Fracture/Dislocation

Fracture/Dislocation (CPG A0805)

Stop

Prioritise pelvic splinting if either
- Suspected fracture, or
- Inadequate perfusion or altered consciousness secondary to possible pelvic injury

Assessment

Mx possible rib fractures as per CPG A0802
If a limb is injured, assess neurovascular status
- Altered sensation, loss of a pulse or cold/dusky skin in a limb distal to a fracture or dislocation are
  indicators of neurological or vascular compromise, which constitutes a limb threatening injury and is
  time critical.

Action

If fracture with neurovascular compromise present, Mx pain as per CPG A0501 and reduce the fracture:
- Provide procedural analgesia as per CPG A0501 Pain Relief
- Irrigate with 500 mL – 1 L of N/Saline prior to reduction if the fracture is compound.
- Apply traction and gentle counter-traction in the line of the limb.
- If required, further manipulation should be done whilst the limb is still under traction.
- Splint the limb once reduced
The general principles of relocating a dislocation are:
- Provide procedural analgesia as per CPG A0501 Pain Relief
- Apply sustained traction in the longitudinal direction away from the joint.
- Have an assistant providing counter-traction above the site of injury.
After reducing a fracture ongoing analgesia is likely to be required, as the pain will persist beyond the
fracture being reduced and splinted. Opioids are indicated for most fractures.

Notes

Pelvic splint and CT-6 can be applied together, but the pelvic splint is the priority
Dislocations with neurovascular compromise within 15 mins transport time should be urgently transported
Dislocations with neurovascular compromise >15 mins transport time consult with receiving hospital and consider relocation on scene

Flow Chart