![]() ![]() Pins are placed in the bone, and the bone ends are held in place by pulleys and weights until union occurs. Skeletal traction may be used instead of a cast or external fixator for certain fractures, such as femoral shaft fractures. The bone may then be immobilized by external fixation until the wound heals. When the wound is clean, a sterile dressing is secured by a bandage. If the area is grossly contaminated, mild soap solution may be used provided it is thoroughly washed away with generous amounts of sterile saline. The wound is then washed and cleaned with sterile saline. Initially, the open fracture should be covered with a clean or sterile dressing and the fracture site immobilized. In open or compound fractures, bleeding must be arrested before the fracture is treated. Afterwards the limb is restored to complete function by physical therapy and exercise. The bone is kept in position by a cast or splint until union has taken place. Radiography should be used to identify the fracture and the exact position of the bone fragments. ![]() Applying a cold pack to the fracture site and elevating it above the level of the heart may limit pain and swelling. ![]() Immediate first aid includes splinting of the fracture site and joints above and below it to limit further movement and displacement. Signs include loss of the power of movement, pain with acute tenderness over the site of fracture, swelling and bruising, deformity and possible shortening, unnatural mobility, and crepitus or grating heard when the ends of the bone rub together. In a fracture due to muscular contraction, the bone breaks from a sudden, violent contraction of the muscles. In a fracture due to indirect violence, the bone is fractured by a force applied at a distance from the site of fracture and transmitted to the fractured bone, as a fracture of the clavicle by a fall on an outstretched hand. In a pathological fracture, bones break, spontaneously and without trauma, due to certain diseases and conditions like cancer, osteomalacia, syphilis, and osteomyelitis, In a fracture due to direct violence, the bone breaks at the spot where the force was applied, as in fracture of a crushed tibia. See: illustration Causesįractures may be due to pathology, direct violence, indirect violence, or muscular contraction. Once closed reduction is accomplished, the bone is immobilized by application of a cast or by an apparatus exerting traction on the distal end of the bone.Ģ. A fracture may also require internal fixation with pins, nails, metal plates, or screws to stabilize the alignment. Open fractures are highly contaminated and must be débrided and copiously irrigated in the operating room. Closed reduction is performed by manual manipulation of the fractured bone so that the fragments are brought into proper alignment no surgical incision is made. Fractures heal with normal bone, not with scar tissue. Fracture healing is truly a process of regeneration. Later it will be treated by reduction, which means that the broken ends are pulled into alignment and the continuity of the bone is established so that healing can take place. Immediate first aid consists of splinting the bone with no attempt to reduce the fracture it should be splinted “as it lies,” which means supporting it in such a way that the injured part will remain steady and will resist jarring if the victim is moved. ![]()
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