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IMMOBILIZATION AND

TRANSPORTATION ON THE
FRACTURE CASES
Dr. GANDA M.R.H. PURBA, MKes, SpOT
ORTHOPAEDIC AND TRAUMATOLOGY DEPARTEMENT
OF MITRA MEDIKA HOSPITAL

Contents:
INTRODUCTION
IMMOBILIZATION
TRANSPORTATION

INTRODUCTION
Fractures: break in the structure continuity of bone and
cartilage
Medical problem
High cost care
Productive age
Mortality
Disability

How Fractures Happen?


Fracture due to injury: direct force, indirect force
Fatique or stress fracture: repeated heavy loading
( Athletes, dancers or military)
Pathological fractures: Change in bone structures

23.1 Mechanism of injury Some fracture patterns suggest the causal mechanism: (a) spiral pattern (twisting);
(b) short oblique pattern (compression); (c) triangular butterfly fragment (bending) and (d) transverse pattern
(tension). Spiral and some (long) oblique patterns are usually due to low-energy indirect injuries; bending and
transverse patterns are caused by high-energy direct trauma.

CLASSIFICATION
Stable and unstable: Can or not retain the stability
Open and close: Skin intact or not

Type of Fractures
Transverse fractures cross the bone at a 90o angle and are
generally stable post reduction.
Oblique/spiral fractures are at a 45o angle to the axis, usually from
a twisting force causing upward thrust. Most long bone fractures
are due to violent twisting motions, such as a sharp twist to the
leg, when the foot is stuck in a hole, producing a spiral fracture.
Comminuted fractures are high-energy injuries where the bone is
splintered in more than two fragments. These are generally
associated with significant soft tissue injury.
Impacted fractures occur when one fragment is forced into
another. The fracture line may be difficult to visualise.

Type of Fractures
Crush fractures occur when cancellous bone is compressed or crushed.
Avulsion fractures occur when soft tissue and bone are torn away from
the insertion site.
Greenstick fractures occur when the compressed cortex bends/buckles.
If the force persists, the cortex will fracture. These are usually seen in
children as their bones are much more porous and soft.
Epiphyseal or growth plate fractures (Salter-type) may affect future
bone growth because of early closure of the epiphyseal plate and
resultant limb shortening. Angulation may occur with partial growth
plate fractures because bone growth continues in the noninjured area
Splinting, Bandaging and Immobilization Techniques and Devices.

Epiphyseal or growth plate fractures


(Salter-type)

Open fracture
AKA: Compound fracture
A fracture in which bone
penetrates through skin;
Open to air
Some define this as a fracture
with any open wound or soft
tissue laceration near the bony
fracture

Closed fracture
Fracture with intact overlying
skin

MANAGEMENT OF FRACTURE

Advance trauma life support is the most important


protocol to save the life of the patients who suffer from
road traffic accidents
life saving Assessment

A-To maintain the air way and cervical spine care


B-Breathing problem is the next priority
C-Circulation to asses the shock and its treatment
D-Disability of the patient
E- Environments

Algorithm of ATLS initial assessment


and management

Diagnosis of the fractures


Complete history
Mechanism of trauma
Pain and swelling at site of injury
Positive tenderness and crepitus at site
X-rays
Some times bone scan
CT scan or MRI

Complication
A. Early complication:

1. Visceral injury
2. Vascular injury
3. Nerve injury
4. Compartment syndrome
5. Haemartosis
6. Gas gangrene
7. Fracture blister
8. Plaster and pressure sore

Complication (cont)
B. Late complication:

1. Delayed union
2. Non union
3. Malunion
4. Avascular necrosis
5. Growth disturbance
6. bed sores
7. Myositis ossificans

8. Tendon lesion
9. Nerve compression
10 Muscle contracture
11. Join instability
12. Joint stiffnes
13. Complex regional and
14. Osteoartitis

Pin syndrome

Immobilization
Purpose: - minimized friction
- Reduced pain
-Prevent
complication
- Easy transportation

Principles: - 2 joint
- Anatomical position
- Comfortable
- no tight
-elevation

Method
A. Splint
B. Bandage
C. Sling

A. SPLINT
Indications
To immobilize and stabilize fractures and dislocations
To decrease pain
To decrease swelling
To immobilize injured areas after burns, bites, and stings.
To immobilize an area during the healing processes
Contraindications
NO absolute contraindications

1. Soft splints non-rigid non rigid


splint
Include:
- bandaging material
- blankets

pillow

sling

- cloth

- plaster

- cravats

- finger splints

- foam rubber

- vacuum

- knee immobilizer

2. HARD-RIGID AND SEMIRIGID SPLINTS


Include:
- Aluminium or other pliable metal
- cervical collars
- backboards wood/fibre glass/ plastic
- cardboard
- fibre glass
- wire ladder splints
- leather
- moulded plastic

