24Types of Fractures Green stick Spiral Transverse Comminuted Pathologic Epiphyseal
25complications of fx blood vessel & nerve damage Fat embolus disability or deformity
26Bleeding (internal) Bones have a blood supply! Fractures bleed internally -Femur - 1 literPelvis - 1 literTibia cc
27Other considerations What is beneath fracture site? open fracture Joint involved?
28Tips & other stuff Angulation or angulated extremity Depressed skull fractureBasilar skull fractureFlail Chest
29Hip Injury Hip Fracture – classic presentation Hip Dislocation Shortened, externally rotatedHip DislocationUsually flexed and internally rotatedRequires significant force
30TX draw-sheet method Make NO attempt to straighten leg Support with rolled blanketsPrevent hip movement
31Assessment of injured extremities PMSCPulseMovementSensationCapillary refillCold, blue, pulseless extremity has circulation problem
32ALWAYS CHECK DISTAL FUNCTION BEFORE & AFTER SPLINTING !!!!! AND DOCUMENT WHAT YOU FOUND !!
33Splinting Why we splint... relieve pain reduce tissue/vessel damage during movement
34Types of splints Self splinting Pillows, blankets, & items of clothing Sling & swathRigidCardboardplasticladderAir or vacuumTraction
35Traction splintsClosed, mid-shaft femur fracture without hip, knee, or ankle injury.
36General Principles of Splinting (1 of 2) Remove clothing areaPMSCDress all woundsDo not move the patient before splinting
37General Principles of Splinting (2 of 2) Immobilize the jointsPad rigid splintsMaintain manual immobilization.Realign angulations PRNWhen in doubt, splintReassess PMSCImmobilize all suspected spinal injuries in a neutral in-line position**pain, resistance, crepitus
38Realignment issues NEVER REALIGN A JOINT NEVER REALIGN A INJURY WITH GOOD DISTAL FUNCTIONOnly pulseless, longbone fractures
39Basic Realignment Steps Have all equipment ready & in placeExplain procedure to patientIn 1 move, with gentle traction, align extremity (goal is anatomical position)Use the least amount of force necessary.If resistance is met or pain increases, splint in deformed position.Reassess distal function
40RememberNo matter how bad the fracture our priorities are the ABC’s
41Hazards of Improper Splinting Further damageDelay in transportReduction of distal circulationAggravation of the injuryInjury to tissue, nerves, blood vessels, or muscle