13. Once the initial assessment, evaluation, and
management of any life-threatening injury
are completed, the open fracture is treated.
Hemostasis should be obtained if there is
significant ongoing bleeding, though bone
bleeding is best reduced by anatomic
reduction.
14. Gross contaminants can be removed if
possible and the soft-tissue wound can be
covered by a sterile dressing moistened
with normal saline. Tetanus immunization
should be provided if the patient does not
have current immunity.
15. Management of Open Fracture
Emergency care of a fracture begins at the site of
accident. In principle it consists of RICE ,which
means
Rest to the part by splinting
Ice therapy, to reduce occurrence of swelling
Compression to reduce swelling
Elevation to reduce swelling
16. At the site of accidient
The following measures are taken
1.The bleeding from the wound is stopped by
applying firm pressure using a clean piece of
cloth.
2.The fracture is splinted
17. In the emergency department
1.Wound care– The wound is washed with saline
under strict aseptic condition and covering it with
sterile dressing.
2. Limb is immobilized with appropriate splint
3. Prophylactic Antibiotic
4.Tetanus prophylaxis
5. Analgesics
6. X-ray of affected limb
20. Causes of pathological fracture
According to Age
At Birth---Osteogenesis imperfecta
0-5 years--- Osteogenesis imperfecta , Osteomyelitis
5-20 years--- Osteomyelitis , simple bone cyst , primary
bone tumour
20-50 years---Cystic lession of the bone, Malignancy
,Osteomalacia ,Giant cell tumour
After 50 years---Osteoporosis, Multiple myeloma
Secondary bone tumour
68. It is very difficult to communicate with
children. children fracture are special
type of fracture which needs special
attension for diagnosis and management
69. There are some fracture which are more common in
children, such as
1. Epiphyseal separation
2.Grenstick fracture
3.Supracondyler fracture of humerus
4.Torus fracture
5.Plastic deformity
75. Principle of treatment
Immature skeleton differs from that of the adult in
both the normal and pathological states.
Capable of plastic deformation before they fail.
Comminuted fractures are rare.
76. Failure of union is rare.
Few fractures require operative treatment.
Presence of growth plate presents a challenge to the
surgeon.
Special considerations :
Pathological fractures
Child abuse
77. Though the principles of fracture management
is described under some structured headings
The practical scene is different.So each case
should be considered on the basis of its own
merit.
Every trauma patient either with or without any
fracture is to be managed on principle of “Total
patient management.”Resucitation” of the pt.to
normal is the most importance before going to
fracture managemant.