Principles of management

Primary aim - healing with preservation of function. Stages:

• resuscitation - ATLS - airway, breathing, circulation, disability, exposure
• reduction - restore the anatomy, relieve pressure on surrounding nerves, vessels, muscle
• stabilisation - hold the reduced fracture
• rehabilitation - restore function

Assume all open fractures are contaminated and prevent progress to infection.

There is evidence that multiply-injured patients with limb fractures have a reduced mortality rate if these are dealt with at the time of admission rather than after a delay in order to stabilise cardiorespiratory function.