This document discusses the basic principles of fracture management. It begins by describing the case of a man found injured on the road after being hit by a vehicle. It then defines a fracture and outlines the key steps in identifying and initially managing fractures, including assessing life threats, identifying specific injuries, providing emergency treatment, and obtaining a history. It discusses fracture mechanisms and clinical features. The document emphasizes the importance of initial stabilization, splinting, analgesia, and obtaining x-rays before and after reduction. It describes indications for open versus closed reduction and different stabilization methods. Finally, it covers rehabilitation, the emergency treatment of open fractures, and potential complications.

1. Basic principles of fracture
management
Nyiiro Francis MBchB, MMed/Ortho,
FCS(ECSA), Fellow Pediatric Ortho (uoT)
Consultant Orthopaedic Surgeon

2. CASE
• Middle aged man picked by police from the
middle of the road, reportedly knocked by
speeding vehicle.
• Unable to walk, leg deformed, in a lot of pain
and extremities cold
• Pulse 100 b/min, Respiratory rate 30 b/min

3. What is a fracture
• Cracking or breaking of hard object or material
• Continuity of bone is broken

4. What we need to achieve
• Able to identify an injured patient
• Identify life threatening conditions
• Identify specific injuries
• Emergency treatment of injured patient
• Initial management of injured patient

5. Mechanism- remember process
leading to fracture
• Traumatic –(high)
• Pathological (low energy)-tumor, metabolic
bone disease, osteopenia, infection
• Stress fractures – repetitive mechanic loading

6. Clinical features of fractures
• Pain /tenderness
• Loss of function- skin, muscles and bones
• Deformity/leg length discrepancy
• Abnormal mobility and crepitus
• Altered neurovascular status

7. Initial management
• ABCDEs
• Limb – attend to neurovascular status
• Rule out other fractures or injuries
• Rule out open fractures
• Take an SAMPLE history- symptoms, allergies, medical
history, past history, last meal, events sorrounding
injury
• Splint fracture – pain control, reduce tissue damage,
blood loss
• Analgesia
• X-ray rule of 2 pre- and post- operative

8. Radiographic description of fractures-
rule of 2s
• 2 sides: bilateral
• 2 views: AP/Lateral
• 2 joints: above and below
• 2 times: before and after reduction

9. Radiographic description of fractures
• Patient identification
• Identify views
• Open or closed: air in
soft tissue-
open#/infection
• site: site, thirds,
metaphyseal,
diaphyseal or intra-
articular.

10. type
• Spiral: rotational force, low energy
• Oblique: angular or rotational force
• Transverse: direct force, high energy
• Comminuted: (>2pcs) – direct force, high
energy

13. Soft tissue
• Cast/splint
• Calcification
• Gas /air
• Foreign bodies

14. Displacement –distal wrt proximal
• Aposition/translation
• Angulation
• Rotation
• shortening

16. reduction
• Is reduction necessary- may not be for #fibula,
clavicle, compression vert #
• Reduce when amount displacement
unacceptable
• Imperfect apposition may be acceptable but
not imperfect alignment
• Closed when possible

17. Indication for open reduction-NO CAST
• N - non union
• O – open fracture
• C – neurovascular compromise
• A – articular fracture
• S- Salter Harris iii, iv v
• T - polytrauma

18. Stabilization
• Displaced fractures
• Potential to displace

19. External fixation
• Splints/tape
• Casts
• Traction
• External fixator

20. Internal fixation
• Percutaneous pinning
• Extra medullary fixation
• Intra medullary fixation

21. Rehabilitation
• Avoid joint stiffness
• Isometric exercises to avoid muscle atrophy
• ROM for adjacent joints
• CPM especially intra-articular fracture
• Muscle strengthening exercises
• Evaluate # healing with x-ray

22. Open fractures
• Emergency! Fracture communicates with skin
surface.
• Examine fracture carefully to classify

24. Initial treatment
• Do not reduce unless neurovascular compromise
• Remove gross debrise
• All open fractures contaminated!
• Administer tetanus vaccine/booster
• Start antibiotics
• Splint
• NPO prepare for OR
• Irrigation and debridement
• Reduction and stabilization

25. Initial treatment
• Go to OR within 6 hrs preferrably
• Re-exam for possible repeat I&D within 48 hrs.

27. Complications of open fractures
• Osteomyelitis
• Soft tissue damage
• Neurovascular injury
• Blood loss
• Non union