Extremity Fractures

Abstract

The assessment of extremity fractures begins with an overall evaluation of the traumatic insults that a patient may have incurred. It is important to keep in mind that fractures will have bleeding that may possibly be life threatening. Obvious external hemorrhage is best treated with direct pressure. Internal bleeding is best controlled with immobilization of the extremity, which may be done with a backboard for critical injuries; otherwise a splint is preferred. Orthogonal radiographs are promptly obtained for any areas with gross deformity, tenderness, or concern for injury due to mechanism. Images of the joint above and below an affected bone are also obtained. A thorough neurovascular exam is performed, and an assessment of the status of the soft tissues is made. In cases of amputation, the amputated part is cleansed with a lactated Ringer solution and then wrapped in solution-soaked gauze. This is then placed in a labeled plastic bag that is further placed in an ice slurry, being careful that the part does not freeze. Instances of suspected vascular injury are investigated with angiography. Clinical findings that will raise the index of suspicion include knee dislocations or extremity injury with an ABI (ankle-brachial index) of <0.9, a cool pale hand or foot with slow capillary refill, or high-energy insult to a vulnerable area. Finally, as part of the tertiary survey, all fractures, including open fractures, are monitored for the development of a compartment syndrome.