Fracture management can be divided into nonoperative and operative techniques. The nonoperative approach consists of a closed reduction if required, followed by a period of immobilization with casting or splinting. Closed reduction is needed if the fracture is significantly displaced or angulated. [] Pediatric fractures are generally much more tolerant of nonoperative management, owing to their significant remodeling potential. [] If closed reduction is inadequate, surgical intervention may be required. Indications for surgical intervention include the following: •. The initial management of fractures consists of realignment of the broken limb segment (if grossly deformed) and then immobilizing the fractured extremity in a splint.
The distal neurologic and vascular status must be clinically assessed and documented before and after realignment and splinting. If a patient sustains an open fracture, achieving hemostasis as rapidly as possible at the injury site is essential; this can be achieved by placing a sterile pressure dressing over the injury site (see ). Once the initial assessment, evaluation, and management of any life-threatening injury are completed, the open fracture is treated. Hemostasis should be obtained if there is significant ongoing bleeding, though bone bleeding is best reduced by anatomic reduction. Gross contaminants can be removed if possible and the soft-tissue wound can be covered by a sterile dressing moistened with normal saline. Sporttracks 3 crack. Harsher adjuncts, such as iodine solutions, are not recommended, because of their cytotoxic effects. [] Tetanus immunization should be provided if the patient does not have current immunity.
Rodriguez et al reported on the use of an evidence-based antibiotic protocol based on open fracture grade, in which patients with grade I or II fractures received cefazolin (clindamycin in the case of allergy) and those with grade III fractures received ceftriaxone (clindamycin and aztreonam in the case of allergy) for 48 hours; aminoglycosides, vancomycin, and penicillin were excluded from the protocol. [] Implementation of this protocol for open fracture antibiotic prophylaxis led to significantly reduced use of aminoglycoside and glycopeptide antibiotics without increasing rates of in skin and soft-tissue infection. The traditional teaching of open fracture management was that urgent irrigation and debridement (I&D) of the wound in the operating room (OR) is mandatory within 6 hours and that open fractures are considered orthopedic emergencies.
Ao Manual Of Fracture Management Hand And Wrist Pdf
More recent data, such as the findings from the Lower Extremity Assessment Program (LEAP), suggested that surgical I&D within 24 hours of injury is sufficient. [] For type II and type III injuries, serial I&Ds are recommended every 24-48 hours after the initial debridement until a clean surgical wound is ensured and no necrotic tissue persists. Management of the open fracture depends on the site of injury and type of open fracture. The wound is subsequently stabilized either temporarily or definitively. If soft-tissue coverage over the injury is inadequate between debridements, wet-to-dry dressings or negative-pressure wound therapy (eg, vacuum-assisted closure [VAC] dressings) may be used. If the fracture reduction cannot be maintained between debridements, an external fixator can be used with the pin sites well outside the zone of injury. Casting Closed reduction should be performed initially for any fracture that is displaced, shortened, or angulated.