Orthopedic Emergencies…take two. Last Fall, we took a look at (and pity on) joint luxations. Take away message, “Get those things reduced ASAP and use lots of narcotics to get there”. Now we turn to our most common ortho emergencies, the fracture. With a standard bandage supply stock and a little attention to detail, we can give all of our broken patients a bit of relief. Read on…
PART 2. LONG BONE FRACTURES
The longer a bone is fractured without proper immobilization and stabilization, the longer an animal suffers the consequences.
Consequence #1: A flopping fracture is painful (and it makes a lot of PEOPLE nauseated to watch!); an immobilized fracture is comfortable, for everyone.
Consequence #2: A fracture dancing around in soft tissue is like the head chef at the local teppanyaki restaurant preparing your meal–have you seen what those chefs can do with a couple of cleavers?
Consequence #3: Take pity not only on the patient, sure; but how about the sorry cuss who has to repair that fracture? The longer the leg remains foreshortened with overlapping fragments, the tighter those muscles surrounding the fracture get. This early contracture– hours to days– brings lots of lactic acid to the muscles of the surgeon attempting open reduction and stabilization! Never mind the overstretching and trauma that can result in the muscles being re-lengthened during surgery.
And, consequence #4: When a fracture is allowed time to go it on its own, with improper immobilization or markedly delayed rigid stabilization, a malunion will result. This typically manifests as two joints, those above and below, being at odd angles relative to each other. This alignment problem renders the leg useless and/or chronically painful.
So, when that patient comes in with a fractured femur, tibia, humerus or radius, throw some bandaging supplies and skill at it that same day (if anesthesia can be tolerated.) The pain of an acute fracture can be ameliorated well with a stiff dose of an analgesic to get the work done. Remember that narcotics/opioids are one of the safest drugs we have on several important fronts– cardiovascular, renal, hepatic. Once that is on-board, immobilization can proceed, with maybe just a little bump with propofol to get past the most painful, initial stage.
Common message for all long bone fractures: Immobilize the joint directly above and below the fracture. Point to each when you are done, and make sure each is well covered by your immobilization masterpiece!
And another strong take-away message from this communiqué is to forget about the off-the-shelf splint options out there (waste of money and space), and go with 3M casting tape(3″). You will be well served, need only keep 2-3 rolls in-stock, and will have more fun splinting patients.