Fracture management involves treating broken bones so they have the best chance of healing. Generally, when doctors are managing fractures, they move the pieces of broken bone back into position and fix them there until they heal. Fracture management is also concerned with alleviating the patient's pain and preventing complications such as infection, nerve damage or excessive blood loss. Apart from these general principles, fracture treatment can vary slightly according to the type of fracture involved. Different care may be required according to the severity of the fracture, which specific bone is affected and whether a bone has broken through the skin.
An injured patient may have other problems apart from fractures and the state of the airway, breathing and blood circulation are always assessed first. Once the patient has been stabilized, any bone fractures can be treated. As part of both the initial assessment and fracture management, it is important to check whether the spine has been injured. If there is any doubt, precautions are taken to avoid moving the vertebral column in case this causes damage to the spinal cord, which could result in paralysis.
One of the first steps in fracture management is to check whether blood vessels and nerves on the far side of the break are still functioning. If they are intact, the bones are placed back in alignment, a process known as reduction, and the nerves and circulation are assessed again. The fracture is immobilized using a splint. This holds the ends of the broken bones in place while they knit together and heal. Although the patient is given painkilling drugs if required, preventing fracture movement also reduces pain and lowers the risk of any further damage to nerves, tissues and blood vessels.
Fractures in which the bone has pierced the skin are known as open fractures. Open fracture management involves preventing infection and preserving a functioning limb, if possible. A tetanus injection may be given along with antibiotic drugs. It is important to clean the wound thoroughly and remove any dead or dirty tissue. Sometimes a piece of skin may have to be moved from elsewhere to cover the wound.
Fracture management includes a number of methods of immobilizing healing fractures. Often, a cast made of a material such as plaster is positioned around the fracture site. In some cases, bones may be fixed together with metal plates, rods and screws. This may be required for fractures where the bone has been shattered into a number of fragments.