Closed fractures

By Tedler D. Depaynos, MD

“ In retrospect, it was a pole climbing contest that the patient participated in. In their line of work, when they do climbing safe precautions were always done. “

The male patient was used to climbing high poles so that it was surprising when he suddenly fell down when he was on top. The height was around 35 feet and luckily he landed on the right side of his body and not on his head or else the funeral parlor would have been called.
At the Emergency Room where he was rushed, he was observed to have swelling and deformity but no open wounds of his right thigh and right upper arm. There was a slight contusion and rugged lacerations on his forhead and from his companions he had minutes of loss of consciousness before he was rushed to the hospital. Although there was no clinical cerebral dysfunction, a routine CT Scan of the head was done because accidents like this may have no obvious manifestations initially. It is always best to know the damage before any significant manifestations are observed. The CT Scan only revealed small and slightly depressed fractures but the trauma must also be severe which may cause brain swelling manifested by headaches later on.
The appearance of the patient’s right upper and lower extremities implied close fractures and these were confirmed by plain x-rays. The fractures were complete transverse ones and the segments were over riding. An Orthopedic Surgeon was called and the x-ray pictures were sent to him just by the use of the cell phone. He then relayed instructions for the initial management of the injuries.
Since there were over riding of the segments, traction was then applied separately on both involved extremities to reduce them. Besides, because of the severe swelling surgery would be done after a few days.
There was a time when close reduction was the routine and the injured extremity was immobilized with a plaster cast or “cement”. Healing may last for 3 months so that immobilization will be that long. Non-use of the extremity may cause atrophy. Nowadays, open reduction is usually done and the fractured segments are immobilized with a non-eroding “titanium” metal inserted inside the bone marrow. The procedure is called “open reduction with internal fixation” or ORIF in short. Although the fracture will heal the usual time early use of the extremity is possible and rehabilitation exercises could be done immediately after surgery to prevent atrophy or fibrosis of the tissues around the fracture site which would limit movement in the future. Of course, the types and sites of fractures would make the Orthopedic Surgeon decide the best and final management.
In this patient, ORIF was done on both his fractured extremities and his recovery was uneventful.
In retrospect, it was a pole climbing contest that the patient participated in. In their line of work, when they do climbing safe precautions were always done. In this incident, it was a pole climbing contest. The participants were all used to this exercise and because of this, the usual safety precautions were not implemented. It was then a very painful and expensive lesson to the organizers.

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