A few days later the patient is seen in the fracture clinic, the part is often X-rayed (to check that there has been no movement) and a full cast is applied. The usual technique is to apply a back slab, held in place by crepe bandages.The trauma of a fracture is usually associated with local swelling and so a full cast must be avoided initially, as the swelling may impede the circulation and can produce ischaemic contractures.The treatment of a fracture involves immobilisation and the general principle is that the joint above and the joint below the fracture should both be immobilised.This is more likely to be required if there is both a fracture and a dislocation. If it is not possible to achieve satisfactory reduction of a fracture, with or without dislocation, then operative treatment is required. The method of reduction varies depending on the fracture.This should be performed by healthcare professionals trained in the technique, not necessarily anaesthetists. Intravenous regional anaesthesia (Bier's block) should be considered when reducing dorsally displaced distal radius fractures in adults (16 or over) in the emergency department.A novel technique, which avoids the risks of local anaesthetic leakage or excess sedation, is the proximal periosteal block.They concluded that there was inadequate evidence of robust quality to make an adequate comparison of the various techniques. However, haematoma block is quicker, easier to perform and less intensive on resources. All methods were effective but regional block was probably more effective than haematoma block. It also looked at associated physical techniques and drug adjuncts used for the management of distal radial fractures in adults. A Cochrane review examined the main methods of anaesthesia: haematoma block, intravenous regional anaesthesia (IVRA), regional nerve blocks, conscious sedation (also known as 'moderate sedation/analgesia') and general anaesthesia.It is also necessary to wait until at least four hours after anything was taken by mouth. General anaesthesia is effective but even a brief anaesthetic has risks, especially in the elderly or those with medical problems.Manipulation of broken bones is very painful some form of anaesthesia is required.In older people the cosmetic result may be subservient to the need for a good functional result. Displacement of fractures, dislocation or subluxation must be reduced.If there is neurovascular compromise, urgent fracture reduction may be needed.Provide analgesia whilst waiting for X-ray.Assess for deformity and examine for any skin defects that might lead to a diagnosis of a compound fracture.
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