Resetting compound fractures

[hawaiian126]

Hi
a quick question and I know that it is very dependent on the situation, but in the case of a compound fracture is it necessary to reset the bone.
I would rather wait for emergency personnel but like when I was hiking yesterday and the guy slipped off the side into a ravine, best to control the bleeding and not reset it. But if help isnt coming for quite a while say 6 hours to a day or more , should it be reset and splinted?
Thanks Guys

[Hmac]

Control bleeding, dress it, splint it (just to immobilize if no one is coming for awhile). Don't reset it. Leave it alone.

[Dead Man]

I don't see how re-setting it could be beneficial in any way, even if rescue is a long ways off, or even non-existent. You can't improve upon a compound fracture in the field. It would be unimaginably painful and could quite possibly do a lot more damage than good- severing more/more important blood vessels, further splintering the bone, enlarging the wound, etc. Control the bleeding as best as possible, immobilize as best as possible, and do what has to be done.

[BruceLeroy]

Sam splint guaze and some ace wraps will fix almost anything. There is almost no need for most of the high dollar stuff in most situations. These items are the 550 c8rd and duct tape of the medic world. And dont forget training and practice! I would not reset anything! Too much liability and you most likely cant maintain traction.

[Hmac]

Infection is the worry, not fracture reduction. Aligning the bones can happen anytime in the first two weeks. Leave that to the professionals. The patient's going to he OR anyway.

[Ttwwaack]

As the previous posters have stated. Control bleeding, immobilize, treat for shock, cold packs and check below the Injury for a pulse. Due to the nature of the of compound fractures, they general require an open reduction to glue the puzzle pieces/fragments together with plates, screws, pins and mesh.

I wish I still had access to my xrays of my left forearm I broke in three places. Within 20 minutes, my left arm was 4" shorter than my right from just muscle contraction. The swelling wasn't bad but the pain from the splinters grinding around inside even after be splinted would test you. The bleeding wasn't bad but it was fresh bone that poked through and I was worried about infection.

[ST911]

Infection is the worry, not fracture reduction. Aligning the bones can happen anytime in the first two weeks. Leave that to the professionals. The patient's going to he OR anyway.

Control bleeding, dress it, splint it (just to immobilize if no one is coming for awhile). Don't reset it. Leave it alone.

Me thinks Hmac is an SME on this one.

My own experience with open fractures echoes the above. Adding... The amount of pain and bleeding depends on the structures involved. A recent one didn't bleed much, nor did the patient experience much pain until later. Except for the emotional response, you might even have found it downright underwhelming.

[Sensei]

I agree with all of the recommendations. However, there is one instance where an attempt at reduction is reasonable even by a layperson:

If the extremity is pulseless AND definitive treatment is more than a few hours away, a single attempt at reduction via gentle traction to restore anatomical alignment is not unreasonable. The goal is to restore blood flow and nothing else at that point. This goes for open or closed fractures where circulation is compromised. Once aligned, the extremity should be splinted. If pulses are not restored with this single attempt, do not try again - just splint it and get them to a hospital

I am repeating for emphasis that this should only be done when access to care is going to be significantly delayed.

[Caduceus]

Hi
a quick question and I know that it is very dependent on the situation, but in the case of a compound fracture is it necessary to reset the bone.
I would rather wait for emergency personnel but like when I was hiking yesterday and the guy slipped off the side into a ravine, best to control the bleeding and not reset it. But if help isnt coming for quite a while say 6 hours to a day or more , should it be reset and splinted?
Thanks Guys

Leave it. Infection alone can be a killer, not to mention pain, tearing up more tissue, etc. You can realign a bit if needed to get onto a stretcher or something, but just let the orthopod do what s/he gets paid to do.

[Arctic1]

It was my understanding that resetting the fracture is supposed to relieve pain and that, along with re-establishing a distal pulse, are the reasons for resetting a fracture. Not realignment of the bones.

Although in our current protocol it is not an injury to focus on, unless it is the sole injury or we need to care for the pt over an extended period of time, we are taught how to reset fractures and to splint/fix them. Although personally I would be very catious if I was resetting a fracture without a dedicated piece of equipment. Ideally I would have either a Kendrick splint or a Vacuum Splint available.

Only ever dealt with a closed ankle fracture myself, although I did not know it at the time. Treated it as a fracture, as the pt presented with swelling, discoloration, severe pain and reduced function. Splinted it and evac'd to the doctors office. They established it to be a fracture, sent him to hospital where x-rays showed it to be extremely complicated, resulting in the pt being dismissed from his conscript service after the surgery.