Management of fractures mnemonic

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Resuscitation
Reduction
Restriction
Rehabilitation

 Eg. A 28 y/o man arrives in ED after a motorbike accident with a fractured tibia and fibula.

1) resuscitate according to ATLS guidelines. Examine limb for neurovascular deficit once patient resuscitated. X rays with 2 views.

2) Reduction - may be closed reduction by manually pulling distal fragment to line up bone under sedation or anaesthesia, or open reduction where pins and plates are put in. Depends on type of fracture etc. Open fractures are managed differently to closed fractures.

3) Restriction - eg. using plaster of paris, External fixation, internal fixation with plates/pins etc. again dependent on injury.

4) Rehab - Encouraging mobilisation, physiotherapy, occupational therapy to help adapt environment etc.

References:
Gosling A, Stansby G, Surgical Talk- Surgery for Finals , London, Imperial College Press, 2004

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