When do you need fracture surgery?

Fractures are usually accompanied by injuries to other parts of the body. In the whole process of treatment, patients must be treated as a whole.

Order of Priority

• Save lives

• Save limbs

• Save joints

• Reconstruction function

  
  

Emergency surgery: treatment principles of vascular injury, open fracture and closed fracture.

• Open reduction and internal fixation as early as possible (within 6h)

• 48h

• 3 ~ 7d: It will increase the occurrence of ARDS and other complications.

• 7 ~ 10d: Endocrine reaction decreased [swelling subsided, inflammation disappeared]

• More than 2 weeks: the difficulty of operation increases and the postoperative function decreases.

Collarbone fracture

• When the fracture block injures subclavian artery, vein and brachial plexus, it is agreed that it is a serious complication and should be operated immediately.

Proximal humeral fracture

• When the elastic return occurs after manual reduction-the tendon of biceps longus, when the symptoms of axillary nerve appear.

Fracture of humeral shaft

• Once the symptoms of radial nerve injury are found in physical examination, the operation will be performed immediately.

Distal humeral fracture

• This kind of fracture may cause any nerve or blood vessel injury that passes through the elbow joint. 

• The laceration of blood vessels is rare, but there may be tension or compression. 

• Fascial space syndrome-immediate incision and decompression.

Injury of olecranon, radial head and complex elbow joint

• Complete the operation within a week.

• 1 ~ 2 weeks operation taboo time-myositis ossificans.

• Surgery in 2 weeks.

  
  

Double forearm fracture

• Or open fracture should be operated within 6 ~ 8h after injury.

• Delayed operation may increase the risk of bone bridge formation between ulna and radius.

Distal radius fracture

• When the physical examination found that the extensor pollicis longus tendon injury and median nerve compression symptoms appeared-immediate surgery.

Hand fracture

• Early reduction and internal fixation are emphasized for both open and closed fractures, especially for those complicated with vascular, nerve or tendon injuries, surgery should be performed immediately.

  
  

Pelvic fracture

• Pelvic fractures are often combined with fractures in other parts, which will lead to hemodynamic instability.

  
  

• Treatment mode of complex pelvic fracture: 30min, 3 decisions

• Immediate surgical exploration to stop bleeding

• Pelvic fixation (C-shaped forceps or external fixator) is completed in 10 ~ 15min.

• After observing for 10 ~ 15min, the patient still has hemodynamic instability-operation.

• For patients with stable hemodynamics, the operation should be performed within 7 days, or 7 ~ 14 days.

Proximal femoral fracture-intertrochanteric fracture

• Once the patient's general condition is under control, internal fixation, DHS, DCS and PFN, should be performed.

Proximal femoral fracture-femoral neck fracture

• Femoral neck fracture, especially intracapsular fracture, can endanger the blood supply of femoral head, so it is necessary to open reduction and internal fixation as soon as possible.

• Internal fixation: < 65 years old

• Joint replacement: > 65 years old

• If emergency surgery is not possible, joint puncture and aspiration of intra-articular hematoma can be performed, and the hip joint can be kept in semi-flexion and external rotation posture.

Distal femoral fracture

• Patients with severe soft tissue injuries, open fractures, or difficulties in early operation-Super-articular external fixator.

• Immediate surgical treatment of isolated injury-—DCS, retrograde intramedullary nail.

  
  

  

Patella Fracture

• The patient's general condition is stable, and the local skin conditions permit, the operation should be performed immediately.

Proximal tibial fracture

• Determine the nature of injury violence

• High energy injury is often accompanied by severe soft tissue injury. It is characterized by limb swelling, blistering, skin abrasion and skin laceration. The operation should be postponed at this time. At the same time, fascial space syndrome and vascular and nerve injuries must be excluded.

Tibial shaft fracture

• The particularity of anatomy-the importance of soft tissue coverage.

• Early stage: within 8h

• External fixator is considered as the first choice for early treatment.

• Gypsum support

• Calcaneal traction

• Phase II: about 2 weeks.

• There was no obvious systemic infection and acute trauma.

• No swelling or exudation of the wound.

• Blister is dry, swelling subsides and bony markers can be touched.

• Wrinkled skin, skin lines appear.

Fracture of distal tibia (pilon)

The treatment result of Pilon fracture depends on the quality of joint reconstruction and the condition of soft tissue coverage.

The best time for surgery depends on the condition of soft tissue:

• Early stage: the operation was performed within 6 ~ 8h, which lasted 2 ~ 3h.

• Delay: 7 ~ 10 days, swelling disappeared and skin wrinkles appeared.

Four traditional principles that must be followed in one-stage surgical reconstruction:

• Reconstruction of fibula

• Reconstruction of tibial articular surface

• Bone grafting

• Support of bone plate

Ankle fracture

• Ankle fracture is intra-articular fracture.

• The purpose of treatment is to restore the normal anatomical structure of joints.

• The timing of surgery depends on the state of soft tissue.

• The ideal time for surgery is before edema and blisters appear in the fracture area.

Foot fracture

• It is the footstone for people to stand and walk. Restoring the normal anatomical structure of the foot plays a vital role in people's standing and walking.

• As with ankle fractures, the timing of surgery depends on the degree and state of soft tissue swelling.

Spinal fracture

• If the whole body is stable, the displaced fracture should be operated immediately if there are neurological symptoms.

  
  

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