closed fracture

You Should about General Management of Closed Fractures

Health

General Assessment: It is essential to consider the patient and not to concentrate only on the fractured part. Examine the general condition of the patient which must include the cardiovascular, respiratory and central nervous systems.

Associated Injury: Precise clinical examination must be done. Examine the other parts of the skeletal system. Check for any cerebral, thoracic and intra- abdominal injury.

Examine the Local Neuro-vascular System

Blood supply of the part distal to the site of fracture must be assessed carefully. Observe for any local oedema, feel for the temperature of the affected limb, palpate the peripheral arterial limb, palpate the peripheral arterial pulsations and test for sensory and motor functions of the muscles distal to the site of the lesion.

Splint the Fracture Site

Splintage of the affected limb is helpful. This minimizes the pain, prevents further damage to the soft tissues like vessels, nerves and muscles. It also gives confidence to the patient that something has been done immediately.

X-ray Investigation

X-ray is done with the minimum handling of the fractured part.

  1. Usually antero- posterior and lateral views are taken. Sometimes oblique view is essential.
  2. Joints above and below the fracture are included in the x-ray for any associated injury. In cases of children the normal limb may need to be x-rayed along with the purpose of comparison. This makes the diagnosis easy, especially where the bony structures are still in a developmental stage.

SPECIFIC TREATMENT

Aim of Treatment: Treatment is directed to restore full function of the limb. Shortening, rotational and angulation deformities must be corrected to achieve this purpose.

Treatment: The general principles of treatment for the fractures as follows:

  1. Reduction
  2. Maintenance of reduction by plaster immobilization, traction and internal fixation.
  3. Excision of the fractured segment and prosthesis.
  4. Care of the fractured part.

REDUCTION

  1. The purpose of reduction is to bring the bony fragments in contact and into a functional position. Reduction Is not essential in undisplaced or slightly displaced fractures, cases of fracture of the ribs, compression fracture of the vertebra, impacted fracture of the neck of humerus, and in many metacarpal bone fractures.

Different Methods of Reduction

  1. Close reduction by manipulation.
  2. Reduction by traction.
  3. Open reduction.
  • Close Reduction
  1. Traction and counter-traction: This is achieved by traction and counter-traction in opposite directions. The surgeon holds the part of the limb distal to the fracture while the assistant holds the one proximal to the site of lesion. Traction is exerted in opposite directions. Now a days surgeons are using implants provided by Orthopedic Products Manufacturers in India and abroad.
  2. Muscle spasm: Muscle spasm prevents the fracture segments from coming into the position of alignment. Traction is exerted when the patient is fully anaesthetized. Muscle relaxant helps to overcome the state of spasm. Prolonged and steady traction corrects the overriding of the fracture segments and puts them into alignment.
  3. Correction of deformity: To correct the deformity and displacement the surgeon exerts pressure on the displaced segment of the bone. The direction of pressure applied is opposite to the force which produced the lesion.
  4. Apposition of fragments: The proximal fragment of the bone is firmly held by the assistant while the distal segment is mobilized by the surgeon till the apposition is achieved. The diagnosis of proper reduction is made by simple palpation during the process of reduction, which is acquired by practice.
  5. Feeling of alignment: During the process of reduction the fractured segments are felt to come together. This may be in the form of a snapping sensation.
  6. Feeling of resistance: In cases of successful reduction, resistance is felt when the manipulator forces the distal segment of the bone towards the site of fracture while the assistant supports the proximal segment.
  7. Palpation of the site of lesion: This is helpful especially when the bone is subcutaneous. Palpation can be helpful in feeling the position of bone fragments. Comparison is made by feeling the corresponding parts of the normal limb. Palpate the bone margins at the site of lesion for any irregularity, overriding and imperfect apposition.
  • Reduction by Traction

In certain places reduction can be obtained only by traction. Reduction by simple manipulation can prove to be difficult in cases where the bone is surrounded by large amount of muscles, e.g., thigh, due to instability at the site of lesion, e.g., unstable supracondylar fracture. Reduction by traction is mostly done in lower limbs, rarely in upper limbs.

  • Open Reduction

Open reduction is always performed with internal fixation. This is usually done when the conservative methods fail.

MAINTENANCE OF REDUCTION

Once the fracture is reduced, the position of alignment is maintained by several methods like:

  1. External fixation by plaster cast.
  2. Immobilization by traction.
  3. Internal fixation.

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Jaspreet Kaur is a professional blogger and Co-founder of wholepost.com . She is a part-time blogger, well acclaimed for his blogs on topics like - lifestyle, health, travel, fashion, entertainment and much more. She is read by thousands of people daily from around the world.

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