Fracture
Olecranon Fractures
- Unstable fractures require emergent orthopedic consultation for operative fixation.
- Apply splint at 50-90% flexion and analgesia.
- Intravenous antibiotics for open or suspected fractures.
- Stable, nondisplaced fractures with intact extensor function
- Immobilized in a long arm posterior splint with 90 degrees of flexion, neutral forearm
- Orthopedic follow-up within 1-2 days.
Compartment Syndrome
- Compartment syndrome is a life and limb threatening emergency that requires early recognition, prompt diagnosis and immediate management with fasciotomy
- While clinical evaluation is flawed, pain out of proportion to injury and pain with passive stretch of muscles within the compartment are the best screening tools.
- Do not wait for the development of pallor, absence of pulse or paralysis to consult surgery. These are late findings that may only arise once the limb is non-salvageable.
- In unconscious patients, there should be a low threshold to measure compartment pressure in patients who are at risk as clinical signs cannot be evaluated
- When measuring compartment pressures, look for an absolute pressure > 30 mm Hg and perfusion pressure (DBP – compartment pressure) of < 30 mm Hg. All patients with a clinical suspicion and normal pressures should have repeat pressures measured.
Femur fracture…splint early
There are two main reasons for use of traction splinting for fractured shaft of femur.
- Analgesia
- Haemorrhage control
Terry Thomas…
This fracture is named after the well-known British comic Terry Thomas (1911-1990) who had frontal dental diastema (a large gap between his two front teeth)