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Orthopedic Fractures and Car Crashes

Fractures are a common complication of car crashes. This is because forces are strong enough in a car crash to break bones, even if the patient is properly restrained in the vehicle, although more fractures occur in unrestrained passengers and drivers. The types of fractures sustained depend on the nature of the forces involved in the accident.

In lateral fractures, the frame of the car can buckle inward at any level, resulting in fractures near the side of the car. There can be ankle fractures, tibial and fibular fractures, hip fractures, pelvic fractures, rib fractures, spine fractures and even skull fractures, depending on the differential sizes of the vehicles involved.

Front end fractures happen with great force. If the victims leg is outstretched at the time of the collision, the fractures can be anywhere from the toes to the pelvis. If the arm is outstretched, there can be hand fractures, ulna and radius fractures, femur fractures or scapular fractures. Often more than one area is fractured.

A person who is ejected from the vehicle is especially prone to getting a skull or C spine fracture. This is because they are usually ejected head first. Fractures from just about any bone, including the entire spine, pelvic and hip bones are possible in an ejected individual.

When the person enters the emergency room after a car crash, the doctor or nurse must first do a primary survey to make sure the patient’s cardiorespiratory tract is intact. Then a secondary survey is done to look at areas of pain for the possibility of other fractures. Bleeding and nerve function are looked at as well.

The patient in a car accident usually needs C spine films to make sure they don’t have a fractured cervical spine. If this is normal, other suspicious areas for fracture, such as the vertebrae, pelvis and extremities are looked at by x-ray to see if any of these areas are fractured.

If a fracture is located, doctors need to find out if it is displaced or in place. For rib fractures, the doctor needs to look for the possibility of a punctured lung or perhaps a punctured liver or spleen. For skull fractures, a thorough neurological exam needs to be done and a CT scan of the head may be done to make sure there isn’t bleeding within the brain. With any fracture, a neurological exam needs to be done to make sure the fracture didn’t damage a peripheral nerve. Peripheral nerve injury can lead to serious later complications with numbness and lack of function of an area of the body.

Fractures of the body from an accident injury need to be treated in order of severity. The most severe fractures are those causing excessive bleeding, nerve damage or are open fractures with a high likelihood of infection. Those fractures that need surgical intervention are then handled, usually all at the same time, if possible. Plates, screws and rods are used to connect the broken fragments of bone.

Closed fractures that can be treated with casting are treated last. These are usually minimally displaced and can be casted after the open fractures and severe fractures are treated.

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