General principles of fracture management

Essentiially, you need to do three things with a fracture: put the bone back together (reduction); hold the bone in place so it heals properly (fixation); and then getting the bone and related body parts back to their best possible level of function (rehabilitation).

Reduction

Broadly speaking, this falls into operative and non-operative. Under the non-operative banner, we have:

• Manipulation - pushing everything back together from the outside
• Traction - using gravity to get evertyhing back together (often with collar-and-cuff). This technique is used a lot in children and used to be used in adults a great deal. It often involves suspending limbs in the air with the patient in bed.
• Fortuitous - doing nothing, basically. Everything goes back into place on its own. Hence "fortuitous".

So now we've done non-operative, we're left with, you've guess it, non-operative. YAY!:

• Closed - this is basically where some form of metal (wire or screw of some form) is used to stick one bit of bone to another but doesn't actually open up the skin.
• Open - an open operation to put the bones back in the right place.

That's about it, really. Now you need to make sure the bones stay there.

Fixation

Many of the techniques used in bone fixation are similar to those used in bone reduction. It is once again split into operative and non-operative. Let's go for non-operative first again:

• Traction - see above. Same techinque, just done to hold it in place rather than get in place.
• I can't think of anything else...

Now for the operations:

• Closed - most techniques used for reduction (like wires and screws) are left in place for fixation purposes.
• Open - once they moved all the bits back together, they hold them there with plates or nails. Plates are long bits of metal put along the length of a broken bone. Nails hold them together from inside.

Rehabilitation

This is where the multidisciplinary team comes in. Firstly, you have things that can be done by vaguely hospital staff.Physios can help with restoring function and OTs can help with stuff in the house. However, there is also a social aspect in the form of help at home or employment (a truck driver who has two broken arms is unlikely to be able to return to work immediately after his injury). As such social workers are important ind ealing with these sequelae of serious injury.