4) fracture managment
4) fracture managment
4) fracture managment
1
1 – Giving Emergency Care for A victim with
Fractured Bone
Fracture – Is a break in the continuity
of a bone.
Bones usually fracture in their shafts
Causes of Fracture;
Traumatic or accidental causes
-It could be as a result of direct or
indirect force application
Pathologic causes of fracture
2
Types of Fractures
Clinical classification of fracture
Simple Closed fracture – In which the broken
bone doesn’t come out through the skin.
Compound or open fracture –.An open (or
compound) fracture occurs when the skin overlying a
fracture is broken, allowing communication between the
fracture and the external environment
It is the severe form of fracture as there is;
3
Common sites for fractures
Upper arm (humerus)
Forearm (radius/ulna)
Wrist
Lower leg (tibia/fibula)
Ankle
These fractures are common because the bones are on
the limbs, so stick out from the body and are
vulnerable to injury from falling over.
4
Clinical classification of fracture
5
Radiological classification of fracture
Depending on the amount of fracture, a
classification is made as;
Complete fracture
Incomplete fractures
Incomplete fractures
Are said when the parts of the broken
bone doesn’t separate from each other.
Examples could be crack or green stick
fracture which is common in child age
groups.
6
Complete fracture
7
• There are different types of bone fracture
by the position of the bone fragments;
1.Comminuted – in which the bone breaks in to
small pieces (3 or more fragments).
2.Impacted – – fragment of bone wedged in to
other bone fragment
3.Oblique – The fracture line crosses the bone
at an angle
4.Displaced- in which the fragments separated
and deformed
5.Overriding- in which fragments overlap and
the total length of the bone is shortened.
8
Oblique Comminuted
9
10
…cont…
8.Greenstick- one side of the bone is broker,
and the other side is bent. .
9. Transverse – straight across the bone
10. Depressed – fragment(s) are driven
inward (skull)
11.Avulsion – fragment of bone pulled off by
ligament or tendon attachment.
12. Spiral – twists around the shaft of the
bone
11
Spiral Green stick
12
Causes of fractures
General
Accidents such as automobile or a fall.
1.Transverse – Results from direct trauma.
2.Oblique – results from a twisted force
3.Spiral fracture – Results from twisting
force with firmly planted foot
4.Comminuted – results from severe direct
trauma
5.Impacted – Results from sever force to top
of head and heel.
13
…cont…
6.Greenstick fracture- Results from
compression force
7.Depression fracture – Results from blunt
trauma to a flat bone, usually involves much
damage.
14
Clinical Presentation
If the victim is conscious and can explain the condition,
you may get important clues to the possible fracture.
The victim may heard bone snap
The victim may indicate the location of pain and
tenderness, and difficulty in moving the injured part
The victim may have heard or feel broken bones rubbing
together (crepitation)
The victim may sense abnormal motion in the injured area
of the body.
15
Signs and symptoms of fracture
Difference in the shape and length of the
corresponding bones on the two sides of the
body.
Pain that is usually severe and gets worse
with
movement
Local swelling
Bruising
A limb or joint that is visibly out of place
Limitation of movement or inability to bear
weight
Numbness and tingling 16
Management
Goals of the management
• Prevention of infection
• Prevention of further damage
• Improving wound healing ( fracture healing )
• Restoration of function
17
Assess and manage ABC.
emergency care measures for fractures
Reassure and calm the causality
Manage bleeding if any and assess for shock.
Splinting (immobilizing) the limb above and
below the suspected fracture ,assess for any
neurological deficit.
The injured area should be elevated to reduce
swelling and pain
Expose the injured area and assess unnoticed
injuries.
Urgent referral
18
Additional supports
Provide analgesics ( anti-pain)
Provide TAT ( tetanus anti toxoid vaccine)
Provide antibiotics
19
Precautions
Transport an injured victim as if the victim has
a spinal cord injury.
Do not attempt to reduce a fracture or try to
push a protruding bone end back.
Never test for fracture by having the victim to
move the part or try to walk on a possibly
broken leg.
Do not allow an accident victim to move his
neck.
20
Complication of fracture
Blood loss, Resulting in shock
Injury to vital organs
Neurological and / or vascular damage
Infection in open fractures
Fat embolism
Compartment syndrome : is the compression
of nerves, blood vessels, and muscle inside a
closed space (compartment) within the body.
This leads to tissue death from lack of
oxygenation; the blood vessels being
compressed by the raised pressure within the
compartment. Compartment syndrome most
often involves the forearm and lower leg . 21
Splint Applications
Splints are devices applied to parts of a body
especially on the arms, leg, and trunk to
immobilize the injured part when a fracture is
suspected or diagnosed.
Splints are used to;
Prevent further injury
Decrease pain
Decrease the likely hood of developing shock
22
Splint Applications
23
Principles of splint application
Though there are standard splints,Splints can be
made from the locally available materials E.g. splint
can be made from a straight stick, pillows, blankets
or other hard boards.
During splint application
Splints should involve the adjacent joint
Splints should be well padded in between the
splint and the skin, specially on the bony
prominences,
Pads should extend above the ends of the splint
Do not hold splints to tight; it may result in
compartment syndrome.
If a fracture is on the arms and legs, check distal
pulses and discoloration frequently. If there is
numbness, tingling sensation loosen the splint. 24
Fractures of the scapula and clavicle
Apply a triangular sling and bandaging the
victims upper arm to the chest wall. Look the
figure below.
25
26
Fracture of the humerus
Apply a pad in the victims arm pit
Apply a splint tied in place above and below
the break
Support the forearm with a triangular sling
Bond the victims upper arm with the chest
wall
Cover the wound with a sterile or clean
dressings
Apply a splint with a window over the break.
Support the victims arm with a sling and bind27
Fracture of the humerus
28
Fractures of the fore arm
30
Sprain and Strain Injuries
32
Rest and elevation
Rest to prevent further injury
Elevate to decrease swelling
Application of cold compress on a sprain
Application of pressure bandages
Or use elastic bandages
Provide analgesics
Surgical treatments may be required or
indicated for an extensive or complete
tear of the structures. 33