating to 130°C. The heat drives off water of crystallization leaving white plaster of Paris powder.
    • CaSO4.2H 2 O+ Heat (130°C)---> CaSO4.½H 2 O + 1. ½ H 2 O
    • When P/P is immersed in water , it is gradually converted back into Gypsum as water is absorbed by it to re-form crystals. Then there is production of Heat which can be felt as the cast is setting.
    • CaSO4.½H 2 O + 1. ½ H 2 O---------> CaSO4.2H 2 O+ Heat
  • 10. Plaster of Paris Powder Commercial Pack
  • 11.
    • Immobilization of fractures
    • Post-operative fixation
    • To prevent or correct deformity
    • As a supporting splintage
    • To immobilize infected limbs, e.g. osteomyelities, cellulitis
    • To take a cast for splint moulding or for record purposes.
  • 12.
    • Advantages:
      • It can be used individualized.
      • It is durable , if taken proper care.
      • It is disposable
      • It is partially X-ray translucent.
    • Disadvantages:
      • The skin cannot ‘breathe’, become scaly and itchy.
      • It is heavy and difficult to keep clean and dry.
      • There can be complication like osteoporosis, pressure sore, muscle wasting and joint stiffness.
  • 13. Cast is Translucent under X-ray Plaster Sore
  • 14.
    • Contact Doctor immediately if you feel..
      • The toes or fingers become blue or swollen.
      • You are unable to move your limb
      • The limbs become painful
      • You feel ‘ pins and needle’ or numbness.
      • Any blister like pain
      • Discharge or wetness under the cast
      • If you drop any object under the cast.
  • 15.
    • Exercise the joints not under the cast.
    • Do not let the limb hang down especially first few days.
    • Do not wet the cast
    • If the cast becomes cracked, soft or loose conact the Doctor.
  • 16. Plaster for the upper limb
    • From
    • ½ “ proximal to MP Joints
    • To
    • 1” below bend of the elbow, diagonally if necessary to allow unimpeded flexion of elbow joint
    Dorsal Slab or Back Slab
  • 17. Plaster for the upper limb
    • From
    • ½ “ proximal to MP Joints and distal Palmar crease.
    • To
    • 1” below bend of the elbow, diagonally if necessary to allow unimpeded flexion of elbow joint
    Fore-arm Plaster