Management of common fractures
- Clavicle
- Rest in sling or collar and cuff for two weeks
- Active shoulder movement started after first week
- Femur - trochanteric region
- Fixation with dynamic hip screw
- Early postoperative mobilisation is important
- Femur - shaft
- Operative reduction usually required
- Internal fixation achieved with intramedullary nail
- Fibula - shaft
- Protect limb in below knee walking cast for 3 weeks
- Humerus - neck
- In elderly disregard fracture and concentrate on shoulder movement
- If fracture impacted begin mobilisation early
- Humerus - supracondylar region
- Reduce by manipulation under anaesthesia
- Place in full length cast with elbow at 90 degrees
- Observe carefully distal circulation
- Olecranon
- Undisplaced fractures need immobilisation in right angled arm plaster
- Displaced and comminuted fractures require internal fixation
- Internal fixation can be achieved with tension band wires
- Patella
- Undisplaced fractures should be protected in full leg cast for 3 weeks
- Displaced fractures require internal fixation with screw or tension band wire
- Comminuted fractures may require patellectomy
- Phalanges
- Undisplaced fractures should be strapped for 2-3 weeks
- Displaced fractures may require manipulation and external fixation
- Radius - head
- If minimal displacement place in collar and cuff for 3 weeks
- If severely comminuted excise radial head
- Scaphoid
- Immobilise in Scaphoid cast until fracture united
- If delayed union consider fixation with Herbert screw
- Tibia - shaft
- Undisplaced fracture require immobilisation in full leg cast
- Displaced fractures may require internal fixation with intramedullary nail
Eponymous fractures
- Bennett's fracture
- Intra-articular fracture of the base of the first metacarpal
- Usually requires open reduction and internal screw fixation
- Colle's fractures
- Fracture of the distal radius with dorsal and radial angulation and backward displacement
- Closed reduction should be followed by immobilisation in forearm cast for 6 weeks
- Position should be checked by radiography one week after injury
- Galeazzi fracture
- Fracture of the radial shaft with dislocation of the inferior radio-ulnar joint
- Usually requires internal fixation of the radius
- Monteggia fracture
- Fracture of the proximal ulna with anterior dislocation of the radial head
- Usually requires internal fixation of the ulna
- Radial head should be reduced or excised
- Pott's fracture
- A general term applied to ankle fracture's
- Smith's fracture
- Fracture of the distal radius with anterior displacement of the distal fragment
- Closed reduction may be successful
- If
fails requires open reduction and fixation with a buttress plate
Bibliography
Krasin E, Goldwirth M, Gold A, Goodwin D R. Review of the current methods in the
diagnosis and treatment of scaphoid fractures. Postgrad Med J 2001; 77: 235-237. |