1-47

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1-47. PRINCIPLES OF FRACTURE MANAGEMENT

a. In treating a fracture, the objectives of the treatment are as follows:

(1) To regain and maintain the normal alignment of the injured part.

 

(2) To regain normal function of the injured part.

 

(3) To achieve the above objectives for the patient in the shortest time possible.

b. The principles of fracture management are reduction, immobilization, and rehabilitation.

(1) Reduction. Reduction is the process of restoring the bone ends (and any fractured fragments) into their normal anatomical positions. This is accomplished by open or closed manipulation of the affected area, referred to as open reduction and closed reduction.

(a) Closed reduction is accomplished by bringing the bone ends into alignment by manipulation and manual traction. X-rays are taken to determine the position of the bones. A cast is normally applied to immobilize the extremity and maintain the reduction.

 

(b) In open reduction, a surgical opening is made, allowing the bones to be reduced manually under direct visualization. Frequently, internal fixation devices will be used to maintain the bone fragments in reduction.

(2) Immobilization. Immobilization is necessary to maintain fracture reduction until healing occurs. Immobilization may be accomplished by external or internal fixation.

(a) Methods of external fixation include casts, splints, and continuous traction.

 

(b) Internal fixation devices include pins, wires, screws, rods, nails, and plates. These devices, attached to the sides of the bone or inserted through the bone,

provide internal immobilization of the bone.

(3) Rehabilitation. Rehabilitation is the regaining of strength and normal function in the affected area. Specific rehabilitation for each patient will be based upon the type of fracture and the methods of reduction and immobilization used. The physician will generally consult with the physical therapist to develop an individualized rehabilitation plan for each patient. This plan is normally implemented and controlled by the physical therapy department.