Powerpoin Fracture
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Transcript of Powerpoin Fracture
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FRACTUREFRACTURE
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Goals Pri mary care general approach to fractu remanagement including maximizingoutcomes and minimizing risks Management of common upper and lowerex tremi ty fractu res Pedi atri c speci fi c concerns Splinting and castingtechniques
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First aid of fracturesOnce the following signs and symptoms have disappeared, administer first aid forthe fracture.(1) Touching or moving causes severe pain(2) Severe swelling or transformations(3) Crooking of the limb in the oppositedirection.(4) The sound that the bone touches(5) A pale complexion, cold sweat.
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First aid of fracturesAp p l y a he mo sta t.I f the b o ne i s p ro tru d i ng f ro m the w o u nd , d o no ti rri g a te . Ap p l y a thi c k sa ni ta ry g a u z e a nd b i nd thef ra c tu re d a re a w i th a b a nd a g e , o r a sl i ng i f ahe mo sta t ha s b e e n u se d .S p l i nti ng w i th a sl i ng o r a c l o th f o r f i x a ti o n i n ano n-p a i nf u l p o si ti o n.
P a ssi ve re w a rmi ng a nd a d mi ni ste ri ng me d i c a ltre a tme nt a s so o n a s p o ssi b l e .
Figure from Editorial Supervisor Dr. OSAWA Seiji, Sugunidekiruoukyuteate
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Substitute splintsplint C ardboard Cushion Blanket Newspaper Magazine Pencil chopsti cks Board Measu re Umbrella B amboo sword (cane)
Figure from Editorial Supervisor Dr. OSAWA Seiji, Sugunidekiru oukyuteatemedemirukyukyujiten, POPLAR Publishing Co.,Ltd., 1995
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Equipment(1) General equipment desk, chair, bed, washbowl,
health education inf ormation, etc.(1)(2) For phy sical examination/health counseling
stature meter, scales, tape measure, ey e char t(Landolt C hart) , blood pressure gauge, etc.
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Equipment(3) For f irst aid/implementation of inf ection anddisease prevention clinical thermometer,
scissors, f orceps, nail clippers, cotton buds, bottlesof water, disinfectant (80% ethanol and 10%povidone- iodine), sanitary gauze, medical tape,bandages, sticking plasters, sanitary napkins,plastic gloves, and penlight.
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Equipment(4) For protection and transport blanket , sling, splint ,
stretcher, etc.(5) Medicine O RS or sugar and salt , bottles of water, eye
lotion, anti- inf lammatory analgesic plasters, digestivemedicine, antibiotics, analgesics, antihistamines,antibiotic ointment, and adrenocorticotrophic hormoneointment, etc.
Figure from Editorial Supervisor Dr. OSAWA Seiji, Sugunidekiru oukyuteate medemirukyukyujiten , POPLAR
Publishing Co.,Ltd., 1995
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Equipment(6) For environmental hygiene inspection: thermometer,hygrometer, illuminan ce meter, noi se level meter,water quality test , etc.
(7) Necessary items for a first-aid carrying case
Scissors, forceps, nail clippers, cotton buds, sling, bandages,
plastic gloves, clinical thermometer, sanitary gauze, splint,sticking plasters, ORS or sugar and salt,(bottles of water),
disinfectant, anti-inflammatory analgesic plasters, digestive
medicine, analgesics, eye lotion, antihistamines, sanitary
napkins, memo pad, ballpoint pen, penlight, and plastic bags.
