How to deal with fractures
Fractures can be dealt with externally and internally.
The easiest and less expensive way of treating fractures is the Plaster Of Paris (POP) or even using newer, lighter thermoplastic materials.
The Colles Fracture is the most common, it is most frequent in older age groups. It is defined as,
- "a fracture of the radius in the wrist, with a characteristic backward displacement of the hand." https://www.google.co.uk/search?q=colles+fracture&espv=2&biw=1440&bih=799&source=lnms&tbm=isch&sa=X&ved=0CAYQ_AUoAWoVChMI9vaJ0IOpyAIVR1IUCh0kMgY8#tbm=isch&q=colles+fracture+dinner+fork&imgrc=1iEVf8RjIKUmmM%3A It is mostly characterised by the "dinner fork" deformity.
If the fracture is unstable then it can secured with engineering.
Screws have to placed into the bone above and below the fracture. The device must be attached to the screws outside from outside the skin, this makes it easier to realign to the bone.
An external fixation device must be used to keep it stabilized and remain in alignment. The device can be adjusted externally to ensure that the bones are in optimal position for the healing process. The fracture site should be kept no more than a 1mm gap whenever it is possible.The external fixation device is most frequently used when the skin above the fracure is badly is injured and a POP cannot be used.
When we are unable to use casting or external fixation cannot be used then an internal fixation must be used. These can be mostly found in unstable fractures of the shaft and around in the neck of femur. This is called an "intramedullary nail" with an "signal arm" attachment,
However there are other choices which could be more appropriate depending on the injury, for instance with older cases of fractured neck of femur (NoF), a hemi - or total arthoplasty is more applicable.
The fractured site must be kept stable and be allowed to move for about
- 4-8 / 52 s for upper limbs fractures
- 8-12 / 52 s for lower limb fractures
Other factors can delay the healing process, for example infection is always an issue. It can be a problem with compound fractures and surgical interventions is always associated with anaesthetic risks. The Fat Embolism can cause damage to the intrameduallary marrow and lead to strokes. Other risks can take the form of immobolisation in bed risks chest or bladder infections / hypostastic pneumonia/ DVT. Pressure sores including those caused by the plaster and other material. One potential danger which can happen is muscle wasting with the loss of function, espically with small muscles atrophy (waste) for example in the hand. Mal- non union of the fracture may require surgical intervention.
A traction is another way to ensure that the fracture is the optimal postion for healing with younger patients. Heavy weights attached to the cord and hanging over the bed. An OT assesment should be place definately before discharge and as an in-patient and be " relevant to the occupational context of the patient"
A continual liason with practising care/ community nursing and social services, are an vital components. As Ot's we need to have on-going interventions/ discharge depending on the pateints indivdual needs and circumstances.
This starts with in-patients 1st day post op and the others as O/PS , this will continue through discharge from treatment
Subluxation ; where the joint surface are in contact but only partially
Dislocation: where the joint surfaces are completly seperated.
Spontaneous subuxation is common at the glenohumeral joint after dislocation and is prone to be recurrent.
Both will be severely affect function and will have to be reduced and stabilised. Just like a fracture as further more serious damage could occur if not treated promptly.