Fractures, Casts and Traction
Neurovascular checks and preventing complications
Fracture basics
- Types: open (skin broken: infection risk), closed, comminuted (fragments), greenstick (children), compression (spine), spiral (twisting: in a non-walking child, consider abuse).
- Signs: pain, deformity, swelling, shortening, crepitus, loss of function.
- First aid: immobilize (splint the joints above and below), don't straighten, cover an open wound with a sterile dressing, elevate if possible, ice.
- Hip fracture: leg shortened and externally rotated; surgery usually within 24–48 h.
Neurovascular checks
Compare with the other side: pain, pallor, pulses, paresthesia (numbness, tingling), paralysis (movement), poikilothermia (temperature), plus capillary refill and swelling. Check often in the first 24–48 h.
Compartment syndrome: emergency
Swelling inside a closed muscle compartment cuts off blood flow (fractures, casts, crush injuries, burns).
Earliest sign: pain out of proportion to the injury, worse with passive stretching, not relieved by opioids; then numbness and tingling, tense swelling. Pallor and pulselessness are late.
Act: notify immediately; loosen dressings or have the cast split; keep the limb at heart level (not elevated, which reduces blood flow); no ice. Treatment: fasciotomy within hours.
Earliest sign: pain out of proportion to the injury, worse with passive stretching, not relieved by opioids; then numbness and tingling, tense swelling. Pallor and pulselessness are late.
Act: notify immediately; loosen dressings or have the cast split; keep the limb at heart level (not elevated, which reduces blood flow); no ice. Treatment: fasciotomy within hours.
Cast care
- Plaster takes 24–72 h to dry: handle with palms, not fingertips; leave uncovered while drying. Fiberglass sets in minutes.
- Elevate above heart level for the first 24–48 h and apply ice (unless compartment syndrome is suspected).
- Keep dry; never push objects inside to scratch (use cool air from a hair dryer).
- Report: increasing pain, numbness, cold or blue fingers or toes, hot spots, drainage, foul smell (infection or pressure injury).
Traction
- Skin traction (e.g., Buck's): short-term; check skin.
- Skeletal traction: pins in bone; pin care per policy (often chlorhexidine); watch for infection.
- Weights hang freely: off the floor and bed; never remove or lift them without an order.
- Keep body alignment; ropes on pulleys; knots away from pulleys.
Fat embolism syndrome
After long-bone or pelvic fractures, usually 24–72 h: sudden shortness of breath and hypoxemia, confusion, and a petechial rash on the chest, armpits, or conjunctiva. Oxygen, supportive care; early fracture fixation helps prevent it.
Other complications
DVT/PE (prophylaxis, early mobility) · osteomyelitis (bone infection: long antibiotic course) · infection of pins and open fractures · delayed healing (smoking, diabetes, poor nutrition).