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Initial Management

The document provides guidance on the initial management and treatment of fractures. It discusses stabilizing the patient by controlling bleeding, immobilizing fractures, and monitoring vital signs. It also covers assessing for additional injuries, administering analgesics, and obtaining diagnostic imaging. Specific attention is given to circulation, the neurological status, and detecting vascular or nerve injuries in the affected limb. The document recommends reducing, restraining, and repairing fractures followed by post-reduction imaging and rehabilitation. It contrasts stable versus unstable fracture types.

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Victor Chan
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81 views2 pages

Initial Management

The document provides guidance on the initial management and treatment of fractures. It discusses stabilizing the patient by controlling bleeding, immobilizing fractures, and monitoring vital signs. It also covers assessing for additional injuries, administering analgesics, and obtaining diagnostic imaging. Specific attention is given to circulation, the neurological status, and detecting vascular or nerve injuries in the affected limb. The document recommends reducing, restraining, and repairing fractures followed by post-reduction imaging and rehabilitation. It contrasts stable versus unstable fracture types.

Uploaded by

Victor Chan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Initial Management

Ice: Reduce pain and swelling


Initial fracture immobilization
Elevation
Compression
Resuscitation and maintain vital sign
Identified and control and external bleeding with pressure and elevation. Temporary cleaning and dressing
Put in collar

Safe Life

Secure Airway with cervical spine protection


By checking vocal response.
Breathing and ventilation
Electric shock: may predispose to respiratory depression due to injury to both CNS and PNS
Check for pneumothorax and immediately decompress if suspect.
Circulation with hemorrhage control
Treating hypovolemia with emergent fluid resuscitation with large bore IV catheter. Also send blood for cross match
Longitudinal traction to a long bone can be considered to stop bleeding from a fracture (because it increases the
pressure inside the hematoma soft tissue envelope according to Laplace Law), with additional benefits of controlling
pain, preventing further damage and fat embolism after long bone fracture, and facilitating subsequent management
by reducing the fracture partially
Disability (Neurological Status)
Exposure: Assess for other injuries
Analgesics
Continuous monitoring of the vitals
Adjunct: Blood Tests (CBC, U/E, Clotting Screen, glucose, cross-match), ECG, Pulse Oximetry and ECG

Safe Limb

Detect any vascular and nerve injuries


Make sure the limb survival by detecting any vascular and nerve injuries before contemplating the treatment of the
fractures
Distal Pulse (Consistency, capillary return, pulse) Detection of an inconsistent distal pulse always indicates there is any
injury to major artery proximally which may be damaged at the fracture site. An urgent angiogram is indicated.
Temperature
Sensation
Swelling
Tenderness
Compartment Syndrome
Acute management: consider Emergent fasciotomy and external fixation

Secondary Survey

Systemic detailed assessment: Rule out other fractures and injuries


AMPLE History: Allergies, medications, past MHx, Laster Meal, Events surrounding injury
Additional imaging:
An open mouth view of the cervical spine helps to evaluate the C1-2 articulation
Aim: Confirm diagnosis and define extent of injury.
Should include joints proximally and distally

Repeated assessment

Fix the Fracture (3R)

Reduction
Restrain using different fixation techniques and Repair
Post-reduction imaging
Rehabilitation
Short-period immobilization to prevent recurrence before healing
Early mobilization to regain functioning and avoid joint stiffness
Early fixation of fracture:
Decreases risk of adult respiratory distress syndrome
Decreases fat embolic syndrome
Facilitates nursing care for other non-orthopedic condition
Makes surgery easier as the fracture ends are still relatively mobile

How do we protect ourselves during fall?

During fall, we protect ourselves by deceleration, which is achieved by two mechanisms


Firstly, the first mechanism is controlled contraction of large muscles of the shoulder and torso trunk against direction of
force.
Secondly, energy of fall is distributed over a large range of joint movement
Injuries occur when the energy of fall cannot be completely absorbed or deflected resulting its transfer to bone, joints and
soft tissues.
During fall, we could not maintain the original centre of gravity and this triggered the protective reaction of automatic
postural reaction, namely righting reflex and equilibrium reaction
In equilibrium reaction, the extremities will produce a protective extension reflex.
Parachute Reflex: Reflex extension of the arm and wrist could help in deceleration of the fall as well to minimize injury
The 3 groups of antigravity muscles including Quadriceps, Hip abductors and Triceps Surae contracted vigorously to
regain the body balance and decelerate to increase the impact time to minimize injury
If we cant retain the balance by the equilibrium reaction, protective reaction serves as a backup
Another aspect: moving the base, widening the base and keeping the centre of gravity over base
Righting reflex are triggered by sensory stimuli such as vestibular/ proprioceptive and corrects the orientation of the body
when it is taken out of its normal upright position. these will finally incorporated into equilibrium for automatic balance.

Stable Fracture

Unstable Fracture

Loss of normal anatomical alignment


Complete fracture
Tendency to further displace even after initial adequate reduction
E.g. Numerous muscular structures that run across the wrist joint and the Smiths fracture may be vulnerable to further
forces applied by muscle contractions/ spasms

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