BOARD SPLINTS

BOARD SPLINTS

Aluminium Splints SAM Splints

Wire Ladder Splints

CARDBOARD SPLINTS

VACUUM SPLINTS

3. PNEUMATIC INFLATABLE SPLINTS


Include:
- air splints
- pneumatic antishock garments (PASG)

4. TRACTION SPLINTS
Include:
- Donway
- Thomas
- Sager
- Hare

THOMAS SPLINT

DONWAY SPLINT

B. Bandage
Purpose: support to an injured area or apply pressure to
an area in order to limit swelling.
Method:
1.tubular bandages
2. roll bandages

1. Tubular bandage

2. Roll bandages

C. Sling
Slings are used to:
- support fractures of the clavicle, scapula, humerus,
elbow, forearm, wrist or hand
- after reduction of dislocated shoulder, dislocated elbow,
or dislocated digits
- infections of the arm
- support a plaster of Paris cast of the arm or any arm
injury
- to reduce swelling of the forearm, wrist or hand
- to provide elevation of the arm for any purpose

Method
1. BROAD ARM SLINGS

2. HIGH ARM SLINGS

Pelvic Slings/Splints

Sheet Wrap

The SAM Sling

The Traumatic Pelvic Orthotic


Device, or T-POD

CERVICAL FRACTURE
SUSPECTED CERVICAL FRACTURE
THINGS TO REMEMBER!!
PATIENT WITH THESE CONDITION:
1. UNCONSCIOUS
2. INJURY ABOVE CLAVICULA
3. MULTIPLE TRAUMA

CERVICAL FRACTURE

Flexion teardrop
Severe
compressiveflexion

Bilateral facet
dislocation
Severe
distractive-flexion

Extension
teardrop
Distractiveextension

IMOBILLIZATION

Cervical Colar

Sandbag

TRADITIONAL

TRANSPORTATION
Interhospital Transfer Criteria, ATLS Table 13.1*
CLINICAL CIRCUMSTANCES THAT WARRANT INTERHOSPITAL TRANSPORT WHEN THE PATIENTS
NEEDS EXCEED AVAILABLE RESOUCES:
Category
Specific Injuries and Other Factors
Central Nervous System
Head injury
Penetrating injury or depressed skull fracture
Open injury with or without cerebrospinal fluid
(CSF) leak
GCS score < 15 or neurologically abnormal
Lateralizing signs
Spinal cord injury or major vertebral injury
Chest
Widened mediastinum or signs of great vessel
injury
Major chest wall injury or pulmonary contusion
Cardiac injury
Patients who may require prolonged ventilation
Pelvis/Abdomen
Unstable pelvic ring-disruption
Pelvic-ring disruption with shock and evidenc of
continuing hemorrhage
Open pelvic injury

Extremities

Multisystem Injuries

Comorbid Factors

Secondary Deterioration(Late Sequelae)

Severe open fractures


Traumatic amputation with the potential for
replantation
Complex Articular Injuries
Major crush injuries
Ischemia
Multisystem injury with face, chest, abdominal,
or pelvic injury
Injury to more than two body regions
Major burns or burns with associated injuries
Multiple prolonged long-bone fracture
Age > 55 years
Children < 5 years of age
Cardiac or respiratory disease
Insulin-dependent diabetes
Morbid obesity
Pregnancy
Immunosupression
Mechanical ventilation required
Sepsis
Single or multiple organ system failure
(deterioration in central nervous system ,
cardiac, pulmonary, hepatic, renal, or
coagulation systems)

TRANSPORTATION
Decision to transfer: Patients injury, local resources and
medical judgment.
Principle: DO NO FURTHER HARM
Timing:
1. distance to transfer
2. available skill level
3. circumstance of local institution
4. intervention patient

Before transfer:
1. Communication
2. Selecting the appropriate mode of transportation
3. Level of care required
4. Stabilizing the patient condition
During transportation:
1. Airway maintenance
2. Fluid volume replacement
3. special procedure that may necessary
4. Revised trauma score
5. Documentation

Treatment during transfer:


1. Monitoring vital sign and pulse oximetry
2. Continued support of cardiorespiratory system
3. continued blood replacement
4. use of appropriate medications as ordered by a
doctor or asallowed by written protocol.
5. Maintenance of communication with a doctor or
institution during transfer
6. Maintenance of accurate records during transfer

Mode of transportation
Helicopter and air ambulance
- Helicopter emergency medical service (HEMS):
- ideal but expensive
- Receiving facility is responsible
Ambulance:
-contact Referring hospital
- provide for a supplemental provider

Helicopter emergency medical


service (HEMS)

Ambulance

River Ambulance

Take Home Message


Fractures are emergencies case in the orthopaedic due
to need special treatment.
Need special skills to manage the fracture at the
accident, transportation and hospitalization.
Good immobilization and transportation can result good
outcomes.
Communications are important thing.

Dont Just Do
it
Thank You