Fracture Management Flashcards
What are the 5 main forces that cause a fracture?
- Tensile (tension) forcesact to lengthen the bone
- Compressive forcesshorten the bone.
- Shearing forcesare typically parallel or tangential to the bone
- Torsional forcesact to twist bone about its long axis.
- Bending forcescreate a convex side of the bone
What is direct fracture healing? (primary healing)
Required rigid internal fixation. Occurs via a combination of contact and gap healing.
What is contact direct healing?
Occurs when the surfaces of the fracture are in direct contact. The fracture is stable, and there is no compression applied to the fragments.
What is gap direct healing?
Occurs when an interfragmentary gap of < 1 mm is present.
What is indirect fracture healing? (secondary healing)
The most common ‘natural’ healing process, whereby the fracture ends are placed close to each other (but not apposed), with intervening haematoma and variable displacement and/or angulation.
What are the conditions for normal fracture healing?
Viability of fragments (i.e. intact blood supply)
Mechanical rest: this can be achieved by not moving and external immobilisation, e.g. cast or internal fixation
Absence of infection
What are some complications of fracture healing?
- Non-union
- Delayed union
- Malunion
- Shortened limb
- Ostteomyelitis
- Fracture disease
- Sequestrum
- Implant Failure
What are the principles of fracture repair? (4 points)
Restoring the continuity of the bone
Restoring length
Restoring functional shape
Maintaining soft tissue function of blood vessels,
muscles and nerve supply.
What is the aim of external coaptation?
To limit motion at a fracture site but immobilising the joint above and below the fracture.
What are methods of external coaptation?
Casts, splints and extension splint
What are the advantages and disadvantages of external coaptation?
Advantages –
Technically simpler
Economical
Non-invasive
Disadvantages –
Limited applications
Not sufficient stabilisation
Decubital ulcers
Slow healing rate and greater callus formation
Fracture disease
Owner Compliance
What are the nursing considerations for coaptation?
Aftercare advice sheets incorporating a care plan to address basic needs
Providing protective cover/anti-chew device
Monitor for swelling/chafing/staining/smell/slipping/collapse
Medications (Analgesia, NSAID’s, Sedatives)
Exercise
Mental Stimulation
Post-op checks
What are advantages and disadvantages of internal fixation?
Advantages –
Any closed fracture, any bone
Accurate reduction
Rigid fixation
Early return to full function – minimal risk of fracture disease
Disadvantages –
Expensive/time consuming
Surgical Skill
Equipment
Surgery risks
Not suitable for open fractures
What are the nursing considerations of internal fixation?
Immobilisation if deemed appropriate
Coaptation as protection
Surgical Site Infections (SSI’s)
Ability to mobilise
Ability to access 5 freedoms
Patient Interference
Monitor for complications
What are surgical site infection protocols?
Ensure infection control is adhered to strictly.
Ensure all equipment is sterile.
Use of sterile surgical gloves/aprons/scrub materials
Aseptically clean surgical site post-op.
Put sterile dressing over surgical wound to prevent infection.
