classification of fractures Flashcards
Bone does not break through the skin
Closed or simple fracture
Fragments of the broken bone break through skin
Open or compound fracture
Open fractures have three grades of severity
Grade I: least severe injury, with minimal skin damage
Grade II: moderately severe injury, with skin and muscle contusions (bruises)
Grade III: most severe injury (wound larger than 6 to 8 cm), with skin, muscle, blood vessel, and nerve damage
Caused by either repeated or prolonged stress
Stress fracture
pulling away of a fragment of a boneby a ligament or tendon and its attachment
avulsion
a fractuture in which bone has splintered into several fragments
communited
a fracture in which damage also involves the skin or mucous membranes
compound
a fracture in which bone has been compressed seen in vertrebral fractures
compression
a fracture in which fragments are driven inward seen frequently in fracture of skull and facial bone
depressed
a fracture through the epiphyseal
epiphyseal
a fracture in which one side of the bone is broken and the other side is bent
greenstick
a fracture in which a bone fragment is driven into another bone fragment
impacted
a fracture occurring at an angle across the bone
oblique
a fracture that occur though the area of diseased bone
pathologic
a facture that remains contained and does not break the skin
simple
a fracture twisting around the shaft of the bone
spiral
a fracture that is straight across the bone
transverse
A bone begins to heal as soon as
an injury occurs
New bone tissue formed to repair the fracture, resulting in a
sturdy union between the broken ends of the bone
Stage 1: hematoma formation
Immediately after a fracture, bleeding and edema occur
In 48 to 72 hours, a clot or hematoma forms between the two broken ends of the bone
Stage 2: fibrocartilage formation
Hematoma that surrounds fracture does not resorb, as it does in other parts of the body
Instead, other tissue cells enter the clot, and granulation tissue replaces the clot
The tissue then forms a collar around each end of the broken bone, gradually becoming firm and forming a bridge between the two ends
Stage 3: callus formation
Within 1 to 4 weeks after injury, granulation tissue changes into a callus, which is made up of cartilage, osteoblasts, calcium, and phosphorus. The callus is larger than the diameter of the bone and serves as a temporary splint
Stage 4: ossification
Within 3 weeks to 6 months after the break, a permanent bone callus, known as woven bone, forms
During this stage the ends of the broken bone begin to knit
Stage 5: consolidation and remodeling
Consolidation occurs when the distance between bone fragments decreases, then closes
During bone remodeling, immature bone cells are gradually replaced by mature bone cells
Excess bone is chiseled away by stress to the affected part from motion, exercise, and weight bearing
Bone then takes on its original shape and size
from contamination of the open wound associated with a fracture or from contamination of indwelling hardware used to repair the broken bone
Osteomyelitis
In deep, grossly contaminated wounds
gas gangrene may develop
gas gangrene
Necrosis or death of tissue, usually due to deficient or absent blood supply. infected by a gas bacillus [often Clostridium perfringens] Part of bone that dies is known as sequestrum and must be removed before healing can take place.)
Complications of FracturesInfection
Signs and symptoms
Local pain, redness, purulent wound drainage, chills, and fever
With gas gangrene, foul-smelling watery drainage with significant redness and swelling
Treatment
Complications of FracturesInfection
IV antibiotics may be given for 4 to 8 weeks, followed by 4 to 8 weeks of oral drug therapy
Wound care: irrigation, treatment with antibiotic beads, and surgical removal of dead bone tissue and/or hardware
Fat globules released from marrow of broken bone into bloodstream, then migrate to the lungs (24-48 hrs after Fx)
Age groups: 20-40 yo males; 70-80 yo elderly
They lodge in capillaries and obstruct blood flow
The fat particles break down into fatty acids, which inflame the pulmonary blood vessels, leading to pulmonary edema
Common with fractures of the long bones, multiple fractures, and severe trauma
Complications of Fractures Fat Embolism
is the first sign of a fat embolism, followed by
Respiratory distress is the first sign of a fat embolism, followed by tachycardia, tachypnea, fever, confusion, and decreased level of consciousness
Treatment:
Complications of Fractures Fat Embolism
bed rest, gentle handling, oxygen, ventilatory support, and fluid restriction and diuretics for pulmonary edema
Venous stasis, vessel damage, and altered clotting mechanisms contribute to formation of blood clots (thrombi), most commonly in deep veins of the legs
DVT increased with immobility often associated with a fracture
Thrombi can break off and travel to the lungs, causing a pulmonary embolism
Complications of Fractures Deep Vein Thrombosis
A condition in which a structure such as a tendon or nerve is contritced in a confined space, it affects nerve innervation leading to subsequent palsy
compartment syndrome
Compartments are located in the
muscles of the extremities. These enclosed spaces are made of muscle, bone, nerves, blood vessels wrapped by fibrous membrane may lead to volkmanns contractions
compartment syndrome
Internal pressure from bleeding/edema into a compartment; there is nowhere for the drainage to go.
Increased fluid puts pressure on tissues, nerves, and blood vessels, so that blood flow is decreased, resulting in pain and tissue damage. Needs immediate treatment. In as little as 4-6 hrs, permanent damage can occur
External pressure also can decrease blood flow to the area
e.g. external pressure from a cast or tight dressing
sign an symptoms
compartment syndrome
Primary symptom is pain, especially with touch or movement, that can’t be relieved with opioids
Other signs and symptoms: edema, pallor, weak or unequal pulses, cyanosis, tingling, numbness, paresthesia, and finally, severe pain
treatment
compartment syndrome
is to relieve pressure
When internal pressure, a surgical fasciotomy, which entails making linear incisions in the fascia, may relieve pressure on the nerves and blood vessels
For external pressure, cast or dressings are replaced
Complications of Fractures Shock
After fracture, a risk of excessive blood loss
Trauma may rupture local blood vessels; internal organs may be punctured; results in internal bleeding
Loss of blood leads to shock, evidenced by tachycardia, anxiety, pallor, and cool, clammy skin
Immobilizing fractures reduces risk of hemorrhage
If severe external bleeding, external pressure should be applied and medical assistance summoned immediately
Complications of Fractures Joint Stiffness and Contractures
Joint fractures or dislocations may be followed by stiffness or contractures, especially in older adults, due to immobility associated with fracture
Prevention requires appropriate positioning and progressive exercise programs
Treatment may employ splints, traction, casts, surgical manipulation, and aggressive physiotherapy
