What should I do if I have a fracture?
Jul 23, 2021
Source: Cainiu Health
Dr. Lin Yunfei
Introduction
1. Wound cleansing and disinfection: For open wounds, debridement is performed—contaminated wounds are thoroughly cleaned and disinfected, followed by excision of wound margins and removal of foreign bodies.
2. Analgesics: Opioids (e.g., morphine) and other analgesics (e.g., tramadol) may be administered for patients experiencing severe postoperative pain.
3. Surgical reduction: Open reduction with internal fixation (ORIF) is indicated for fractures with interposed soft tissue or when closed reduction has failed.
Fractures may involve a single site or multiple sites. However, prompt and appropriate management following a fracture is essential. With proper treatment, most patients achieve satisfactory recovery of the fractured area; conversely, inadequate management may lead to post-fracture complications. So, what should one do when a fracture occurs? The following section addresses this question.
What to Do When a Fracture Occurs
1. Wound Cleansing and Disinfection
For open wounds, debridement is performed—contaminated wounds are thoroughly irrigated and disinfected, wound edges are excised, foreign bodies removed, and necrotic or nonviable tissue excised to convert the wound into a clean one. For active bleeding, direct pressure dressings are applied; tourniquets may be used if necessary. An inflatable tourniquet is preferred, with recorded pressure settings and application time. The wound is then covered with sterile dressings or clean cloth to minimize recontamination.
2. Antibiotic Therapy
Analgesics such as morphine or tramadol may be administered for severe postoperative pain. Concurrently, antimicrobial prophylaxis is recommended—typically broad-spectrum antibiotics, most commonly first- or second-generation cephalosporins. In cases at high risk for Gram-negative bacterial contamination, an aminoglycoside may be added. If anaerobic infection is suspected, high-dose penicillin or other antibiotics with proven activity against anaerobes are recommended.
3. Surgical Reduction
Open reduction with internal fixation (ORIF) is indicated in the following scenarios: soft-tissue interposition between fracture fragments; failure of closed reduction; intra-articular fractures with poor alignment after closed reduction that compromise joint function; failure to achieve functional reduction with closed reduction and external fixation, resulting in significant functional impairment; associated vascular or nerve injury; open fractures unsuitable for external fixation; and multiple fractures, where ORIF at selected sites facilitates nursing care, treatment, and prevention of complications.
The above outlines key steps to take when managing a fracture. We hope this information is helpful to you.
