Blog Post by Swati Gupta, ACCS Trainee

As enthusiastic emergency department clinicians, it is sometimes harder not to do anything than to actively manipulate fractures or refer them to our orthopaedic colleagues. Outlined below are four commonly conservatively managed fractures, some important things for us to know about these injuries and what to let our patients know.


Question 1 – Proximal Humerus

There is a break, is it through the surgical neck or the anatomical neck of humerus? Why is this important and how are you going to treat it?

Figure 1 humerus

Image sourced from http://commons.wikimedia.org/wiki/File:Surgical_neck_fracture_of_humerus.jpg9

What does this x-ray show?
Surgical neck fracture
Anatomical neck fracture
ED Care

Question 2 – Sacrum

Spot the fracture….

figure 2 sacrum

Figure 2 from (http://int-prop.lf2.cuni.cz/heart_sounds/ekg3/sacral1.jpg)

What does this x-ray show?
Are fractures of this section of the spine too low to result in serious neurological compromise?

Question 3 – Rib fracture

Figure 3

Image sourced from http://radiopaedia.org/cases/pneumothorax-due-to-rib-fractures-1

When should you request a chest x-ray for a patient with suspected rib fracture?
Rib fracture management
Discharge advice


Question 4 – 5th metatarsal fracture

image sourced from http://radiopaedia.org/articles/fractures-of-the-proximal-fifth-metatarsal

Which fracture zone is conservatively managed?

Summary

These fracture patterns are common and are normally managed conservatively. It is important not to miss similar fractures which may need operative management or associated neurovascular injuries. As with everything in Emergency Medicine if you are unsure please discuss with a senior doctor.

 


About the Author:
  • Dr Swati Gupta is an ACCS Anaesthetic trainee working in the South West of England.
  • Post edited and reviewed by Dr Thomas Mitchell, ED Consultant
Tom Mitchell
Author: Tom Mitchell

Emergency Medicine Consultant UK