Fractures and Dislocations: Principles of Management for PLAB 1
This module covers the fundamental principles of managing fractures and dislocations, crucial for the PLAB 1 exam. Understanding these concepts ensures you can effectively assess, diagnose, and initiate appropriate management plans for patients presenting with these injuries.
Understanding Fractures
A fracture is a break in the continuity of bone. The management principles aim to restore alignment, achieve stability, promote healing, and regain function. Key considerations include the type of fracture, location, patient factors, and associated injuries.
Understanding Dislocations
A dislocation occurs when the articular surfaces of a joint are completely separated. Like fractures, management focuses on restoring joint congruity, stabilizing the joint, and facilitating functional recovery.
Key Management Principles & Considerations
| Principle | Fracture Management | Dislocation Management |
|---|---|---|
| Initial Assessment | History, examination (deformity, swelling, pain, neurovascular status), imaging (X-ray) | History, examination (deformity, pain, inability to move, neurovascular status), imaging (X-ray) |
| Reduction | Closed or open, to restore alignment | Closed or open, to restore joint congruity |
| Immobilization | Casts, splints, traction, internal/external fixation | Splints, braces, slings, sometimes surgical fixation for associated injuries |
| Pain Management | Analgesics, nerve blocks | Analgesics, nerve blocks |
| Rehabilitation | Physiotherapy, gradual return to function | Physiotherapy, focus on stability and proprioception |
| Complications | Non-union, malunion, infection, nerve/vessel damage, compartment syndrome | Recurrent dislocation, joint stiffness, nerve/vessel damage, osteoarthritis |
Specific Considerations for PLAB 1
For the PLAB 1 exam, focus on recognizing common fractures and dislocations, understanding the immediate management steps, and identifying potential red flags. Be prepared to discuss the principles of reduction, immobilization techniques, and the importance of neurovascular assessment.
Always prioritize a thorough neurovascular assessment before and after any manipulation or reduction. Compromised circulation or nerve function can turn a manageable injury into a limb-threatening emergency.
Reduction, immobilization, and rehabilitation.
To perform a prompt reduction of the displaced joint.
UK Guidelines and Professional Standards
While specific UK guidelines for every fracture and dislocation are extensive, the core principles align with international best practices. The emphasis is on evidence-based medicine, patient safety, and timely, appropriate care. Familiarize yourself with the general approach to trauma management as outlined by NHS England and other relevant bodies. This includes principles of ATLS (Advanced Trauma Life Support) where applicable for polytrauma patients.
The process of bone healing involves several stages: inflammation, soft callus formation, hard callus formation, and bone remodeling. Understanding these stages helps in appreciating the rationale behind immobilization periods and the importance of avoiding premature stress on the healing bone. The inflammatory phase involves bleeding and the formation of a hematoma. The soft callus phase sees the formation of fibrocartilage, bridging the fracture gap. The hard callus phase involves the conversion of soft callus to woven bone. Finally, bone remodeling reshapes the bone to its original form.
Text-based content
Library pages focus on text content
Learning Resources
A comprehensive overview of the fundamental principles guiding fracture management, covering reduction, immobilization, and fixation methods.
Official guidance from NHS England on trauma care, providing a framework for managing acute injuries, including fractures and dislocations.
Access to various surgical guidelines, including those relevant to orthopaedics and trauma, from a leading professional body.
A patient-facing resource that explains fractures in clear terms, useful for understanding the patient's perspective and common symptoms.
Provides accessible information on dislocations, their causes, symptoms, and initial management from a patient's viewpoint.
A detailed medical overview of fracture management, including diagnosis, treatment options, and complications, aimed at healthcare professionals.
An in-depth medical resource covering the management of dislocations, including reduction techniques and post-reduction care.
A clear and concise video explaining the fundamental principles of fracture management with visual aids.
An educational video detailing the core principles and steps involved in managing joint dislocations.
BMJ Learning offers modules on various medical topics, including orthopaedics and trauma, which can provide structured learning on fracture and dislocation management.