Fracture (cont.)
What is the treatment of a fracture?
Initial treatment for fractures of the arms, legs, hands and feet in the
field include splinting the extremity in the position it is found, elevation and
ice. Immobilization will be very helpful with initial pain control. For injuries
of the neck and back, many times, first responders or paramedics may choose to
place the injured person on a long board and in a neck collar to protect the
spinal cord from potential injury.
Once the fracture has been diagnosed, the initial treatment for most limb fractures is
a splint. Padded pieces of
plaster or fiberglass are placed over the injured limb and wrapped with gauze
and an elastic wrap to immobilize the break. The joints above and below the
injury are immobilized to prevent movement at the fracture site. This initial
splint does not go completely around the limb. After a few days, the splint is
removed and replaced by a circumferential cast. Circumferential casting does not occur
initially because fractures swell (edema). This swelling would cause a
build up of pressure under the cast, yielding increased pain and the potential
for damage to the tissues under the cast.
Surgery
Surgery on fractures are very much dependent on what bone is broken, where it
is broken, and whether the orthopedic surgeon believes that the break is at risk
(for staying where it is) once the bone fragments have been aligned. If the
surgeon is concerned that the bones will heal improperly, an operation will be
needed. Sometimes bones that appear to be aligned normally are splinted, and at a
recheck appointment, are found to be unstable and require surgery.
Surgery can include closed reduction and casting, where under anesthesia, the
bones are manipulated so that alignment is restored and a cast is placed to hold
the bones in that alignment. Sometimes, the bones are broken in such a way that
they need to have metal hardware inserted to hold them in place. Open reduction
means that, in the operating room, the skin is cut open and pins, plates, or rods
are inserted into the bone to hold it in place until healing occurs. Depending
on the fracture, some of these pieces of metal are permanent (never removed),
and some are temporary until the healing of the bone is complete and surgically
removed at a later time.
References: Stiell IG, et al. The Canadian CT head rule for patients with minor head injury. Lancet May 5, 2001;357:1391-6. Stiell IG, et al. The Canadian CT head rule for patients with minor head injury. Lancet May 5, 2001;357:1391-6.
Last Editorial Review: 8/7/2007
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