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The skeletal system provides a supportive framework for the body. It is the hardest of all living tissue and provides mineral storage, protection of many internal organs from injury e.g. the brain by the skull, and storage of blood producing cells. Bones are connected at joints and make movement possible as well as providing sites of attachment for muscles. The skeleton consists of 206 bones classified into four general groups of shapes: long, short, irregular and flat.

 

A fracture is a break in the continuity of any bone. Fractures are classified (named) usually after the mechanism of injury, that is, the way the bone has been broken or the appearance of the bone after the fracture.

 

Fractures are painful. The pain is usually localised to the fracture. The area surrounding the fracture is tender to touch and restricts movement. Swelling can be present, but may not relate to the severity of the injury and can occur several hours after the initial break. There may be associated bruising within the area of the fracture. There is loss of function of the area e.g. the fractured arm or leg, as a result of extreme pain on movement.

 

Types of Fractures

Simple Fractures:

  • Partial or incomplete - a fracture in which the break is incomplete
  • Closed (simple) - the bone does not break through the skin

Complicated fractures:

Complicated fractures involve injury to other important organs or structures such as nerves, arteries and internal organs.

  • Complete - a fracture in which the break is complete across the bone so that it is broken into two or more pieces
  • Open (compound) - the broken ends of the bone protrude through the skin
  • Comminuted - the bone is splintered at the site of impact and smaller fragments of bone are found between the main fragments
  • Greenstick - a partial fracture in which one side of the bone is broken and the other side bends. Often occur in children.
  • Spiral - the bone is usually twisted apart
  • Transverse - a fracture at right angles to the long axis of the bone
  • Impacted - one fragment of the bone is driven into the other
  • Pott's fracture - a fracture at the distal end of the fibula with serious injury of the distal tibial articulation
  • Colle's fracture - a fracture of the distal end of the radius in which the distal fragment is displaced posteriorly
  • Stress - a partial fracture resulting from inability to withstand repeated stress due to a change in training, harder surfaces, longer distances and greater speed. About 25% of stress fractures involve the fibula.


Complications

Several complications can result for a fracture. Deformity, or misshapenness, can present as limb shortening, curvature (abnormal bending) of the limb, and limb rotation (twisting). Lumps associated with the fracture are usually due to muscle damage rather than the fracture.
There may be abnormal movement of the limb such as: 
- the ability to move a limb at a site other than a joint may indicate a fracture or dislocation.

- Loss of use (function) can occur from damage to the nerves and blood supply surrounding the fracture.

- Bone ends can rub together or grate against one another and the noise (crepitus) creates a similar sound to the rubbing of hair between fingers.

- It is an extremely painful sensation for the patient.

 

Poor management can result in:

  • Delayed healing
  • Weak union of the fractured bone ends
  • Joint stiffness
  • Osteomyelitis (bone infection)
  • Disuse osteoporosis (weakening of the bone due to lack of use)

 

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Treatment

A doctor will diagnose the type of fracture and decide upon the most appropriate method of treatment. Treatment of damaged underlying structures such as muscles and nerves takes precedence over treatment of the fracture.

 

An x-ray is normally taken and where the fracture is relatively simple, a preliminary reduction of the fracture is performed and a cast is applied to immobilise the area and allow healing of the fractured bone. Casts are used to stabilise limb fractures. More complicated fractures will require surgery in an operating theatre in which the patient may need a metal rod placed down the centre of the bone, and in compound fractures metal rods may be affixed to the outside of the limb.

 

Primary Casting

Depending on the type and severity of the fracture a back-slab or a partial cast (doesn't fully surround the limb) may be applied to stabilise and support the fracture and surrounding muscles and allow for potential swelling (oedema), acting as a splint. The cast should be easy to remove if necessary. This is known as primary immobilisation.

 

The limb is padded with undercast wadding such as Soffban# , and a backslab of plaster of Paris e.g. Gypsona# , or Dynacast# Prelude synthetic casting material, is applied and held in place with a simple bandage such as Easifix Crinx# or Easifix# crepe. If it is a forearm fracture, the cast will be placed in a sling and the patient instructed in care of the cast and injury.

 

Secondary Casting

The secondary cast is intended to provide full support for the injury throughout its healing. Removal of the primary cast is done by cutting away and removing the bandage and padding material with scissors. A further x-ray may be requested to check the placement of the fractured bone ends and the fracture further reduced to ensure good bone alignment before the application of a full cast.

 

Synthetic casting materials - Delta-Lite Plus, Delta-Cast Elite, Delta-Cast Prints - are popular due to their lightweight nature and allow the application of a waterproof cast liner such as Delta-Dry or Gore Procel to replace the cotton or synthetic padding or stockinette.

 

The cast should:

  • Fit well
  • Not constrict blood flow
  • Be smooth inside
  • Be light weight
  • Not apply excess pressure to the skin
  • Have a smooth outside
  • Be well laminated
  • Interfere with movement as little as possible
  • Be prevented from having any load put on it until it has fully set

Complications of Casts
The circulation or nerves can be impaired where there is excessive swelling, an over-tight cast, or insufficient padding to the limb.

 

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Product Selection

 

Treatment Pathway Complications / Considerations Product Selection

 

Primary Immobilisation

 

Objective:

Reduce and stabilise fracture, manage soft tissue injury, reduce oedema.

 

Pain, oedema, fracture stability, wound management, diagnosis.

 

Tensoplast# Skin Traction Kit

Gypsona#

Dynacast# Prelude

Elastolite#

Delta-Cast# Soft

 

Secondary Immobilisation

 

Objective:

Maintain alignment, achieve union, promote bone growth.

 

 

Muscle atrophy, skin deterioration, non/mal union, joint stiffness, wound management.

 

Gypsona#

Delta-Lite# Plus

Delta-Cast# Elite

Delta-Cast# Prints

Delta-Cast# Soft

 

Supra and Sub Cast Protection

 

Objective:

Protect limb/soft tissue, protect cast, position limb.

 

 

Skin sensitivity, maceration/breakdown, pressure sores, smell, cast breakdown.

 

Soffban#

Soffban# Natural

BSN# Cast Shoes

Delta-Dry#

 

Cast Removal

 

Objective:

Remove cast quickly and safely.

 

 

Fear of saw, dust inhalation, heat build up.

 

DeSoutter# Cast Saws, Cast Spreaders, Shears and Scissors

 

Post-healing Rehabilitation

 

Objective:

Protect injury site, promote strength and mobility.

 

 

Nerve palsy, muscle atrophy, joint stiffness, range of movement loss.

 

Co-Plus#

Co-Plus# Latex Free

Dynacast# Prelude

 

 

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Related Links

CastNews - www.auscast.org

 

New ZealandOrthopaedic Association - www.nzoa.org.nz



 

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