Emergency Treatment of the Fracture

Emergency treatment consists of splinting the limb above and below the suspected fracture, applying a cold pack, and elevating the limb to reduce edema and pain. 

In severe fractures that cause blood loss, apply direct pressure to control bleeding, and administer fluid replacement as soon as possible to prevent or treat hypovolemic shock. 

After confirming a fracture diagnosis, begin treatment with reduction (which involves restoring displaced bone segments to their normal position).

After reduction, the fractured arm or leg must be immobilized by a splint, a cast or with traction. In closed reduction (accomplished by manual manipulation), a local anesthetic such as lidocaine and an analgesic such as I.V. morphine help relieve pain; a muscle relaxant such as I.V. diazepam or a sedative such as midazolam facilitates the muscle stretching necessary to realign the bone.

Treatment of open fractures also requires tetanus prophylaxis, prophylactic antibiotics, surgery to repair soft-tissue damage, and thorough debridement of the wound.

When closed reduction is impossible, open reduction during surgery reduces and immobilizes the fractured area by means of rods, plates, or screws. Afterward, a cast is usually applied.

When a splint or cast fails to maintain the reduction, immobilization requires skin or skeletal traction, using a series of weights and pulleys. In skin traction, elastic bandages and sheepskin coverings are used to attach traction devices to the patient’s skin. In skeletal traction, a pin or wire inserted through the bone distal to the fracture and attached to a weight allows more prolonged traction.

X-rays are ordered to confirm that the reduction was successful and that proper bone alignment was achieved.