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Fracture and dislocations-complications, prevention, emergency management

POSSIBLE COMPLICATIONS OF A BONE FRACTURE

Heals in the wrong position – this is known as a malunion; either the fracture heals in the wrong position or it shifts.

Disruption of bone growth – if a childhood bone fracture affects both ends of bones, there is a risk that the normal development of that bone may be affected, raising the risk of a subsequent deformity.

Persistent bone or bone marrow infection – if there is a break in the skin, as may happen with a compound fracture; bacteria can get in and infect the bone or bone marrow, which can become a persistent infection (osteomyelitis).

Bone death (avascular necrosis) – if the bone loses its essential supply of blood it may die.

PREVENTION OF FRACTURES

a)      Nutrition and sunlight – Human body needs adequate supplies of calcium for healthy bones. Milk, cheese, yoghurt and dark green leafy vegetables are good sources of calcium. Body needs vitamin D to absorb calcium – exposure to sunlight, as well as eating eggs and oily fish are good ways of getting vitamin D.

b)      Physical activity – More weight-bearing exercises make stronger and denser y. Examples include skipping, walking, running, and dancing. Older age not only results in weaker bones, but often in less physical activity, which further increases the risk of even weaker bones. It is important for people of all ages to stay physically active.

c)      Female menopause – Estrogen, which regulates woman’s calcium, starts to drop after menopause. Calcium regulation is much more difficult. Consequently, women need to be especially careful about the density and strength of their bones during and after the menopause. The following steps may help reduce post-menopausal osteoporosis risk:

  • Do several short weight-bearing exercise sessions each week.
  • Do not smoke.
  • Consume only moderate quantities of alcohol, or don’t drink it.
  • Make sure you get adequate exposure to daylight.
  • Make sure diet has plenty of calcium-rich foods

EMERGENCY MANAGEMENT OF FRACTURES

In community settings

  • Seek medical attention immediately: Call for EMS. Wait for EMS and DO NOT attempt to transport victim if suspected head, back, or neck injury; a visible deformity of bone; or if the victim cannot be splinted or transported without causing more pain.
  • Suspect back or neck injury if victim is unconscious or has head injury, neck pain, or tingling in arms or legs. If neck or back injury suspected, DO NOT move victim unless necessary to save victim’s life.
  • Immobilize and support affected bone in position found. DO NOT try to push protruding bone back into body or let victim move or use affected area.
  • If no open wound present, apply ice pack wrapped in clean cloth.
  • Control any bleeding through direct pressure, but DO NOT elevate affected area.
  • If bone is protruding, cover with clean cloth once bleeding is controlled.
  • Observe for shock. DO NOT give victim anything to eat or drink.
  • If an injured patient must be removed from a vehicle before splints can be applied, the extremity is supported above and below the fracture site to prevent rotation as well as angular motion.

In hospital settings

Life saving measures

C       Circulation (treatment and diagnosis of cause)

A       Airway and cervical spine immobilisation

B       Breathing

D       Disability (neurologic deficit)

E       Exposure (musculo-skeletal injury)

    • Treat life threatening injuries first
    • Ensure airway, breathing and circulation
    • Control external bleeding with direct pressure or sterile pressure dressings
    • Splint joints above and below fracture site
    • Check neurovascular status distal to injury before and after splinting
    • Elevate injured limb if possible
    • Do not attempt to straighten fractured or dislocated joints
    • Do not manipulate protruding bone ends
    • Apply ice packs to affected area
    • Obtain x-rays of affected limb
    • Administer tetanus prophylaxis if skin integrity is violated
    • Mark location of pulses to facilitate repeat assessment
    • Splint fracture site, including joints above and below fracture site
    • Ongoing monitoring
    • Monitor vital signs, level of consciousness, oxygen saturation , peripheral pulses and pain
    • Monitor for compartment syndrome characterized by excessive pain, pain with passive stretch, pallor, paresthesia, paralysis, pulselessness
    • Monitor for fat embolism

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