Page 160 - ASOP ROT Study Guide

wrist are treated in the elderly. The fracture may be treated under local anaesthesia in the Accident
and Emergency department. Although this might not achieve the perfect result, the injured person
can then be discharged home to an environment where they may function satisfactorily without
further extensive treatment, which could lead to unnecessary complications such as bedsores,
pneumonia or urinary infections.
On the other hand a young fit, right handed craftsman or woman who injures his/her right wrist
joint may be prepared to spend many months undergoing treatment to ensure a perfect result
because mat is what is required for his/her long term health and employment security.
As always, the benefit must outweigh the risk in the treatment strategy and the psychological effects
of injuries on all patients, irrespective of age, should not be underestimated. A young and well
person will tolerate long term treatment and surgery with no physical detriment, but in the older
patient, perfect function may sometimes only be achieved at the expense of the risk of
complications. These examples illustrate some of the diverse problems facing the fracture surgeon.
7.3 Basic Rules
In order to achieve acceptable function, the anatomy of a fracture should be returned to as near
normal as is safely and practically possible. If the fracture passes into a joint then the anatomy
should be restored accurately if acceptable function is to be achieved. If a fracture occurs through
the shaft of a long bone then the margin for error is much greater and something less than perfect
is acceptable. However, some injuries are so severe that normal restoration is impossible.
Restoration to normal position is achieved by a process which is called reduction. The fracture
must be reduced to the normal position and then held there until the bone heals naturally.

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7.4 Reduction

Closed reduction may be achieved by traction on the distal fragment and then a relocation of that
distal part back onto the proximal fragment by manipulation. In order to achieve a reduction,
adequate analgesia is necessary and general or regional anesthesia may be used. The manipulative
procedure usually involves reversing the direction of the deforming force.
If such a maneuver is unsuccessful then open reduction may be required whereby the fracture site
is opened surgically and the fragments are relocated directly under vision.

7.5 Holding

Once the fracture is adequately realigned, it must be held in the desired position until the bone has
become strong enough to support itself (united) and then protected until it is strong enough to bear
some load (consolidated).