classification of fractures 2

Question 1

Expected healing time is appropriate but unsatisfactory alignment of bone results in external deformity and dysfunction

Answer 1

Malunion

Question 2

Failure of a fracture to heal in the expected time
The bone usually heals eventually; it may just be
slower

Answer 2

Delayed Union

Question 3

Occurs when a fracture never heals

Answer 3

Nonunion

Question 4

Treatment Nonunion

Answer 4

Osteogenic method: implantation of bone grafts
Osteoconductive methods: synthetic materials to provide a matrix for bone growth
Osteoinduction: substances such as platelet-derived growth factor
Electric stimulation
Internal or external; up to 10 hours a day for 3-6 months
Time consuming but can prevent further surgery and bone grafts

Question 5

Weight-bearing joints are most vulnerable to posttraumatic arthritis
Excessive stress and strain on the joint or fracture must be avoided to reduce the risk of this complication
Can be a result of nonunion of a fracture

Answer 5

Post-Traumatic Arthritis

Question 6

A variety of factors can interfere with blood supply after a
bone injury
Once bone cells are deprived of oxygen and nutrients,
they die (necrosis) and their cell walls collapse

Answer 6

Avascular Necrosis

Question 7

Signs and symptom

Avascular Necrosis

Answer 7

Pain, instability, and decreased function in the

affected area

Question 8

Treatment

Avascular Necrosis

Answer 8

Relief of weight bearing and removal of part of the bone to decrease pressure
If conservative measures fail, surgical procedures may be recommended
Sometimes amputation is necessary

Question 9

Precipitated by a fracture or other trauma

Answer 9

Complex Regional Pain Syndrome Type 1 (CRPS—Type 1)

Question 10

Symptoms

Complex Regional Pain Syndrome Type 1 (CRPS—Type 1)

Answer 10

Severe pain at the injury site despite no detectable nerve damage (Type 2 has detectable nerve damage), edema, muscle spasm, stiffness, vasospasms, increased sweating, atrophy, contractions, and loss of bone mass
Symptoms persist longer than expected with the type of injury suffered

Question 11

Treatment

Complex Regional Pain Syndrome Type 1 (CRPS—Type 1)

Answer 11

Nerve blocks, physical therapy, transcutaneous electrical stimulation, and analgesics, muscle relaxants, and antidepressants

Question 12

Signs and Symptoms of a Fracture

Answer 12

Depend on type and location of the break

Some fractures have so few manifestations that they can be detected only with x-ray

Signs and symptoms are swelling, bruising, pain, tenderness, loss of normal function, abnormal position, and decreased mobility

Question 13

Signs and symptoms of a fracture on pg 1076

Answer 13

pain, loss of function, deformity, false motion (untatural motion), creptus( grating sound of bone ends moving over each other) edema, spasm

Question 14

Detect small bone fractures or fractures caused by stress or disease

Answer 14

Bone scan

Question 15

Detect fractures of complex structures, such as the hip and pelvis, or compression fractures of the spine

Answer 15

Computed tomography (CT)

Question 16

Reveal bone disruption, deformity, or malignancy

Answer 16

Standard radiographs

Question 17

The process of bringing the ends of the broken bone into proper alignment and maintaining alignment

Answer 17

Reduction

Question 18

Closed Reduction or Manipulation

Answer 18

Nonsurgical realignment that returns bones to their previous
anatomic position

No surgical incision is made; however, general or local
anesthesia is given

By using traction, manual pressure, or a combination

After reduction of a fracture, x-ray taken and a cast usually
applied

Question 19

Open Reduction

Answer 19

A surgical procedure in which an incision is made at the fracture site

Usually for open (compound) or comminuted (bone broken or crush into small pieces) fractures to clean the area of fragments and debris

Question 20

An attempt to attach the fragments of the broken bone together when reduction alone is not feasible because of the type and extent of the break

Answer 20

Fixation

Question 21

Internal Fixation (ORIF)

Answer 21

Done during open reduction surgical procedure
Rods, pins, nails, screws, or metal plates used to align bone fragments and keep them in place for healing
Promotes early mobilization; preferred for older adults who have brittle bones that may not heal properly, or who may suffer the consequences of immobility

Question 22

External Fixation

Answer 22

Pins are inserted into the bone, above and below fracture
Pins are then attached to an external frame and adjusted to align the bone
If there is soft tissue damage or infection, external fixation allows access to the site and facilitates wound care
Pin care is extremely important to prevent the migration of organisms along the pin from the skin to the bone
Patients should be taught to do their own pin care and to recognize signs of infection

Question 23

Fracture of the Hip

medical treatment

Answer 23

Traction and surgical repair (internal fixation, femoral head replacement, or total hip replacement)
Patients may begin physical therapy as early as 1 day after surgery, depending on the type of repair; begin by sitting in a chair and then progress to a walker

Question 24

Fracture of the Hip

Assessment

Answer 24

Pain, impaired peripheral circulation on the affected side, soft tissue trauma, complications of immobility (affected leg shorter than unaffected and externally rotated), skin breakdown, and ability to carry out activities of daily living

Question 25

A break in the distal radius

Answer 25

Colles’ Fracture

Question 26

Medical treatment

Colles’ Fracture:

Answer 26

Closed reduction or manipulation of the bone and immobilization in either a splint or a cast

Question 27

Assessment

Colles’ Fracture:

Answer 27

Pain and swelling following treatment of the fracture

Question 28

Fracture of the Pelvis

Medical treatment

Answer 28

A less severe non–weight-bearing fracture treated with bed rest on a firm mattress or bed board for a few days to 6 weeks
Severe weight-bearing fracture may require a pelvic sling, skeletal traction, double hip spica cast, or external fixation
Monitor patient so injuries can be treated immediately
Check for presence of blood in urine and stool, and watch abdomen for signs of rigidity or swelling

Question 29

Assessment

Fracture of the Pelvis

Answer 29

Signs of bleeding, swelling, infection, thromboembolism, and pain
Assess urine output because the absence of urine may indicate a perforated bladder

Question 30

Interventions

Fracture of the Pelvis

Answer 30

When handling patients, take extreme care to prevent displacement of the fracture fragments
Turn patient only on the order of a physician
Provide back care when patient raised from the bed using the trapeze or with adequate assistance from others
Ambulation may be encouraged even though painful; follow physician’s orders

Question 31

What are some common complications of fractures?

Answer 31

shock (hypovelemic) compartment syndrome, delayed bone healing, infection, avasclular necrosis
Fat embolism, DVT’s, joint stiffness and contracture