Fracture Flashcards
What is a break in a bone?
Fracture
What is a closed/simple fracture?
The skin is intact
What is an open or compound fracture?
The ends of the bone have broken through the skin or into one of the body cavities
What is a complete fracutre?
The bone is broken into two or more pieces
What is an incomplete fracture?
The bone is bent or cracked but the periosteum is intact
What is an avulsion fracture?
A piece of bone attached to a tendon or ligament gets pulled away from the main part of the bone
Which type of fracture occurs when it is shattered or crushed?
Comminuted
Which type of fracture occurs when the bone does not break all the way through?
Greenstick
Which fracture occurs when break line runs at an angle to the length of the bone?
Oblique
Which type of fracture occurs when it spirals down the bone?
Spiral
Which type of fracture occurs when the bone is broken in 2 transversely?
Transverse
Which type of fracture occurs when small, hairline cracks in the bone, usually due to repeated activity?
Stress
What is the etiology of fracture?
- Trauma
- Contributing factors
- pathologies such as osteoporosis, osteopenia, tumors, local infection
Where are the common fractures?
- Humerus
- Distal radius (Colle’s & Gelazzi)
- Ankle (Pott’s)
- Femur
- Tibia
- Metatarsals
- PelvisW
What are the signs & symptoms?
- Inflammation; the pain is severe
- Deformity
- Bleeding
- Bruising
- Severe fracture can cause numbness & tingling due to the nerve damage
What are the signs & symptoms during immobilization?
- Pain, local and possibly distant
- Tissue repair is occurring at the fracture site
- Under the cast :
- reduced circulation, edema, disuse atrophy, contracture, decreased cartilage health - HT, TPs in compensatory mm
What are the signs & symptoms following immobilization?
- Fracture site continues to heal
- Decreased tissue health, fragility, disuse atrophy & weakness
- Possible loss of proprioception & altered gait & posture
- Scars (open reduction)
- HT, TPs
- Adhesions
- Contractuer
What are complicatons?
- Infection : open fractures
- Delayed union : healing takes longer
- Nonunion : gap does not fill
- Acute compartment syndrome
- DVT
What are CI’s & Precautions DURING immobilization?
- No testing of muscles & joints directly involved
- No traction of the limb until union has occurred
- No heat applications distal or immediately proximal to the cast
- Only careful, pain free AROM proximal & distal
- AROM & PROM with physician approval only, if the fracture sire is a muscle attachment, or if a tendon cross the fracture site was severed or lacerated.
- No local treatment following reduction until the wound has healed
- Stress fractures that are point tender are local CI
What are CI’s & Precautions FOLLOWING immobilization?
- No overpressure on involved joints until union has occurred
- Until tissue health & muscle tone normalize, avoid deep techniques & temp extremes
- Caution with stretching
- Avoid local hot hydrotherapy over metal implants
What are assessment findings DURING immobilization?
- Antalgic giant and/or posture
- Crutches, cane, or sling may be present
3.Possible pained facial expression
4.Pain referred to nearby tissue
5Protective spasm palpated in muscles crossing the injury
6.AROM (pain free proximal & distal only) limited
7.Physician approval - Stress fractures are painful upon direct compression
- Likely impact on ADLs
What are assessment findings FOLLOWING immobilization?
- Habituated antalgic gait & posture may be observed
- Initially dry, scaly or flaky skin where cast was
3.Disuse atrophy, residual edema, bruising, point tenderness, inflammation or ischemia may be noted
4.Hypertonicity & TPs in compensatory structures
5.AROM (pain free proximal & distal only) limited
6.PROM (careful, pain free & no overpressure until consolidation has occurred) limited, tissue stretch end feel
7.RROM (submaximal & pain free) weakness
8.Stress fractures are painful upon direct compression
What is the stage where new bone trabeculae appear in the fibrocartilaginous callus, which then converts into a bony callus? This occurs how many weeks after injury?
Consolidation, 3-4 weeks
What are goals DURING immobilization?
- Reduce excess inflammation
- Treat compensatory structures without disturbing the healing process
- Maintain proximal circulation
- Maintain proximal & distal ROM
What are goals FOLLOWING immobilization?
- Reduce excess inflammation
- Improve tissue health
- Reduce HT & TPs
- Maintain & eventually increase ROM
- Decrease ADH
What are goals FOLLOWING consolidation?
- Normalize mm tone, strength, tissue health & ROM
- Decrease pain
- Decrease postural imbalances
- Restore function
What are homecare exercises during immobilization?
- RICE for pain reduction
- Cold application for any distal edema
- ROM & submaximal isometrics if safe
- Address compensatory tissue changes
What are homecare exercises following immobilization?
- Elevation for residual edema
- Thermal applications (warm & cool)
- Px free ROM & strengthening (isometric to isotonic)
- Self massage to adhesions
- Dry brushing for tissue health
