An initial assessment process for suspected fractures and dislocations after a fall, accident, or impact, aimed at relieving pain, preventing tissue damage, and preparing the patient for appropriate surgical or orthopedic treatment.
Indication
- Pain, swelling, and deformity in a limb after a fall, blow, or impact
- Restricted movement and inability to bear weight (especially of the foot or hip)
- Open fracture (bone ends protruding through the skin) or fracture associated with a wound
- Joint dislocation (shoulder, finger, elbow dislocations)
- Suspected multiple injuries after a traffic accident or fall from height
- Sudden sprain and loss of strength during sports activities
Preparation
- At the scene of the accident, the injured area must not be moved and should be supported with a splint or rigid object
- In open fractures, a clean cover is placed over the wound; pressure is not applied
- Known allergies and regular medications are reported
- Fasting may be required (until anesthesia approval, in case surgery is needed)
How it's performed
- Clinical examination evaluates swelling, deformity, circulation, and nerve integrity
- Plain radiograph (X-ray) is taken; CT or MRI may be added when needed
- In open fractures, wound cleaning, antibiotics, and tetanus prophylaxis are administered; surgery is planned
- In closed fractures, closed reduction (manual realignment) and immobilization with a cast or splint may be performed
- In dislocations, the joint is reduced, followed by a control radiograph
- When needed, orthopedic consultation and surgical fixation (plate-screw, nail) are planned
Post-procedure
- Patients with a cast or splint are monitored for swelling and circulation for 24-48 hours
- A control radiograph is performed at the end of the first week to assess position
- Cast immobilization typically lasts 4-8 weeks; varies with age and bone involved
- Physiotherapy and gradual weight-bearing are recommended after cast removal
- Severe pain, bluish discoloration of the fingers, or numbness require immediate medical attention
Risks
- Infection or osteomyelitis development in open fractures
- Missed vascular or nerve injury (especially in the elbow, knee, shoulder)
- Compartment syndrome (increased pressure in a contracted muscle; emergency surgery is required)
- Delayed healing, malunion, or nonunion of the fracture
- Joint stiffness, muscle weakness, or chronic pain (long term)
FAQ
How can I be sure there is a fracture?
Symptoms include severe pain, swelling, deformity, inability to move, and inability to bear weight. A definitive diagnosis requires a plain radiograph (X-ray); physical examination alone is not sufficient.
What is the difference between an open and a closed fracture?
In a closed fracture the skin remains intact; in an open fracture the bone ends protrude through the skin or the skin is torn. Open fractures require emergency surgery due to infection risk.
Should I try to reduce a dislocation myself?
No. An incorrect attempt may cause vascular, nerve, and joint damage. Keep the area immobile and seek emergency care as soon as possible; reduction must be performed by a physician under appropriate anesthesia.
What should I do if I feel numbness inside the cast?
Bluish discoloration of the fingers, numbness, coldness, or increasing pain are emergency signs. The cast may be too tight or compartment syndrome may be developing; seek hospital care without delay.
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