classification of fractures 2 Flashcards
Expected healing time is appropriate but unsatisfactory alignment of bone results in external deformity and dysfunction
Malunion
Failure of a fracture to heal in the expected time
The bone usually heals eventually; it may just be
slower
Delayed Union
Occurs when a fracture never heals
Nonunion
Treatment Nonunion
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
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
Post-Traumatic Arthritis
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
Avascular Necrosis
Signs and symptom
Avascular Necrosis
Pain, instability, and decreased function in the
affected area
Treatment
Avascular Necrosis
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
Precipitated by a fracture or other trauma
Complex Regional Pain Syndrome Type 1 (CRPS—Type 1)
Symptoms
Complex Regional Pain Syndrome Type 1 (CRPS—Type 1)
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
Treatment
Complex Regional Pain Syndrome Type 1 (CRPS—Type 1)
Nerve blocks, physical therapy, transcutaneous electrical stimulation, and analgesics, muscle relaxants, and antidepressants
Signs and Symptoms of a Fracture
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
Signs and symptoms of a fracture on pg 1076
pain, loss of function, deformity, false motion (untatural motion), creptus( grating sound of bone ends moving over each other) edema, spasm
Detect small bone fractures or fractures caused by stress or disease
Bone scan
Detect fractures of complex structures, such as the hip and pelvis, or compression fractures of the spine
Computed tomography (CT)
Reveal bone disruption, deformity, or malignancy
Standard radiographs
The process of bringing the ends of the broken bone into proper alignment and maintaining alignment
Reduction
Closed Reduction or Manipulation
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
Open Reduction
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
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
Fixation
Internal Fixation (ORIF)
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
External Fixation
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
Fracture of the Hip
medical treatment
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
Fracture of the Hip
Assessment
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
A break in the distal radius
Colles’ Fracture
Medical treatment
Colles’ Fracture:
Closed reduction or manipulation of the bone and immobilization in either a splint or a cast
Assessment
Colles’ Fracture:
Pain and swelling following treatment of the fracture
Fracture of the Pelvis
Medical treatment
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
Assessment
Fracture of the Pelvis
Signs of bleeding, swelling, infection, thromboembolism, and pain
Assess urine output because the absence of urine may indicate a perforated bladder
Interventions
Fracture of the Pelvis
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
What are some common complications of fractures?
shock (hypovelemic) compartment syndrome, delayed bone healing, infection, avasclular necrosis
Fat embolism, DVT’s, joint stiffness and contracture
