Fracture – Its Management


Management of fracture involves both first aid and further treatment by health professionals – doctors, nurses and physiotherapist.

1. First aid management

This is the treatment you give to the patient before the arrival of a medical doctor or before transferring the patient to the hospital.

i. Make sure the airway is patent. If there is any obstruction clear it away.

ii. Check for breathing. If no breathing, then institute breathing through the mouth-to-mouth or mouth-to-nose respiration.

iii. Ensure there is circulation. Listen to the heart beat or check the pulse. If not heart beat, start CPR

iv. Call for help

v. Arrest any external haemorrhage (bleeding)

vi. Immobilise affected part. Get enough hands before moving the patient. This helps to minimize further tissue damage. Immobilization can be achieved through the use of mechanical splint or body splint.

vii. Open wounds may be cleaned and sterile dressings applied. Do not make any attempt to reduce the fracture if the limb is in an abnormal position or alignment.

viii. Treat for shock if there are signs. Remove clothing through the uninjured side.

ix. Remove rings from the fingers in case of fracture of the arm or hand. This is to prevent the ring cutting off blood supply to the fingers and subsequently gangrene when massive swelling occurs.

x. Do not give anything by mouth in case the patient would need a general anaesthesia in hospital.

2. Reduction: Reduction involves bringing the bones into proper alignment or their pre-injury positions. It helps to restore the shape and length of the bone thereby promoting their union. Reduction is achieved in two ways:

a. Closed Reduction: This involves manipulating the bones externally without use of surgery.

b. Open Reduction: Involves the use of surgery to restore bone alignment when external manipulation cannot give the desired result. It is also employed when there is displacement of bone fragments or when tissue or blood clots are lodged between the ends of the fractured bone. An incision is made into the fracture site under general anaesthesia and realignment is carried out.

3. Immobilization: Immobilization is done after bone reduction to ensure the limb is not moving for a specific period of time. Immobilization is usually done through application of traction, cast or splint. Cast involves the application of the Plaster of Paris bandage around the site and allowed to dry to provide support for the part and the joint below and above the fracture point.

Traction on the other hand involves applying a force to pull the end of the limb and also a counter traction in the opposite direction to create a balance. Splint in form of metal, plastic or plaster of Paris can be applied to extend over the joint immediately above and below the fracture to prevent movement.

4. Exercises: Limbs should be moved through a range of motion to prevent joint stiffness, muscle atrophy, renal calculi or hypercalcaemia from arising. The exercise of the legs improves circulation and promotes bone healing.

5. Physical care: Pay proper attention to pressure areas. Patient should be told not to alleviate itching by pushing coins, spoons, sticks, combs, etc into the cast. Should they push any hard object into the cast it would produce pressure and pains. Fingers and toes distal to the cast should be bathed and lightly massaged at least once daily if irritation occurs.

6. Nutrition: Patient should be encouraged to eat well balanced diet to aid tissue repair. Increase fibres in patient’s food to prevent constipation if the patient is confined to bed. Protein and vitamin c should be increased to aid healing. Patient should also eat foods containing calcium which aid the formation of callus needed for the bone repair.

7. Diversional therapy: Occupational therapy and diversional therapy such as reading, movies, radio, and handicraft should be employed to help reduce boredom or depression.

8. Skin care: Skin over the elbows, sacrum, shoulders and ankles should be cleaned and powdered at least 4hourly to prevent pressure sore.

9. Self care: Patient should be encouraged to carry out assisted self care. He should be taught to carry out deep-breathing and coughing exercises which help to prevent circulatory impairment and pulmonary complications.

10. Elimination: The nurse should assist the patient unto the bedpan if the patient is on traction since patient may find it difficult to raise himself unto the bedpan. Enema should be given if there is constipation or faecal impaction.

11. Rehabilitation: Patient should not be allowed to move out of bed immediately after the removal of traction if the patient has been confined to bed and the foot of bed elevated. This is to prevent fainting attack and possibility of falling. The head of the bed should be elevated for sometime for proper readjustment before patient is finally allowed out of bed.

The physiotherapist should be employed to help patient with exercise and gradual regain of the use of the affected limb and also to minimize stiffness and muscle atrophy. Both passive and active exercises are encouraged. Patient is also taught how to use crutches and canes to assist movement while recovering from fracture of the lower limb.