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    Closed Fracture Treatment and Management

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    Muruga Dass
    The document discusses various treatment options for closed fractures. Closed reduction aims to improve the position of bone fragments without surgery, using traction and manipulation. Open reduction requires surgery to directly visualize and position the fragments. Immobilization methods include casts, splints, traction, and internal or external fixation to hold the reduction. The choice depends on factors like the fracture type and whether closed reduction was successful.

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    Closed Fracture Treatment and Management

    Uploaded by

    Muruga Dass
    199 views16 pages
    The document discusses various treatment options for closed fractures. Closed reduction aims to improve the position of bone fragments without surgery, using traction and manipulation. Open reduction requires surgery to directly visualize and position the fragments. Immobilization methods include casts, splints, traction, and internal or external fixation to hold the reduction. The choice depends on factors like the fracture type and whether closed reduction was successful.

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    Closed Fracture treatment and management

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    The document discusses various treatment options for closed fractures. Closed reduction aims to improve the position of bone fragments without surgery, using traction and manipulation. Open reduction requires surgery to directly visualize and position the fragments. Immobilization methods include casts, splints, traction, and internal or external fixation to hold the reduction. The choice depends on factors like the fracture type and whether closed reduction was successful.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    199 views16 pages

    Closed Fracture Treatment and Management

    Uploaded by

    Muruga Dass
    The document discusses various treatment options for closed fractures. Closed reduction aims to improve the position of bone fragments without surgery, using traction and manipulation. Open reduction requires surgery to directly visualize and position the fragments. Immobilization methods include casts, splints, traction, and internal or external fixation to hold the reduction. The choice depends on factors like the fracture type and whether closed reduction was successful.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 16

    Treatment for closed fracture

    First consideration-general treatment-treat the

    patient, not the fracture 3 principles:


    hold-hold until unite reduce improve position of fragmnets Exercise- promotes fracture healing

    Reduction
    aim for adequate apposition and normal alignment

    of the bone fragments The greater the contact surface area between fragments the more likely healing is to occur
    Two methods

    Closed reduction

    Open reduction

    Closed reduction
    Done under appropriate anaesthesia and muscle

    relaxation three-fold manoeuvre: 1. the distal part of the limb is pulled in the line of the bone 2. as the fragments disengage, they are repositioned 3. alignment is adjusted in each plane.

    Difficulty in reduction due to powerful muscle pullskin traction or skeletal traction

    Open reduction
    Operative reduction of the fracture under direct

    vision is indicated: 1. when closed reduction fails 2. when there is a large articular fragment that needs accurate positioning 3. for traction (avulsion) fractures in which the fragments are held apart

    Immobilization

    Methods of holding reduction

    Sustained traction Cast splintage Functional bracing Internal fixation External fixation

    Casts and Splints

    Appropriate for many fractures

    especially hand and foot fractures Adults typically will get plaster splints initially transitioned to fiberglass casts as swelling decreases Kids typically will get fiberglass casts

    Complications of cast splintage

    Tight cast

    Pressure sores
    Skin abrasion or laceration Loose cast

    Traction
    Useful in patients who are too sick for surgery

    Useful to maintain alignment until definitive fixation

    Traction by gravity

    Skin traction: fixed

    Skin traction: balanced

    Skeletal traction

    Operative
    ORIF (open reduction internal fixatation)
    Pin & wire fixation. Screw fixation. Plate & screws fixation. Intra-medullary fixation.

    External fixation

    screws

    Plate & screws

    Flexible Intramedullar nails

    Sinple k-wires

    Indications of ORIF
    Absolute Indications for ORIF of fractures Unable to obtain an adequate reduction Displaced intra-articular fractures Certain types of displaced epiphyseal fractures Major avulsion fractures where there is loss of function of a joint or muscle group Non-unions Re- implantations of limbs or extremities

    Relative Indications for ORIF of fractures


    Delayed unions Multiple fractures to assist in care and general

    management Unable to maintain a reduction Pathological fractures To assist in nursing care To reduce morbidity due to prolonged immobilisation For fractures in which closed methods are known to be ineffective

    EXTERNAL FIXATION
    Indications Fractures associated with severe soft-tissue damage Fractures around joints that are potentially suitable for internal fixation but the soft tissues are too swollen to allow safe surgery Patients with severe multiple injuries Ununited fractures Infected fractures

    External fixation cont,

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