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Bone Description In growing bones
Metaphysis=end or neck
of bones
Diaphysis=shaft
In immature bones,
above definitions plusPhysis=growth plate
Epiphysis=outside of the
physis
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Fracture Description Transverse
Oblique
Spiral Comminuted
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Common Upper Extremity
Fractures-Distal Radius
Fall on outstretched with wrist in extension
Understand normal anatomy of 10 degrees of
volar tilt and radial length of 1cm
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Distal Radius Fracture
Management
For minimally displaced (less than 10-15
degrees dorsal angulation) initial splint-to
control suppination-pronation for 2-4 days
until swelling decreases Short arm cast for 4-6 wks or until fx is non
tender
ALWAYS EVALUATE NEUROVASCULAR in
all fractures
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Distal Radius Fracture (colles) Significantly displaced
fractures require reduction
after anesthesia (Bier block,
axillary or hematoma block
and will need more frequent
follow up to assure stability of
fracture
Orthopedic referral for more
complicated potentially
unstable fractures which may
require internal fixation
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Distal Radius Torus Fractures
Torus (buckle) in children
with minimal angulation
may be managed byshort arm casting for 3-4
wks then volar splint for
at risk activities for
another 3-4 wks3
Use of volar splinting
rather than casting has
also been shown to be
effective
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Common Hand Fractures
Mallet finger
Mechanism-Forced flexionif DIP joint while in
extension
X-Rays important to assess
boney avulsion and
possible displacement
Treatment is Stack splint inhyper extension for 8-10
wks and see every 2 wks
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Middle Phalanx Fracture
Oblique fractures of the
middle phalanx are
often unstable Always check for
rotation
Non displaced fractures
can be buddy taped for
3-4 wks and seen every
1-2 wks to assessstability
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Boxers Fracture
Mechanism: Fist striking a hard object
X-ray shows a 5th metacarpal neck fx with
flexion.
Up to 40 degrees of flexion deformity or more
(measured on lateral) can be tolerated with
goodeventual function. Closed reduction required
with
greater angulation.
Immobilization with an ulnar gutter splint in
90
degrees flexion at the MCP and 30 degrees
extension at the wrist
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Management of Scaphoid
Fractures (high risk)
Displaced fx.- refer to orthopedic surgery.
Suspected- Thumb spica splint and re xray in 10 to 14 days.
Non displaced fxa
Distal=4-6wks short arm thumb spica cast, middle=6wks long arm
thumb spica and 4-6 short thumb spica cast, proximal=refer.
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Clavicle Fractures
Middle Third Most common is middle
third fractures and
especially in children, can
be treated with a sling
rather than a figure of 8
Immobilization is 4-8
weeks or until fracture site
is non tender Nonunion is less than 1%
of mid 3rd fxs
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Clavicle Fracture
Distal Third
Distal third fractures are more rare and displacement
may be indicative of instability due to significant
ligament injury requiring surgical repair Non displaced can be treated with sling for 3-6 weeks
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Clavicle Fracture
Proximal Third
Less than 5% (less than 1% in children) of
clavicle fractures Can be associated with vital neuro vascular
injury with posterior displacement which
could
necessitate emergent treatment
Difficult to image
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Lower Extremity Fractures
Distal fibular or Tibial Maleolar
With stable mortice,
may be managed with4-6 wks in short leg
walking cast or walking
fracture boot in 90
degrees of flexion
(neutral)
Appropriate rehab isessential
Distal fibular shaft
immobilize 6-8 wks
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General Pediatric Considerations
Good news
Healing is usually faster
Excellent callus formation and remodeling
Caution
Injury to the area if the physis can cause
disrupted growth and need longer follow
up and possible referral
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Salter-Harris
Classification Types of fractures by
frequency:II, I, III, IV,V (crush injury)
Type I may not be visible on
x-ray and is suspected when
tenderness is at the site of
the physis
Suggest referral of alldisplaced type I and all Type
III and above due to high
complication rates
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Other Pediatric Fractures
Torus (buckle) is
due to a
compressive force
Greenstick is a long
bone shaft fracture
with involvement of
only one cortex
(>15 degrees angulationrequires closed
reduction)
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Stress Fractures
Hx of significant increase in intensity orfrequency of exercise/use
Must review underlying risk!
(ie, bone metabolism, diet deficiency)
Concept of bone stress reaction to overt
stress fracture
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.THE END.THE END