
A fracture is a complete or incomplete break in a bone.
Causes
- Trauma e.g. road traffic accident, assault, falls, sports
- Bone weakening by disease, e.g., cancer, TB, osteomyelitis, osteoporosis
Clinical features
- Pain, tenderness, swelling, deformity
- Inability to use/move the affected part
- May be open (with a wound) or closed
Differential diagnosis
- Sprain, dislocations
- Infection (bone, joints and muscles)
- Bone cancer
Investigations
- X-ray: 2 views (AP and lateral) including the joints above and below
Management
Suspected fractures should be referred to orthopaedics after initial care.
If polytrauma
- Assess and manage airways
- Assess and treat shock
Closed fractures
- Assess nerve and blood supply distal to the injury:
if no sensation/pulse, refer as an emergency - Immobilise the affected part with a splint
- Apply ice or cold compresses
- Elevate any involved limb
- Give an analgesic e.g. paracetamol 1 g every 6-8
hours to relieve painChild: 10 mg/kg every 6-8 hours
- For severe pain, use opioids stat
- Morphine 5-10 mg IV or Pethidine 50-100 mg IM
- Refer to hospital for further management
Open fractures
- Stop any bleeding by applying pressure
- Clean open wound and cover with sterile dressing
- Give Tetanus Toxoid if not fully vaccinated
- Start antibiotic
- Amoxicillin 500 mg every 8 hours
Child: 25 mg/kg every 8 hours (or 40 mg/kg every
12 hours)
- Amoxicillin 500 mg every 8 hours
If severe soft tissue damage
- Add gentamicin 2.5 mg/kg every 8 hours
- Refer URGENTLY to hospital for further
management
Note
- Treat sprains, strains and dislocations as above
Caution
- Do not give pethidine and morphine for rib fractures and
head injuries as they cause respiratory depression