Principles of management

Early treatment (neurovascular problems)

The principle of management of fractures is to deal with life-and limb-saving problems first. This means paying attention to ABC (airway, breathing and circulation) and to the neurovascular status of the limb before dealing with the fracture itself. If there is vascular compromise and the limb is distorted, it is always worth straightening the limb as far as possible in case it is simply the pressure of the displaced bone which is causing the problem.

Reduction of fractures and dislocations

Some fractures may not need reduction, especially if the minimal malunion which results will cause no cosmetic or functional problem. An impacted stable fracture, which is only slightly displaced, may actually be made worse by reduction. The position may be improved but the fracture will become unstable. This may make future management much more difficult.

Holding a fracture

Once a fracture has been reduced it needs to be held until it has united (the bone ends have joined together).

Rehabilitation

Once the fracture is stabilised, the patient may need help with rehabilitation so that they can return to as full and as independent a life as possible (Table 21.3).