4) fracture managment

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CHAPTER SEVEN

BONE AND JOINT INJURIES

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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
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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;

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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.

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Clinical classification of fracture

Open fracture Closed fracture

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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.

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Complete fracture

When the parts of the broken bone are


completely separated from each other.
Types of fracture could be
Transverse fractures
Spiral or oblique fractures
Comminuted fractures
Compressions
Impactions
Avulsions

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• 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.
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Oblique Comminuted

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…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

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Spiral Green stick

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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.

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…cont…
6.Greenstick fracture- Results from
compression force
7.Depression fracture – Results from blunt
trauma to a flat bone, usually involves much
damage.

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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.

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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

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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
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Additional supports
Provide analgesics ( anti-pain)
Provide TAT ( tetanus anti toxoid vaccine)
Provide antibiotics

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 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.

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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

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Splint Applications

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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.

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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

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Fractures of the fore arm

Gently bend the victim’s forearm to a


right angle position to his arm, keep the
thumb in the upper most position.
Apply a well padded splint to the front
and back of the fore arm, extending from
the elbow to the fingers
Bind the splint in position
Place the tie on the level above the fracture
and around the wrist and hands.
Apply a large triangular sling.
(Fracture at the wrist is treated in the 29
Fractures of the fore arm

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Sprain and Strain Injuries

Sprain and strain are grouped under the


soft tissue injuries that involve muscles,
tendons and ligaments.
Strain- is a condition in which the muscle
is partially torn on being
unduly/excessively stretched. It is
commonly seen in athletes.
Sprain- is an injury to tendons and
ligaments surrounding a joint. It is
commonly seen on ankle, knee, or wrist.
. 31
Signs and Symptoms
Localized pain or point tenderness
Swelling and bruising or ecchymosis
 stiffness
Discoloration (bruising)
Decreased range of movement
Loss of function of the joint when there is a
complete or extensive tear of the involved
structures.

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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

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