3 Minute Fracture Talk
Reduce fracture with traction and hold with Plaster Of Paris.
What is it
A fracture is a break in a bone
It can be open (to air) or closed
It can be transverse, oblique or comminuted
It can be at the end or the middle of a bone
Describe displacement as tilt (angulation), shift (% loss of end to end contact) or twist (rotation, too difficult).
The patient may be young (< 14 years), co-operative or unwell, the bone maybe abnormal (pathological).
Why treat it
To prevent muscle spasm (pain) and malunion.
Fracture blisters
Supracondylar fracture humerus in child - the most difficult fracture - requires traction and expert judgement.
How to treat it
Save patient. Save limb. Debride and later (closure) soft tissues. Reduce (closed, manipulation, or open, surgery) and hold (externally with POP or external fixateur or internally with screw, plates, rods).
Fracture Healing 5 phases ( See Man. Sp. Med. chapter 2).
Haemorrhage (minutes), granulation tissue (hours), forget days, immature callus (weeks, clinical union), mature callus (months, x-ray union) and re-modelling (years).
Complications
Late is secondary osteoarthritis. Early is: general (death, fat embolism, DVT, pneumonia) or local (skin: blisters, pressure areas, necrosis, RSD; nerves: - neuro proxia/axonotmesis/ neurotmesis; tendons torn or trapped;, blood vessels blocked with ischaemia, no pulse, or venous swelling; muscles: compartment syndrome with pain at rest / paraesthesia / pain on movement; bone healing. Bone healing be slow to heal (delayed union), won’t heal (non-union), can’t heal (necrosis) or heal crooked (malunion).
Fractures just about always operated on
Multiple trauma, pathological fractures, fractures of femur, displaced fractures into joints or of forearm.
Fractures just about never operated on
Children’s fractures (except of hip), tibial shaft fractures, clavicle fractures.
Try not to operate on
The disturbed, drug addicts, and unreliable people.
Quick review of all fractures
Orthopaedics starts at tip of odontoid process. Cervical spine reduce: hold in traction/collar, exclude neuro loss; thoracic spine: high neuro loss; lumbar spine: seldom operate. Pelvis maybe life threatening (give blood). Fractures of hip and femur need ORIF, most foot fractures need reduction with K-wire fixation. Fractures clavicle need sling, shoulder and humerus are forgiving, elbow fractures often need ORIF, forearm fractures often need ORIF, colles fractures closed reduction, most hand fractures closed reduction with K-wire fixation. Growth plate (end of bones) injuries in children may result in growth arrest and shortening or angulation of limb (use Salter Harris classification).
Never apply a full POP to a new fracture; always follow up all fractures.
Know how to reduce a Colles fracture and a shoulder dislocation before finishing medical school. | 
