Page 174 - ASOP ROT Study Guide

9.2 Fractures Involving Joints
If fractures involve joints then, generally internal fixation is appropriate if the fracture is displaced.
Reduction to the degree of accuracy required for intra-articular fractures is unusual without an
operation. Around joints, where cancellous bone tends to be fragmented and often with little soft
tissue support, holding requires accurate reconstruction of the fragments, usually with screws to
aid stability (Figure below).

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FIGURE ABOVE. TYPICAL ANKLE FRACTURES HELD USING INTERNAL FIXATION
TECHNIQUES.

9.3 High Velocity Injuries
High velocity fractures, whether open or closed, require special attention because of the damage
to the blood supply. They are fortunately few, but are the most challenging and ideally should
be treated by experienced clinicians. They require early attention, followed by expert decisions
about definitive management. External fixators are particularly valuable in mis-type of injury, as
outlined above, although fixation, traction and splintage all have their place. A more detailed
discussion of the management of these injuries is beyond the scope of this unit.
9.4 The Injured Person
Fractures should be held using fixation if it is of benefit to the injured person. This is particularly
so in the elderly, where fixation will relieve pain and permit early mobility so preventing some
of the complications caused by immobility including bedsores, chest and urinary infections and
muscle wasting. For similar reasons pathological fractures should be fixed. Pathological
fractures occur when a bone subjected to normal forces behaves abnormally by fracturing.