General principles of acute fracture management
- Richard Derby, MD
Richard Derby, MD
- Faculty Teaching Physician
- Assistant Professor of Family Medicine
- St. Louis University Family Medicine Residency Program
- Anthony Beutler, MD
Anthony Beutler, MD
- Associate Professor of Family Medicine
- Uniformed Services University
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Patients with suspected fractures require urgent and sometimes emergent evaluation to determine if serious complicating conditions exist. Such conditions, including any neurovascular injury, often require immediate surgical consultation [1,2]. Nevertheless, many fractures are uncomplicated and can be managed effectively in a non-surgical setting.
The acute management of uncomplicated fractures is reviewed below and involves the following steps:
●Initial clinical assessment
- Eiff PM, Hatch RL. Fracture Management for Primary Care, 3rd, WB Saunders, Philadelphia 2011.
- DeLee JC, Drez D Jr. DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice, 3rd, WB Saunders, Philadelphia 2010.
- Sprague S, Madden K, Dosanjh S, et al. Intimate partner violence and musculoskeletal injury: bridging the knowledge gap in orthopaedic fracture clinics. BMC Musculoskelet Disord 2013; 14:23.
- Wu V, Huff H, Bhandari M. Pattern of physical injury associated with intimate partner violence in women presenting to the emergency department: a systematic review and meta-analysis. Trauma Violence Abuse 2010; 11:71.
- PRAISE Investigators, Sprague S, Bhandari M, et al. Prevalence of abuse and intimate partner violence surgical evaluation (PRAISE) in orthopaedic fracture clinics: a multinational prevalence study. Lancet 2013; 382:866.
- Benjamin, HJ, Hang, BT. Common acute upper extremity injuries in sports. Clin Ped Emerg Med 2007; 8:15.
- Malanga GA, Ramirez-Del Toro JA. Common injuries of the foot and ankle in the child and adolescent athlete. Phys Med Rehabil Clin N Am 2008; 19:347.
- Ahn JM, El-Khoury GY. Occult fractures of extremities. Radiol Clin North Am 2007; 45:561.
- Joshi N, Lira A, Mehta N, et al. Diagnostic accuracy of history, physical examination, and bedside ultrasound for diagnosis of extremity fractures in the emergency department: a systematic review. Acad Emerg Med 2013; 20:1.
- Chan SS. Emergency bedside ultrasound for the diagnosis of rib fractures. Am J Emerg Med 2009; 27:617.
- Douma-den Hamer D, Blanker MH, Edens MA, et al. Ultrasound for Distal Forearm Fracture: A Systematic Review and Diagnostic Meta-Analysis. PLoS One 2016; 11:e0155659.
- Tuzun HY, Turkkan S, Arsenishvili A. The effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures: Contribution for management of metacarpal fractures. Am J Emerg Med 2016; 34:674.
- Aksay E, Kilic TY, Yesılaras M, et al. Accuracy of bedside ultrasonography for the diagnosis of finger fractures. Am J Emerg Med 2016; 34:809.
- Newton EJ, Love J. Acute complications of extremity trauma. Emerg Med Clin North Am 2007; 25:751.
- Mazzola TJ. Splint and casting. In: The Sports Medicine Resouce Manual, Seidenberg PS, Beutler AI (Eds), WB Saunders, Philadelphia 2007. p.152.
- Black KJ, Bevan CA, Murphy NG, Howard JJ. Nerve blocks for initial pain management of femoral fractures in children. Cochrane Database Syst Rev 2013; :CD009587.
- Choi JJ, Lin E, Gadsden J. Regional anesthesia for trauma outside the operating theatre. Curr Opin Anaesthesiol 2013; 26:495.