Fractures

Fractures, or broken bones, vary in severity and treatment depending on alignment, location, and involvement of nearby tissues. Proper assessment and stabilisation are key to recovery and pain management.

Non-Displaced Fracture

A non-displaced fracture occurs when the bone is broken, but the two ends remain properly aligned. These fractures generally heal well with immobilisation and conservative care.

Treatment

  • Administer pain relief medication as needed
  • Apply ice to reduce swelling and pain
  • Immobilise the limb with a cast, if applicable
    • Ribs are not castable; allow to heal naturally
    • Spine and Skull require specialised fixation; casting not possible
  • Use UV curing (e.g., with /e weld) to harden casts if applicable

Patients can typically be discharged after stabilisation with follow-up instructions.

Displaced Fracture (Non-Skull)

A displaced fracture means the bone fragments are misaligned and must be realigned (reduced) before healing can occur.

Initial Care

  • Provide pain relief and ice for swelling
  • Evaluate if reduction can be performed non-surgically or if surgical intervention is required

Non-Surgical Realignment

  • Manually reduce the fracture through physical manipulation (pulling, rotating, or pushing limbs to re-align)
  • Confirm alignment with repeat imaging
  • Once aligned, cast the limb for immobilisation

Surgical Realignment

Required when closed reduction fails or the injury is complex.

Procedure:

  • Sedate and intubate the patient, or administer a local nerve block if appropriate
  • Make a clean incision over the affected area
  • Irrigate with saline and bacitracin to reduce infection risk
  • Use suction to clear the surgical field
  • Align bone fragments and fixate using:
    • Plates, screws, rods, or pins
  • Re-irrigate and clear the area
  • Close the wound, apply antibiotic ointment, and cover with sterile gauze
  • Apply a removable cast if wound access is necessary for follow-up care

Notes:

  • Spinal fractures require surgical fixation—no casting
  • Rib fractures heal naturally with time and pain management

Skull Fracture

A skull fracture is a serious injury where the cranial bones are compromised. These are categorized by whether the bone is depressed or linear.

Non-Surgical Skull Fracture (Linear)

Occurs when the skull is cracked but the bone remains in place.

  • Confirm with CT or X-ray imaging
  • Monitor for signs of:
    • Intracranial bleeding
    • Swelling
    • Traumatic Brain Injury (TBI)
  • If no signs of complications, no surgical intervention is needed
  • Provide pain management
  • Patient may resume normal activity within several days
  • Refer to [Neurological] section if TBI is suspected

Surgical Skull Fracture (Depressed)

Occurs when a portion of the skull is sunken inward, potentially compressing the brain.

Procedure:

  • Sedate and intubate the patient
  • Make a large incision to access the fracture
  • Irrigate with saline and bacitracin
  • Use suction to maintain visibility
  • Lift and realign bone fragments
    • Use plates, pins, or synthetic material as needed
  • If the brain is swollen:
    • Delay reconstruction to allow for decompression
    • Store bone flap under scalp or discard and replace in follow-up
  • Re-irrigate and clear the surgical field
  • Close wound, apply ointment, and cover with sterile gauze

Post-op monitoring for neurological function and intracranial pressure is essential. May require ICU stay or protective helmet if bone repair is delayed.

Fractures of any type should always be documented with imaging, treated promptly, and followed by recovery instructions to avoid long-term complications.

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