![]() For the first 2-weeks, plasters are not circumferential (not always the case in children).When applying a plaster cast, the most important principles to remember are: There most common ways to immobilise a fracture are via simple splints or plaster casts. Most commonly this is where the muscular pull across the fracture site is strong and the fracture is inherently unstable. Initially, it is important to consider whether traction is needed, such as for subtrochanteric neck of femur fractures, femoral shaft fractures, displaced acetabular fractures, or certain pelvic fractures. ‘Hold’ is the generic term used to describe immobilising a fracture. The specific manoeuvre used invariably requires two people (one to perform the reduction manoeuvre and one to provide counter-traction), with a third person needed to apply the plaster. More commonly, the patient requires a short period of conscious sedation, often can provided in the Emergency Department where there is access to anaesthetic agents, airway adjuncts, and monitoring (such as in a specialist anaesthetic room or in a resuscitation area) phalangeal/metacarpal/distal radius fractures), this would be the method of choice. Where regional or local blockade is both sufficient and easily provided (e.g. Reduction is painful and requires analgesia. *Excessively swollen soft tissues have higher rates of wound complications and surgery may be delayed to allow this to regress Clinical Requirements However, some fractures need to be reduced open (by directly visualising the fracture and reducing it with instruments) intra-operatively. The main principle in any reduction, regardless of the method employed, is to correct the deforming forces that resulted in the injury.įracture reduction is typically performed closed in the Emergency Room. Reduction of pressures on traversing blood vessels, restoring any affected blood supply.Reduction in the traction on the traversing nerves, therefore reducing the risk of neuropraxia.Reduction in the traction on the surrounding soft tissues, in turn reducing swelling*.Tamponade of bleeding at the fracture site.We now recommend open reduction and internal fixation of severely displaced fractures of the middle third of the clavicle in adult patients.Reduction involves restoring the anatomical alignment of a fracture or dislocation of the deformed limb. No other patient variable, treatment factor, or fracture characteristic had a significant effect on outcome. Final shortening of 20 mm or more was associated with an unsatisfactory result, but not with nonunion. We found that initial shortening at the fracture of > or = 20 mm had a highly significant association with nonunion (p < 0.0001) and the chance of an unsatisfactory result. No patient had significant impairment of range of movement or shoulder strength as a result of the injury. Of the 28 who had cosmetic complaints, only 11 considered accepting corrective surgery. Thirteen patients had mild to moderate residual pain and 15 had some evidence of brachial plexus irritation. Eight of the 52 fractures (15%) had developed nonunion, and 16 patients (31%) reported unsatisfactory results. We reviewed 52 of these patients at a mean of 38 months after injury. Of these, 66 (27%) were originally in the middle third of the clavicle and had been completely displaced. We evaluated 242 consecutive fractures of the clavicle in adults which had been treated conservatively.
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