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TRANSPORTATION ON THE
FRACTURE CASES
Dr. GANDA M.R.H. PURBA, MKes, SpOT
ORTHOPAEDIC AND TRAUMATOLOGY DEPARTEMENT
OF MITRA MEDIKA HOSPITAL
Contents:
INTRODUCTION
IMMOBILIZATION
TRANSPORTATION
INTRODUCTION
Fractures: break in the structure continuity of bone and
cartilage
Medical problem
High cost care
Productive age
Mortality
Disability
23.1 Mechanism of injury Some fracture patterns suggest the causal mechanism: (a) spiral pattern (twisting);
(b) short oblique pattern (compression); (c) triangular butterfly fragment (bending) and (d) transverse pattern
(tension). Spiral and some (long) oblique patterns are usually due to low-energy indirect injuries; bending and
transverse patterns are caused by high-energy direct trauma.
CLASSIFICATION
Stable and unstable: Can or not retain the stability
Open and close: Skin intact or not
Type of Fractures
Transverse fractures cross the bone at a 90o angle and are
generally stable post reduction.
Oblique/spiral fractures are at a 45o angle to the axis, usually from
a twisting force causing upward thrust. Most long bone fractures
are due to violent twisting motions, such as a sharp twist to the
leg, when the foot is stuck in a hole, producing a spiral fracture.
Comminuted fractures are high-energy injuries where the bone is
splintered in more than two fragments. These are generally
associated with significant soft tissue injury.
Impacted fractures occur when one fragment is forced into
another. The fracture line may be difficult to visualise.
Type of Fractures
Crush fractures occur when cancellous bone is compressed or crushed.
Avulsion fractures occur when soft tissue and bone are torn away from
the insertion site.
Greenstick fractures occur when the compressed cortex bends/buckles.
If the force persists, the cortex will fracture. These are usually seen in
children as their bones are much more porous and soft.
Epiphyseal or growth plate fractures (Salter-type) may affect future
bone growth because of early closure of the epiphyseal plate and
resultant limb shortening. Angulation may occur with partial growth
plate fractures because bone growth continues in the noninjured area
Splinting, Bandaging and Immobilization Techniques and Devices.
Open fracture
AKA: Compound fracture
A fracture in which bone
penetrates through skin;
Open to air
Some define this as a fracture
with any open wound or soft
tissue laceration near the bony
fracture
Closed fracture
Fracture with intact overlying
skin
MANAGEMENT OF FRACTURE
Complication
A. Early complication:
1. Visceral injury
2. Vascular injury
3. Nerve injury
4. Compartment syndrome
5. Haemartosis
6. Gas gangrene
7. Fracture blister
8. Plaster and pressure sore
Complication (cont)
B. Late complication:
1. Delayed union
2. Non union
3. Malunion
4. Avascular necrosis
5. Growth disturbance
6. bed sores
7. Myositis ossificans
8. Tendon lesion
9. Nerve compression
10 Muscle contracture
11. Join instability
12. Joint stiffnes
13. Complex regional and
14. Osteoartitis
Pin syndrome
Immobilization
Purpose: - minimized friction
- Reduced pain
-Prevent
complication
- Easy transportation
Principles: - 2 joint
- Anatomical position
- Comfortable
- no tight
-elevation
Method
A. Splint
B. Bandage
C. Sling
A. SPLINT
Indications
To immobilize and stabilize fractures and dislocations
To decrease pain
To decrease swelling
To immobilize injured areas after burns, bites, and stings.
To immobilize an area during the healing processes
Contraindications
NO absolute contraindications
pillow
sling
- cloth
- plaster
- cravats
- finger splints
- foam rubber
- vacuum
- knee immobilizer
BOARD SPLINTS
BOARD SPLINTS
CARDBOARD SPLINTS
VACUUM SPLINTS
4. TRACTION SPLINTS
Include:
- Donway
- Thomas
- Sager
- Hare
THOMAS SPLINT
DONWAY SPLINT
B. Bandage
Purpose: support to an injured area or apply pressure to
an area in order to limit swelling.
Method:
1.tubular bandages
2. roll bandages
1. Tubular bandage
2. Roll bandages
C. Sling
Slings are used to:
- support fractures of the clavicle, scapula, humerus,
elbow, forearm, wrist or hand
- after reduction of dislocated shoulder, dislocated elbow,
or dislocated digits
- infections of the arm
- support a plaster of Paris cast of the arm or any arm
injury
- to reduce swelling of the forearm, wrist or hand
- to provide elevation of the arm for any purpose
Method
1. BROAD ARM SLINGS
Pelvic Slings/Splints
Sheet Wrap
CERVICAL FRACTURE
SUSPECTED CERVICAL FRACTURE
THINGS TO REMEMBER!!
PATIENT WITH THESE CONDITION:
1. UNCONSCIOUS
2. INJURY ABOVE CLAVICULA
3. MULTIPLE TRAUMA
CERVICAL FRACTURE
Flexion teardrop
Severe
compressiveflexion
Bilateral facet
dislocation
Severe
distractive-flexion
Extension
teardrop
Distractiveextension
IMOBILLIZATION
Cervical Colar
Sandbag
TRADITIONAL
TRANSPORTATION
Interhospital Transfer Criteria, ATLS Table 13.1*
CLINICAL CIRCUMSTANCES THAT WARRANT INTERHOSPITAL TRANSPORT WHEN THE PATIENTS
NEEDS EXCEED AVAILABLE RESOUCES:
Category
Specific Injuries and Other Factors
Central Nervous System
Head injury
Penetrating injury or depressed skull fracture
Open injury with or without cerebrospinal fluid
(CSF) leak
GCS score < 15 or neurologically abnormal
Lateralizing signs
Spinal cord injury or major vertebral injury
Chest
Widened mediastinum or signs of great vessel
injury
Major chest wall injury or pulmonary contusion
Cardiac injury
Patients who may require prolonged ventilation
Pelvis/Abdomen
Unstable pelvic ring-disruption
Pelvic-ring disruption with shock and evidenc of
continuing hemorrhage
Open pelvic injury
Extremities
Multisystem Injuries
Comorbid Factors
TRANSPORTATION
Decision to transfer: Patients injury, local resources and
medical judgment.
Principle: DO NO FURTHER HARM
Timing:
1. distance to transfer
2. available skill level
3. circumstance of local institution
4. intervention patient
Before transfer:
1. Communication
2. Selecting the appropriate mode of transportation
3. Level of care required
4. Stabilizing the patient condition
During transportation:
1. Airway maintenance
2. Fluid volume replacement
3. special procedure that may necessary
4. Revised trauma score
5. Documentation
Mode of transportation
Helicopter and air ambulance
- Helicopter emergency medical service (HEMS):
- ideal but expensive
- Receiving facility is responsible
Ambulance:
-contact Referring hospital
- provide for a supplemental provider
Ambulance
River Ambulance
Dont Just Do
it
Thank You