Fracture Management

Anthony Safi
 Reduction
• There are two types of reductions: open and closed, depending
on the type of injury and the approach to fix it.

• Closed reduction is a procedure to reduce a broken bone

without cutting the skin open. The broken bone is put back in
place, which allows it to grow back together. It works best
when it is done as soon as possible after the bone breaks.

• There are some complications that could occur during the

closed reduction: injury of blood vessels and nerves, formation
of a blood clot and subsequent PE, occurrence of a new
fracture. And finally if the procedure does not work, patient will
require surgery (ORIF).
 Maintenance of Reduction
• A cast or splint will be put on the patient’s limb to keep the
bone in the right position and protect it while it heals.
•

• Take an x-ray to make sure the bone is in the right position.

•

• Tell the patient not to bear weight on the injured leg or arm.
•

• Start patient on anticoagulants to avoid thrombus formation due

to stasis and not bearing weight on the limb.
 Casts and Splints
• Casts & Splints. Casts and splints are orthopedic devices that
are used to protect and support fractured or injured bones and
joints. They help to immobilize the injured limb to keep the
bone in place until it fully heals. 
• Casts are often made from fiberglass or plaster.
• Custom splints are often made with plaster, fiberglass, or
aluminum, each secured with an elastic or self-adhesive wrap.
Preformed splints are often made of hard plastic and Velcro.
• Depending on the specific type of fracture, the splint or cast
may be worn for anywhere from a few days to a couple of
months. The purpose of the cast is to keep the bones in rigid
alignment to allow the body to heal them over several weeks to
months.
 Open Reduction and
Internal fixation
• Open reduction means a surgeon makes an incision to re-align
the bone. Internal fixation means the bones are held together
with hardware like metal pins, plates, rods, or screws.

• Open reduction internal fixation (ORIF) is a surgery to fix

severely broken bones. It's only used for serious fractures that
can't be treated with a cast or splint. ... After the bone heals, this
hardware isn't removed. ORIF is an urgent surgery done if
bones break in multiple places, moves out of position or sticks
out through the skin.
 Open Reduction and
Internal fixation
• Some complications patients might encounter post ORIF
surgery:
1. bacterial infection, either from the hardware or incision
2. bleeding or blood clot
3. nerve or blood vessel damage
4. tendon or ligament damage
5. incomplete or abnormal bone healing
6. metal hardware moving out of place
7. reduced or lost mobility
8. muscle spasms or damage
9. arthritis or tendonitis
10. audible popping and snapping
• External fixation is a
surgical treatment wherein
rods are screwed into bone
above and below the
fracture and exit the body to
be attached to a stabilizing
structure on the outside of
the body.
• An external fixation device
may be used to
keep fractured
bones stabilized and in
alignment. The device can
be adjusted externally to
ensure the bones remain in
 External Rotation
• Complications that might occur post external rotation:
A. Nerves, blood vessels, ligaments, muscles, and bones may be
damaged.
B. Patient’s leg, foot, or toes may become stiff, swollen, painful,
numb, or weak.
C. Even after surgery, patient’s leg may not fully heal.
D. In case of a pediatric patient, the injured leg might not grow as
much as the other, some nearby joints may become stiff, and
muscles may become weak and this will cause the child to have
trouble returning to daily activities such as sports.
 Traction
• Traction means pulling on part of the body. Most
often, traction uses devices such as weights and pulleys
to put tension on a displaced bone or joint.
• The purpose of traction is to guide the body part back into place
and hold it steady. Traction may be used to stabilize and realign
bone fractures, such as a broken arm or leg.
• The length of time you will be in traction depends on the
location, type, and severity of your broken bone or
injury. Traction time can vary from 24 hours to six weeks, or
more. If you are waiting for corrective surgery,
skin traction may be short-term to immobilize the fracture until
your doctor can operate.
 Compartment Syndrome
• Acute Compartment Syndrome is defined as increased pressure
within an osteofascial compartment that can lead to ischemic
necrosis

• It is usually caused by fractures, vascular compromise,

reperfusion injury, compressive dressings, or any
musculoskeletal injury.

• Diagnosed clinically, but measuring intracompartmental

pressure is also useful. If pressure is higher than 40mm Hg is it
an indication for fasciotomy.

• Forearm Compartment Syndrome is caused mainly by

supracondylar humerus fracture, brachial artery injury,
radius/ulna fracture or crush injury.
 Compartment Syndrome
• The most common site of compartment syndrome is the calf,
which is divided into 4 compartments: anterior, lateral, deep
posterior and superficial posterior.

• Here are some situations we should be on the lookout for in a

compartment syndrome:

1. Supracondylar elbow fractures in children

2. Proximal/midshaft tibial fractures

3. Electrical burns

4. Arterial/venous disruption
 Signs and Symptoms
• The symptoms of Compartment Syndrome are what’s known as
the 4Ps:

1. Pain

2. Paresthesia

3. Paralysis

4. Pulselessness (however patients can sometimes have a palpable or

Doppler detectable distal pulse)
 Signs and Symptoms
• The signs of Compartment Syndrome are:

A. Pain on passive movement (out of proportion to injury)

B. Cyanosis or Pallor

C. Hypoesthesia which is a decreased sensation and a decreased 2-

point discrimination

D. Firm compartment
 Complications and
Treatment
• Complication of missed anterior compartment is foot drop due
to superficial peroneal nerve injury.
• Possible complications of compartment syndrome are: Muscle
necrosis, nerve damage, contractures and myoglobinuria.
• The initial treatment of the Compartment Syndrome includes
bivalve and split casts, remove constricting clothes/dressings,
place extremity at heart level.
• The definitive treatment of Compartment Syndrome is
Fasciotomy within 4 hours (6 to 8 hours maximum).