Fracture

Fracture

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Fracture

  • Exam
  1. Document neurovascular examination (and address deficits immediately)
    1. Perform on initial exam and repeat before and after any intervention
    2. Keep high index of suspicion for Compartment Syndrome
    3. Check Capillary Refill and distal pulses
    4. Check motor and Sensory Examination
  2. Evaluate skin over Fracture site
    1. Signs of open Fracture
    2. Signs of displaced Fracture (Skin Tenting)
    3. Clues suggesting Fracture (swelling, Ecchymosis, and point tenderness over Fracture site)
    4. Devitalized skin at risk of necrosis
  3. Evaluate joints, muscles, ligaments, and tendons above and below the Fracture
  • Indications
  • Referral to Orthopedics
  1. Emergent referral indications
    1. Fracture with neurologic deficit
    2. Fracture with vascular deficit
    3. Fracture with secondary Compartment Syndrome
    4. Open Fracture
    5. Severe crush or shearing injury resulting in skin devitalization
  2. Prompt referral indications
    1. Fracture site and type specific
    2. See High Risk Fractures
  • Management
  1. Initial management
    1. See specific Fractures for management
    2. Closed reduction under Procedural Sedation as needed
    3. See Fracture Splinting
    4. See RICE Therapy (RICE-M)
    5. Initial non-weight bearing for lower extremity Fractures
    6. NSAIDs are typically safe for short-term use unless other contraindications (e.g. renal disease, peptic ulcer)
      1. Theoretical risk of delayed Fracture healing, but variable findings in human studies
      2. Ibuprofen does not appear to significantly delay Fracture healing
      3. See NSAIDs for details
      4. (2017) Presc Lett 24(2): 9
      5. DePeter (2017) J Emerg Med 52(4): 426-32 +PMID:27751698 [PubMed]
  2. Follow-up
    1. Re-evaluation in 5-7 days (sooner for High Risk Fractures)
    2. Repeat XRay and Casting at time of follow-up
  3. Patient precautions for immediate return
    1. Numb, cold, pale, immobile distal extremity
    2. Increasing pain out of proportion to what would be expected after Fracture
  • Complications