Treatment

REDUCTION

Refers to the process of realigning the bone back to its original anatomy.

Types

Close reduction, realignment of the fractured bone without surgical exposure of the fracture site.

Open reduction, realignment of the fractured bone that involves surgical exposure of the fracture site.

IMMOBILISATION

A process of holding a bone or joint for a considerable period of time to allow proper healing (union) of the fracture site .

Types

Splints

Refers to noncircumferential immobilizers that are commonly used in management of a variety of acute musculoskeletal conditions in which swelling is anticipated.

They are used in acute fractures or sprains, or for initial stabilization of reduced, displaced, or unstable fractures before definitive orthopedic intervention.

Casts

Refers to circumferential immobilizers which are made up of plasters (For example Plaster of Paris) or fiberglass. They are commonly used for definitive treatment of pediatric long bone fractures and initial immobilization of acute fractures before definitive orthopedic treatment.

Traction

Refers to application of a pulling force around the fracture sight. It can be used for both reduction and immobilisation.

Types of Traction (Based on method)

Manual traction involving applying the pull manually with the hands.

Skin traction involving applying the force over a large area of skin/soft tissue to transmit traction to the bone.

Skeletal traction involving applying the force directly to the bone through metal pins inserted through the bone. Two additional methods for skin and skeletal traction.

Sites for skeletal traction

• Olecranon
• Second & Third Metacarpals
• Greater trochanter (Upper end of femur)
• Distal femur
• Proximal tibia
• Calcaneus

Types of Traction (Based on mechanism)

Fixed traction in which pull is between two fixed points. For example Thomas Splint traction and Gallows traction.

Sliding traction the pull is exerted by a pull between hanging weights and the patient’s own body weight. For example Hamilton-Russell traction.

External fixation

Refers to a process of fracture fixation by which pins or wires are inserted into the bone percutaneously and held together via an external frame system. An External fixator can be a uniplanar, multiplanar, unilateral, bilateral or circular in type.

Indications

• Unstable pelvic ring injuries
• Comminuted periarticular fractures
• Fractures with large amounts of soft tissue injury
• Fractures in a patient that is hemodynamically unstable or cannot undergo an open procedure
• Comminuted long bone fractures
• Fractures with significant bone loss
• Open fractures with soft tissue loss
• Limb deformity and limb lengthening
• Osteomyelitis with bone loss
• Immobilization of joint after soft tissue flap
• Arthrodesis (a surgical procedure stabilizing a joint by fusing the bones across the joint)
• Malunion or Nonunion
• Features of Infection
• Traction to aid in intraoperative fracture reduction

Open reduction and Internal fixation

It is a surgical procedures in which an incision is made through the skin and underlying muscles to expose the fracture site after which reduction is done and implants are used to stabilise the fracture site. Nails , rods, screws, wires and plates are used in stabilising the fracture site.

Indications

• Displaced intra-articular fractures
• Uncontaminated Open fracture
• Polytrauma
• Associated neurovascular injury
• Multi segmented fractures
• Failure of closed treatment