11.3 Fractures, Compartment Syndrome, Traction

Question 1

Accidental vs Abusive Injuries

Answer 1

• Children under 2 are at highest risk of abuse
• Abuse tends to happen on the weekday and during the winter (due to wearing long clothes)

Look out for the 5 B’s
- Bumps
- Bruises
- Breaks (femur/humerus)
- Burns
- (Accidents in the Bathroom)

Question 2

Fractures

Answer 2

• Compound (Open fractures)
• Simple (Closed fractures)

S/S
- Swelling, pain, bruising
- Deformity and diminished function of affected extremity

• ANYTIME A PATIENT IS IN A CAST, THEY CAN DEVELOP COMPARTMENT SYNDROME WHICH IS A SEVERE COMPLICATION

Question 3

Compartment Syndrome

Answer 3

• Occurs when nerves, blood vessels and muscle are compressed inside a closed space. (Typically seen if too much pressure is put on internal structures when a cast is placed)
• Can cause tissue necrosis
• EMERGENCY

6 P’s
- Pain
- Pressure (feelings of tenseness underneath cast)
- Pulselessness
- Pallor
- Paresthesia
- Paralysis (decrease in movement distal to fracture)

Nursing Interventions
- Neurovascular check anytime a cast is placed

Question 4

Nursing Care for Cast

Answer 4

• Neurovascular checks every 2 hours
• Promote mobility as much as possible to prevent loss of muscle, bone demineralization, loss of joint mobility, DVT, PE, metabolic/renal caliculi (from bone demineralization), isolation.

Nursing Interventions
- Maintain proper alignment of extremity
- Elevate extremity
- Reduce swelling
- Pain control

Education
- Teach parents of infection (hot spots or smelly areas)
- Do not place objects into cast
- Educate that the material of the cast may feel warm as it’s drying (normal)

Question 5

Traction

Answer 5

• Applied after a very severe/complex injury to allow stability and alignment of bone.
• Reduces muscle spasms, position bone ends together, helps immobilize a fracture until they realign.

Types of Traction
- Manual Traction - Hands placed distally to the fracture (used for closed reduction)
- Skin Traction - Adhesive bandages are applied to the skin that pulls in opposing directions (Buck’s Traction used for Calve or Russel Traction)
- Skeletal Traction - Pins or wires are applied to a skeletal structure (Halo vest/brace)

• Weights applied to pull bone/skin to allow for realignment

Question 6

Nursing Intervention for Traction

Answer 6

• Nurses are responsible for making sure the traction remains stable and does not move.

NEVER
- Release a patient’s traction
- Lift the weights of the traction
- Do not allow lines to get tangled

Interventions
T - Temperature (infection)
R - Ropes hang freely
A - Alignment
C - Circulation check (5 P’s)
T - Type and location of fracture
I - Increase fluid intake
O - Overhead Trapeze
N - No weights on bed or floor