fracture Flashcards
patho of a fracture
A fracture is a break in the bone secondary to trauma or a pathological conditional.
complete fracture
when a bone breaks into two separate pieces
incomplete fracture
when the bone cracks and bends but does not completely break
pathological fracture
occurs to bone that is weak from a disease process (bone cancer or osteoporosis)
fatigue fracture
results when excess strain occurs from recreational and athletic activities
compression fracture
Produced by a loading force applied to a long axis of cancellous bone
stage 1
Occurs within 24-72 hours after injury. Hematoma form at fracture site
stage 2
Typically begins on day 3 and lasts 2 weeks. Granulation tissue invades fracture site and fibrocartilage forms.
stage 3 `
A callus formation has begun, and bone healing occurs
stage 4
the callus is gradually resorbed and transformed into bone.
stage 5
Remodeling of bone occurs
four major complications of acute fractures
infection
acute compartment syndrome
vte
fat embolism
infections cm
fever, high WBC, chills and sweats, SOB, inflammation, swelling
acute compartment syndrome
pain due to reduced perfusion: pain severe despite being medicated, which causes further ischemia. Sensory perception deficits and paraesthesia. Pale color due to low perfusion and weak pulses. Cyanosis, tingling, and numbing can occur if not treated.
vte cm
SOB, rapid breathing, chest pain upper rib cage, heart rate increases, leg pain or tenderness of the leg or calf, edema to the LE
fat embolism cm
Dyspnea, increased RR, decreased o2 sat, tachycardia, confusion, chest pain
delayed union
Fracture takes longer than usual to heal (longer than 6 months)
nonunion
Fracture that never heals
- Electric bone stimulation and bone grafting can treat
- Low intensity pulsed ultrasound can promote healing to treat
- Can occur more frequently in older adults due to impaired healing process
- Can cause immobilizing deformity of the bone involved
malunion
Fracture heals incorrectly
Can cause immobilizing deformity of the bone involved
What assessment methods do you need to include as part of this neurovascular assessment and what are your expected normal findings for each assessment?
Color and temperatures Movement Sensation Pulses Cap refill Pain
closed reduction and imbolization
The doctor realigns the bones by use of splints, orthopedic boots or casts
open reduction and internal fixation
The doctor cuts open your lower leg to view the broken bones and may put in metal pins, screws, rods or plates
The ABG results are available, and an additional set of vitals were just obtained.
Arterial Blood Gases Vital Signs
pH 7.55 BP 150/92 mmHg
PaCO2 24 mmHg HR 110 bpm
HCO3 24 mEq/L RR 28 bpm
Pa02 56 mmHg T 99F
Sa02 86% Room Air
What is your interpretation of the ABG’s? What do you think is happening to M.M.?
Respiratory alkalosis
Pulmonary embolism
The chest x-ray shows a small right infiltrate. The physician suspects and embolism, either pat or pulmonary and orders a STAT ventilation/perfusion (VQ) lung scan. The interpretation of the results reads “strongly suggestive of a pulmonary embolism (PE).
- What are the most likely sources of the embolism?
M.M was bed bound developed dvt or a fat embolism due to fracture , PTT was low, High pH and CO2
fiberglass cast
- When it is first applied it feels hot because of chemical reaction on skin then it becomes damp and cool
- It takes 24 hours to dry.
- If tissue integrity is impaired they can cut a window to ventilate.
- Frequent monitor of neurovascular assessment
You perform a quick CMS (color, motion, sensitivity) check on the toes, and note that the toes are more swollen than this am, they appear pale, are cool to touch and M.M. reports despite receiving his pain medication his pain is more severe. What do you think is happening to M.M.?
Compartment syndrome
Cast preventing expansion
what causes compartment syndrome
Pressure builds up inside the fiberglass cast.
if compartment syndrome left untreated, what could happen
cyanosis
necrosis
amputation
how to treat compartment syndrome
Fasciotomy- fascia is cut to relieve swelling and pressure in compartment of the body
