Indirect force may be

1. Twisting
2. Bending
3. Bending + compression
4. Combination

Direct force may be

1. Tapping
2. Crushing

1. Direct healing - when a feature is rigidly fixed

However, callus forms in response to motion, then bone grows across the fracture (natural healing)

Most #'s heal spontaneously

2. Indirect healing - # haematoma

We splint most #'s, not to ensure union but

1. To alleviate pain
2. To ensure union takes place in good position
3. Generally more conservative for UL, rehab at early stage
4. LL: if long-leg plaster applied, Pt cannot walk properly

1. Fix #
2. Proper position
3. Pain: ends grinding together
4. Rehab
5. Cosmesis

1. Look - swelling, bruises, deformity

2. Feel - tenderness

3. Move - crepitus + abnormal movt

• 2 views: if in one plane only, 2 # ends may be overlapping one another
• 2 occasions: sometimes # not obvious at first (eg. Crack more obvious after 2w because bone ends resorbed a little)
• 2 joints: may be another # in nearby joint (eg. # midshaft femur may have # hip as well); nearby joint subluxation/ dislocation
• 2 limbs: usu. paediatrics (ossification centres), compare L + R

• Closed or open

1. Traction
2. Plaster
3. Functional bracing
4. Internal fixation - not a must, but in adults always desirable

1. Difficult fractures
2. Prone to non-union - eg. # of neck of femur
3. Prone to malunion - eg. # ankle, elbow
4. Intra-articular features for better reduction to prevent early degeneration
5. Pathological #'s
6. Multiple #'s
7. Nursing difficulties - eg. Elderly hip #'s

• Injury usually more severe
• Risk of bacterial entrance to wound
• ST problems to cover the exposed bone

Tx includes

1. Wound debridement
2. Fixation of #'s
3. Wound closure
4. After-care: ABX, skin graft, bone graft

1. Shortening; of radial end
2. Dorsal angulation: tilts tibial fragment dorsally
3. Dorsal displacement
4. Radial angulation

1. Shortening; lengthen (traction to opposed m pull on #'ed ends)
2. Angulation: palmar-flex at # site
3. Displacement: move back
4. Radial angulation: ulnar angulation to correct

• Periosteum usually intact on shorter side (ruptured on longer side)
• Need 3 point fixation (or else bends back into original displacement)
• Apply plaster that is slightly curved (once ST swelling subsides, there is room inside for fracture to spring back to original displacement)
• Apply cotton wool first (padding)
• Plaster: calcium sulphate
• Dip in water, squeeze Xs water, but still remains wet (air bubbles escape)
• Overlap each turn
• Flat of hand to smooth out liquid form of plaster (to ensure all layers even - no weak points within plaster)
• Make sure no dimples on outside (otherwise transmitted to inside -> pressure necrosis)
• Squeeze in AP manner (because originally applied as cylinder, and wrist if not oval in shape)
• Then palmarflex wrist (bend down)
• Once hardened, releases a lot of heat, becomes one homogenous layer
• Dries in one day
• Afterwards; make sure Pt can move wrist, move shoulder/ elbow (or else frozen shoulder)
• Need rehabilitation: move fingers, elbow, shoulder (physio); ADL (OT)