Significance of fractures and dislocations

Fractures (breaks) and dislocations are failures of the skeleton to cope with the loads put upon it. When they do occur there are other structures which can also fail which may not be so obvious but which may have much more serious consequences. After the initial trauma, tissues tend to spring back into place. Nerves and blood vessels may also have been stretched far beyond their physiological limit at the time of trauma. If the nerve has been disrupted and the ends have separated, surgery may improve the prognosis dramatically. If the blood supply to that limb has been disrupted, then it is a surgical emergency to restore that circulation (Fig. 21.1).

    The check for neurovascular damage in a traumatised limb is, if anything, more important than the diagnosis of the fracture or dislocation.