Fractures

Closed vs. Open Fractures:

1. Closed Fracture:

   • The skin over the fracture site remains intact.
   • Risk of infection is minimal.
   • Swelling, bruising, and deformity may be present.

2. Open Fracture:

   • The broken bone punctures the skin or is exposed through a wound.
   • High risk of infection (osteomyelitis).
   • Requires urgent medical attention to clean and stabilize the fracture.

Dislocations of Joints:

• Dislocation involves the displacement of bones in a joint, disrupting normal alignment.
• Symptoms include visible deformity, severe pain, swelling, and loss of function.
• Common sites: shoulder, elbow, hip, and finger joints.

Diagnosis Protocol for Fractures and Dislocations

1. Initial Assessment:

   • History: Mechanism of injury, timing, and previous injuries.
   • Physical Examination:
     • Inspect for deformity, swelling, and wounds.
     • Palpate for tenderness and abnormal movements.
     • Assess neurovascular status (pulses, capillary refill, sensation, and motor function).

2. Imaging Modalities:

   • X-ray: Standard first-line investigation; two views (AP and lateral).
   • CT Scan: For complex fractures or suspected bone involvement not clear on X-rays.
   • MRI: Ideal for soft tissue injuries and ligament involvement.
   • Ultrasound: Useful for pediatric cases or soft tissue evaluation.

First Aid and Emergency Management

1. Initial Steps:

   • Avoid moving the injured part unnecessarily.
   • Check and manage bleeding with sterile dressings.
   • Assess for shock and maintain vital functions.

2. Stabilization:

   • Immobilize the fracture using splints or slings.
   • Ensure the joint above and below the fracture is supported.
   • Avoid attempting to realign the bones or reduce dislocations without expertise.

3. Transportation:

   • Use a stretcher for safe patient transfer.
   • Maintain immobilization during transport to prevent further injury.

Treatment Modalities

Non-Surgical Interventions:

• Closed Reduction: Realignment of bone fragments or dislocations manually.
• Immobilization: Using casts, splints, or braces to maintain position.
• Traction: Gradual pulling force for realignment in specific fractures.

Surgical Interventions:

• Open Reduction and Internal Fixation (ORIF):
  • Fixation using plates, screws, or intramedullary nails.
  • Common for complex fractures or displaced joints.
• External Fixation:
  • Stabilization using external frames.
  • Often used for open fractures or when soft tissue healing is a concern.
• Arthroscopy:
  • Minimally invasive technique for joint injuries.
• Joint Replacement:
  • For severe joint damage, such as irreparable hip or shoulder dislocations.

This framework ensures a comprehensive approach to managing fractures and dislocations while prioritizing patient safety and recovery.