Common and eponymous fractures

Management of common fractures

Clavicle
o Rest in sling or collar and cuff for two weeks
o Active shoulder movement started after first week
Femur - trochanteric region
o Fixation with dynamic hip screw
o Early postoperative mobilisation is important
Femur - shaft
o Operative reduction usually required
o Internal fixation achieved with intramedullary nail
Fibula - shaft
o Protect limb in below knee walking cast for 3 weeks
Humerus - neck
o In elderly disregard fracture and concentrate on shoulder
movement
o If fracture impacted begin mobilisation early
Humerus - supracondylar region
o Reduce by manipulation under anaesthesia
o Place in full length cast with elbow at 90 degrees
o Observe carefully distal circulation
Olecranon
o Undisplaced fractures need immobilisation in right angled arm
plaster
o Displaced and comminuted fractures require internal fixation
o Internal fixation can be achieved with tension band wires
Patella
o Undisplaced fractures should be protected in full leg cast for 3
weeks
o Displaced fractures require internal fixation with screw or
tension band wire
o Comminuted fractures may require patellectomy
Phalanges
o Undisplaced fractures should be strapped for 2-3 weeks
o Displaced fractures may require manipulation and external
fixation
Radius - head
o If minimal displacement place in collar and cuff for 3 weeks
o If severely comminuted excise radial head
Scaphoid
o Immobilise in Scaphoid cast until fracture united

If delayed union consider fixation with Herbert screw

Tibia - shaft
o Undisplaced fracture require immobilisation in full leg cast
o Displaced fractures may require internal fixation with
intramedullary nail

Eponymous fractures

Bennett's fracture
o Intra-articular fracture of the base of the first metacarpal
o Usually requires open reduction and internal screw fixation
Colle's fractures

Fracture of the distal radius with dorsal and radial angulation

and backward displacement
o Closed reduction should be followed by immobilisation in
forearm cast for 6 weeks
o Position should be checked by radiography one week after
injury
Galeazzi fracture
o Fracture of the radial shaft with dislocation of the inferior
radio-ulnar joint
o Usually requires internal fixation of the radius
Monteggia fracture
o Fracture of the proximal ulna with anterior dislocation of the
radial head
o Usually requires internal fixation of the ulna
o Radial head should be reduced or excised
Pott's fracture
o A general term applied to ankle fracture's
Smith's fracture
o Fracture of the distal radius with anterior displacement of the
distal fragment
o Closed reduction may be successful
o If fails requires open reduction and fixation with a buttress
plate
o

Bibliography
Krasin E, Goldwirth M, Gold A, Goodwin D R. Review of the current
methods in the diagnosis and treatment of scaphoid fractures. Postgrad Med
J 2001; 77: 235-237.