Fracture - Its administration

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Management of fracture involves both first aid and further medicine by condition professionals - doctors, nurses and physiotherapist.

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1. First aid management
This is the medicine you give to the outpatient before the arrival of a medical doctor or before transferring the outpatient to the hospital.
i. Make sure the airway is patent. If there is any obstruction clear it away.
ii. Check for breathing. If no breathing, then produce breathing straight through the mouth-to-mouth or mouth-to-nose respiration.
iii. Ensure there is circulation. Listen to the heart beat or check the pulse. If not heart beat, start Cpr
iv. Call for help
v. Arrest any external haemorrhage (bleeding)
vi. Immobilise affected part. Get adequate hands before enthralling the patient. This helps to minimize further tissue damage. Immobilization can be achieved straight through the use of mechanical splint or body splint.
vii. Open wounds may be cleaned and sterile dressings applied. Do not make any effort to reduce the fracture if the limb is in an abnormal position or alignment.
viii. Treat for shock if there are signs. Remove clothing straight through the uninjured side.
ix. Remove rings from the fingers in case of fracture of the arm or hand. This is to forestall the ring cutting off blood provide to the fingers and subsequently gangrene when heavy swelling occurs.
x. Do not give anyone by mouth in case the outpatient would need a general anaesthesia in hospital.

2. Reduction: discount involves bringing the bones into allowable alignment or their pre-injury positions. It helps to restore the shape and length of the bone thereby promoting their union. discount is achieved in two ways:
a. Accomplished Reduction: This involves manipulating the bones externally without use of surgery.
b. Open Reduction: Involves the use of surgical operation to restore bone alignment when external manipulation cannot give the desired result. It is also employed when there is displacement of bone fragments or when tissue or blood clots are lodged in the middle of the ends of the fractured bone. An incision is made into the fracture site under general anaesthesia and realignment is carried out.

3. Immobilization: Immobilization is done after bone discount to ensure the limb is not enthralling for a exact period of time. Immobilization is commonly done straight through application of traction, cast or splint. Cast involves the application of the Plaster of Paris bandage nearby the site and allowed to dry to provide reserve for the part and the joint below and above the fracture point.

Traction on the other hand involves applying a force to pull the end of the limb and also a counter traction in the opposite direction to originate a balance. Splint in form of metal, plastic or plaster of Paris can be applied to extend over the joint immediately above and below the fracture to forestall movement.

4. Exercises: Limbs should be moved straight through a range of petition to forestall joint stiffness, muscle atrophy, renal calculi or hypercalcaemia from arising. The practice of the legs improves circulation and promotes bone healing.

5. Corporal care: Pay allowable concentration to pressure areas. outpatient should be told not to alleviate itching by pushing coins, spoons, sticks, combs, etc into the cast. Should they push any hard object into the cast it would furnish pressure and pains. Fingers and toes distal to the cast should be bathed and lightly massaged at least once daily if irritation occurs.

6. Nutrition: outpatient should be encouraged to eat well balanced diet to aid tissue repair. Growth fibres in patient's food to forestall constipation if the outpatient is confined to bed. Protein and vitamin c should be increased to aid healing. outpatient should also eat foods containing calcium which aid the formation of callus needed for the bone repair.

7. Diversional therapy: Occupational therapy and diversional therapy such as reading, movies, radio, and handicraft should be employed to help reduce boredom or depression.

8. Skin care: Skin over the elbows, sacrum, shoulders and ankles should be cleaned and powdered at least 4hourly to forestall pressure sore.

9. Self care: outpatient should be encouraged to carry out assisted self care. He should be taught to carry out deep-breathing and coughing exercises which help to forestall circulatory impairment and pulmonary complications.

10. Elimination: The nurse should assist the outpatient unto the bedpan if the outpatient is on traction since outpatient may find it difficult to raise himself unto the bedpan. Enema should be given if there is constipation or faecal impaction.

11. Rehabilitation: outpatient should not be allowed to move out of bed immediately after the extraction of traction if the outpatient has been confined to bed and the foot of bed elevated. This is to forestall fainting assault and possibility of falling. The head of the bed should be elevated for sometime for allowable readjustment before outpatient is ultimately allowed out of bed.

The physiotherapist should be employed to help outpatient with practice and gradual procure of the use of the affected limb and also to minimize stiffness and muscle atrophy. Both passive and active exercises are encouraged. outpatient is also taught how to use crutches and canes to assist movement while recovering from fracture of the lower limb.

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