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Disclosures
None that I am aware of that will bias this
talk
Objectives
1.
2.
3.
4.
5.
6.
7.
8.
General Principles
Two (2) Principle Questions
1. What to Refer?
How to stabilize
Casting - Overview
Mainstay of treatment for most fractures
Joint above and a joint below
Avoid pressure points
Proper molding
Cast indentations
Appropriate padding
Splinting - Overview
Purpose
Reduce pain
Reduce bleeding and swelling
Prevent further soft tissue damage
Prevent vascular constriction
What to splint
Fracture
Dislocation
Tendon rupture
Supplies
Stockinette
Padding material
Cast material
Procedure
Apply stockinette
Apply padding
Patient Instructions
Keep injured limb elevated and iced
Warning signs
Anti-histamines
Splint Types
Upper Extremity:
Wrist Cock-up
Ulnar Gutter
Long arm Splint
-Sugar-tong
-Radial Gutter
-Coaptation
Lower Extremity:
-Stir-ups
Fractures
General Principles
Two (2) Principle Questions
1. What to Refer?
1. How to stabilize
OLD ACIDS
Mnemonic
O: open or closed
L: location
D: degree
A: articular involvement
C: comminution/type
I: instrinsic bone quality
D: displacement
S: soft tissue injury
Metatarsal / Phalanges
Keep
1.
2.
3.
Minimally/Non-displaced fractures
Short leg cast
NWB 4-8 weeks
Refer
1.
2.
3.
4.
Ankle Fractures
Keep:
Ankle Fractures
Refer:
Bi/Trimalleolar Fractures
Bimalleolar Equivalency Fractures
Talar subluxation
Articular impaction
Syndesmosis dysruption
Treatment: Reduce and Splint (Posterior slab with
stirrups)
Significant Joint involvement Obtain post-reduction
CT
Clavicle Fractures
Keep
Refer
1.
2.
3.
4.
Helps determine
treatment
1-Part
2-Part
3-Part
4-Part
Proximal Humerus
Majority need close follow up with
Orthopedics
Even if non-displaced initially may
displace later or present with later stage
rotator cuff issues.
Sling or Sling and Swathe
Osteoporotic Fracture
Distal Radius
Most common orthopaedic injury with a
bimodal distribution
Manage?
Non-displaced extra-articular
Well reduced extra-articular with good bone
quality in a well-molded cast/splint
Chauffer's
Radial styloid fx
Die-punch
Colles'
Smith's
Surgical Options
How to treat?
Options:
Scaphoid Fractures
Scaphoid is most frequently fractured carpal
bone; 15% of wrist injuries
Prognosis
Oops
If texting an
imageplease
include the
whole xray
Osteoporosis
By Definition: Fall from standing resulting
in Proximal Humerus, Distal Radius, Hip
fracture, Spine compression fracture
CBC, CMP, T4, TSH, Vit D3 level
Bisphosphonate?
Forteo?
1.
2.
3.
4.
5.
#1 Answer
5. All of the above
Question #2:
1.
2.
3.
4.
5.
6.
#2 Answer
2. Scaphoid
Question #3:
1.
2.
3.
4.
5.
#3 Answer
2. Fifth (5th) Metatarsal Avulsion fx
Question #4:
1.
2.
3.
4.
5.
#4 Answer
4. Profound dexterity achievement after cast
immobilization
i.e. If you had poor piano skills
before
Question #5:
Which Clavicle is a good candidate for
non-operative management?
A
B
C
D
B
C
#5 Answer
C
References
Eiff MP, et al. Fracture management for Primary
Care, 2nd edition. Saunders. 2003.
Honsik K, et al. Sideline splinting, bracing and
casting of extremity injuries. Current sports
Medicine Reports. 2003;2:147-154.
Meredith RM, et al. Field splinting of suspected
fractures: preparation, assessment, and
application. The Phys and Sports Med.
1997;25(10).
None
Short leg splint; NWB
Complicated High long-term pain rate
Typically Higher energy fractures
Very few
Most - Long leg splint and refer
Operative:
Operative:
Operative:
Radial Head/Neck Fx
Mason Classification
Type I Minimally displaced fx,
no mechanical block to
rotation, intra-articular
displacement <2mm
Type II Displaced fx >2mm or
angulated, possible
mechanical block to forearm
rotation
Type III Comminuted and
displaced fx, mechanical block
to motion
Type IV (Hotchkiss
modification)Radial head fx
with elbow dislocation