- Clinical science
The conservative treatment of fractures involves repositioning of the bone fragments, wound closure (if necessary), and application of a cast or a splint to hold the bones in place. Immobilization facilitates the joining of the fragments and with it the healing process. Early mobilization should be achieved as soon as feasible to prevent stiffening of the joints. Further complications may be poor blood circulation due to dressings that are too tight or an increased risk of thrombosis and embolism caused by immobilization of lower extremities.
Healing time depends on the location of the fracture but the standard time period for cast immobilization is six weeks. It is important to bear in mind that an immobilized limb can only carry limited weight while full loading of a limb is possible soon after an operative treatment (osteosynthesis). Radiological controls should be performed regularly until the fracture is fully healed since dislocations (e.g., caused by a fall) may occur during the healing process. Sufficient analgesia and early functional treatment should be provided.
- Principle: immobilization of the fracture and adjacent joints
- Pain or discomfort after application of the cast might be a warning sign and should be taken seriously as poor blood circulation may result in necrosis within a few hours.
- Volkmann's contracture: permanent shortening of the forearm muscles resulting in a claw-like deformity of the fingers, hand, and wrist; caused by atrophy of the flexors of the hand and fingers when casts are too tight or blood vessels or nerves have been damaged during fracture or repositioning of the bones
Peripheral blood circulation, motor functions, and sensation should be checked before and after every surgery/cast application and during every ward round!
“A patient with a cast is always right!” In case of doubt, remove and reapply the cast!
- Gilchrist bandage
- Procedure: The affected shoulder and the corresponding arm are positioned closely to the body and immobilized with elastic bandages that are wrapped around the thorax, upper arm, shoulder joint, and elbow joint.
- Principle: immobilization of the shoulder joint
- Clavicle bandage
- Indication: broken toe
- Procedure: The broken toe is immobilized by fixing it to an adjacent, unaffected toe using a splint and imbricated tape (adhesive bandage)
- SAM splint: a moldable splint made of soft aluminum with a foam coating that is mainly used in emergency settings to quickly and temporarily immobilize broken extremities.
- Glisson sling: a traction device to relieve strain in the spine (e.g., used for cervical traction in the case of damaged spinal discs)