Fracture/Dislocation CPG

Question 1

What are the general principals for reducing a fracture?

Answer 1

• Provide procedural analgesia
• Irrigate with 500ml-1L normal saline if fracture compound
• Apply traction and mental contour traction
• If further manipulation required this should be done under traction
• Splint following reduction

Question 2

What are the general principals of relocating a dislocation?

Answer 2

• Provide procedural analgesia
• Apply sustained traction in longitudinal direction from joint
• Have assistant providing counter traction above the injury

Question 3

What do you do if a person has compromised neurovascual observations?

Answer 3

Transport them to the nearest higher level care within 15 minutes. If Travel time exceeds 15 minutes consult for further information.

Question 4

What constitutes time criticality in a patient with a fracture?

Answer 4

Altered sensation, cold skin, loss of pulse or indicators of neuromuscular compromise as it is a threat of loosing the limb.

Question 5

When should a pelvic splint be applied?

Answer 5

If there is suspected pelvic fractures due to injury to pelvis
If there is suspected haemorrhage as it acts as a haemorrhage control device

Question 6

If a patient has both a suspected pelvic and mid shaft femur fracture what do you do?

Answer 6

Apply both the CT6 splint and pelvic splint. The Pelvic splint should be prioritised and applied first.

Question 7

What can you not do with a patient in a pelvic splint/with a pelvic injury and why?

Answer 7

Log roll them as it may displace blood clots.

Question 8

If you need to relocate a dislocation what should be considered?

Answer 8

• Ability to provide sufficient analgesia

- The chance of successful relocation

Question 9

What are the care objectives of the CPG?

Answer 9

• Control external haemorrhage
• Apply good splinting
• Resolve compromises in neuro-vascular compromise where possible
• Use judicious analgesia

Question 10

When should you prioritise pelvic splinting

Answer 10

• When there is a suspected pelvic fracture

- inadequate perfusion, altered conscious state secondary to mechanism that may cause pelvic injury

Question 11

If there are compromised neuro-vascular observations for a fracture what should you do?

Answer 11

Provide pain relief and reduce the fracture and apply appropriate splinting

Question 12

If there is a dislocation with compromised neuro-vascular observations what should you do?

Answer 12

Prioritise transport and consult with clinician to receive advise around relocation.

Question 13

When should you re-asses neuro-vascular observations ?

Answer 13

Whenever you Manipulate, apply a splint or apply a sling.