ORTHOPEDIC NURSING

EMERGENCY MANAGEMENT OF FRACTURES

EMERGENCY MANAGEMENT OF FRACTURES

FRACTURE -IMMEDIATE CARE

• Provide some kind of support or splint before
moving the person– immobilize the joints above
and below the fractured bone.

• Open fracture: cover with a sterile dressing to

prevent contamination.
• Do not attempt to reduce the fracture.

• Splinting: joints distal and proximal to the

suspected fracture site must be supported and
immobilized
• Assess neurovascular status before and after
splinting.

• Cold application is done during the first 24 hours

to reduce hemorrhage, and edema and contribute
to the patient’s comfort.

• The bed should be provided with a fractured

board and the injured part should be elevated.
• Preserve body alignment.

Open fractures require treatment to prevent

infection.
• Tetanus prophylaxis, antibiotics, and cleaning and
debridement of the wound
• Observe the injured part for
• Closure of the primary wound may be delayed to
o local changes in color, sensation, or
permit edema, wound drainage, further
temperature
assessment, and debridement if needed.
o Tingling, numbness, or burning pain may
indicate nerve injury.
o Coldness, whiteness, or cyanosis may
indicate interference with circulation.
o Increased warmth and swelling may
indicate infection.

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EMERGENCY MANAGEMENT OF FRACTURES
THERAPEUTIC MANAGEMENT
• Closed reduction is bringing the bony fragments
into position (ends in contact) by
o manipulation and manual traction.
o general anesthesia.
• Cast is applied to immobilized extremity and
maintain reduction.
IMMOBILIZATION – It has two methods.
• External fixation – plaster cast fixation, splints,
traction
• Internal fixation – pin and plaster technique,
internal fixation devices
EXTERNAL FIXATION
EXTERNAL FIXATORS
• An external fixator is a device (known as a
"frame") that is positioned outside the body.
• It is used to connect pins and screws to the inside
of the body through the skin and muscle soft
tissues to the bone.
• There are several types of external fixators:
o Unilateral
o V-Shape
o Circular
• Unilateral external fixators
o set along one side of the limb.
o At the thigh, the fixator is set on the
outer lateral side of the limb.
o At the leg, the fixator is set on the inner,
internal, or medial side of the leg.
o The main section of the external fixator is
connected to the bone with screws or
half-pins.
• Roger Anderson – fracture long bones.
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EMERGENCY MANAGEMENT OF FRACTURES
o Small pins or wires are used under
tension and eventually combined with
screws or half-pins.
o allows complex lengthening with
multiple-axis correction, which is
gradually obtained after the surgery.

• ORTHOPIX – FOR FRACTURES LONG BONES

• Hybrid – fracture tibia and fibula

Spanning external fixator – patellar fracture

• Ilizarov Circular Skeletal Bone Fixator -

comminuted fracture, non-healing

• V-Shape Fixators (Delta frame)

o fracture of tibia and fibula
V-shape external fixators are 2 unilateral
external fixators set in triangulation.

o designed to assist in lengthening bones,

correction of angulation, and rotation
defects, and treatment of nonunion.

• Circular External Fixators

o Allow better stability of bone fragments.

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EMERGENCY MANAGEMENT OF FRACTURES
O.R.I.F

Application-External Fixator
• The sharp pin heads are covered with plastic,
cork, or rubber covers to protect the other
extremity and caregivers.

EXTERNAL FIXATION
• Used to manage open fractures with soft tissue
damage.
• ADVANTAGES
o Provide support for complicated or
comminuted fractures.
o Facilitates wound care (debridement,
irrigation change of dressing) and soft
tissue reconstruction.
o Allows early function of muscles and
joints.
o Allows early patient comfort.

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EMERGENCY MANAGEMENT OF FRACTURES

TECHNIQUES OF INTERNAL FIXATION

A. Plate and 6 screws for a transverse or short

oblique fracture
B. Screws for a long oblique and spiral fracture
C. Screws for a long butterfly fragment

D. Plate and 6 screws for a short butterfly fragment.

E. Medullary nail for a segmental fracture

Examples of Internal Fixation for Hip Fractures

IM NAILING

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