Johns Hopkins Orthopaedic Surgery
Division of Trauma Surgery
General Treatments for Trauma
Generally applied to decrease movement, to provide support and comfort through stabilization of an injury. In the emergency department, splints are primarily used to stabilize non emergent injuries to bones until the patient can be evaluated by a consultant such as an orthopedic surgeon, at which time definitive casting can be performed.
Principle is similar to a splint, however the extremity is fully wrapped in the dressing and splint. This is usually applied for a non- operative treatment, i.e. certain types of distal radius fractures (wrist fracture).
Sugar Tong Splint
A special type of splint used to temporary stabilize distal radius fractures until surgery or for the first 2-3 weeks in case of a non operative treatment. Last, the splint will be changed to a cast for final treatment.
An External Fixator is a method of immobilizing bones to allow a fracture to heal. External fixation is accomplished by placing pins or screws into the bone on both sides of the fracture. The pins are then secured together outside the skin with clamps and rods. The clamps and rods are known as the "external frame."
An external fixation is usually used when internal fixation is contraindicated- often to treat open fractures, or as a temporary solution.
Installation of the external fixator is performed in an operating room, normally under general anesthesia.
Intramedullary Nail or Rod
An IM Nail is inserted in the bone at one or both ends of this. The nail is than blocked at each end with screws inserted from the side of the limb, through the bone and the nail. If part of the bone has been lost because of the fracture, the surgeon may opt for a bone graft to keep healing on track.
Bone graft is a bone substitute needed to fill area of bone loss, that will either be taken from the patient’s own bone (autograft) or from a donor (allograft).
Open Reduction and Internal Fixation (ORIF)
Open reduction internal fixation is a two-part surgery.
First, an incision (cut) is made over the fracture. This enables the surgeon to put the bone back into place (reduced). Once the bone has been reduced anatomically, screws, pins, plates or rods are attached to stabilize it and to hold the broken parts together. Often large bones like the thigh bone (femur) are fixed with the insertion of an IM Nail through the center of the bone to hold the pieces in place.
When a person has an injured arm or leg, bleeding and swelling can occur inside the muscles. This causes pressure on the muscles, nerves, and blood vessels. This pressure can further harm or kill the muscles. It is very important to lower the pressure in the muscle. If the pressure is not relieved the limb may need to be removed.
What are the dangers?
Swelling or infection can injure the arm or leg. Infection in the bone is very serious and can take months to heal.
What is the treatment for compartment syndrome?
The nursing staff will be checking the limb to see if pain is getting worse and if swelling is shutting down the blood flow.
Surgery will be done to open the muscles and allow the pressure to be released. A bandage will cover the open wounds until the swelling goes away. If the bone is broken a plaster brace called a splint may be used for support. Pain relief medication will be used to help with pain.
Usually the swelling goes down in a few days. The skin over the wounds will be stitched closed. It may take more than one surgery to close the wound.