Basic Fracture Management

Author: Lisa Curatolo   @Curlytoes12

Consultant Paramedic & Advanced Retrieval Practitioner


Lets set the scene..... You get called to someone who has fallen down a couple of stairs and they have an isolated ankle injury. You get there and find a female in her 50s who is alert, bright and ‘looks in pain!’ You examine her ankle by cutting away her trousers and taking her shoe and sock off, knowing how important it is to expose the whole area.

When you see the ankle, it is a query closed fracture and the foot is not in a correct anatomical position (the foot is pointing the wrong way and looks dislocated). The foot is white and after checking both the dorsalis pedis and the posterior tibial pulses, you cannot feel a distal pulse. The foot is also cold (although its always freezing outside in Scotland) & the capillary refill is slow.

 Ok, so not quite an old lady.....but 'ouch'!  And those socks look expensive!

Ok, so not quite an old lady.....but 'ouch'!  And those socks look expensive!

 
 Posterior Tibial Pulse

Posterior Tibial Pulse

 Dorsalis Pedis Pulse

Dorsalis Pedis Pulse

This is Limb Threatening!

So what are you going to do?

 

Considerations:

  • Pain relief
     
  • Manipulation of the joint back to normal anatomical position & restore distal pulse
     
  • Splint
     
  • Pre-alert to hospital
     
  • Make the patient as comfortable as possible with an emphasis on pain relief, and transport urgently to hospital.
Hannah Bell