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Fracture Assessment

Fracture Assessment. LAMRT Oct 08. Why Assess Fractures?. Early selection of transportation (Helicopter vs. Walking) Highlight the potential for Other injury. e.g. Fractured Femur suggests significant force & high potential for pelvic & spinal injury

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Fracture Assessment

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  1. Fracture Assessment LAMRT Oct 08

  2. Why Assess Fractures? • Early selection of transportation (Helicopter vs. Walking) • Highlight the potential for • Other injury. e.g. Fractured Femur suggests significant force & high potential for pelvic & spinal injury • Developing problems e.g. Shock, Compartment Syndrome • Select appropriate treatment • High flow Oxygen? • Pain Relief? • Splinting? • Antibiotics?

  3. What’s “Normal”

  4. Tissue Profusion Note bright red living tissue • Adequate supply of oxygen and nutrients to tissue above and below the fracture site. • Effective transport of waste products away from tissue above and below the fracture site. • Failure to achieve this can result in • Death of the tissue • Accumulation of toxic by products and subsequent toxic shock to the body on release Tissue death due to lack of profusion

  5. Maintaining Tissue Profusion Blood Vessels • Maintain • Blood flow to and from the site • Maintain blood oxygen saturation • Blood flow is compromised if the vessels are compressed, pinched or severed • Returning the limb to neutral alignment is likely to be the most effective method of maintaining profusion • Splinting should retain neutral alignment and protect tissue and blood vessels from further damage Tibia Nerves

  6. What’s Compartment Syndrome? • Tissue in an enclosed space is deprived of blood supply. • Anaerobic metabolism causes the tissue to swell. • Swelling within the enclosed space increases the pressure which further reduces blood supply • A “vicious” circle

  7. Symptoms & Treatment Of Compartment Syndrome • Pain • Pulselessness (late sign) • Paralysis • Loss of sensation in the “Web Space” • Parlour • Swelling Treatment • Repositioning • Oxygen • Rapid Transfer

  8. Risk Of Complication

  9. LAMRT Examples Open ankle fracture Open fracture of Tib & Fib Closed Femur Fracture

  10. Modified Ottawa Guidelines • Suspect Fracture If :- • Bone Tenderness at A, B, C,D • Bone Tenderness in the Patella / Knee Joint • Can’t bend the knee 90 Deg • Can’t weight bear • Immediate swelling • LAMRT Action will probably be similar regardless of this assessment. Only in exceptional circumstances would we ask a person in pain to walk or use the injured limb e.g. poor access, immediate danger to casualty or team members.

  11. LAMRT Dec 7th 2008 Fall from mountain bike on to frozen ground. Capillary refill slow at 3-5 sec Closed Dislocated Fracture Of The Ankle

  12. Vascular Status • Vascular Status • Radial (Wrist directly below the thumb) • Femoral (Groin) • Popliteal (Inner back of knee) • Pedal 1. (Top of foot directly above 2nd toe) • Pedal 2. Inner ankle, above heal bone, behind tendon. • Capillary Refill. • Check for feeling, note any unusual sensation. • Colour, temperature. • Pulse Oximeter

  13. LAMRT Algorithm For The Assessment & Management Of Fractures. • Other Possible Actions • Oxygen 15 l/min. • Monitor Pulse / BP • If pulse increasing and/or BP falling consider IV fluids • Check for other signs of shock • Mild Pain. Entonox. IF NOT Contraindicated • Sever Pain. Morphine. IF NOT Contraindicated • Antibiotics for open fractures with long transfers • Suspect other injuries e.g. Spine, Pelvis • Vascular Status • Radial (Wrist directly below the thumb) • Femoral (Groin) • Popliteal (Inner back of knee) • Pedal 1. (Top of foot directly above 2nd toe) • Pedal 2. Inner ankle, above heal bone, behind tendon. • Capillary Refill. • Check for feeling, note any unusual sensation. • Colour, temperature. • Pulse Oximeter RAF or Air Ambulance

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