Fracture Management and Stabilisation Flashcards
Define fracture
A complete or incomplete break of the bone continuity, with or without displacement of the resulting fragments
What is ideal to diagnosis a fracture?
Radiograph of BOTH sides of the bone
Describe the secondary healing (or indirect healing) of a fracture?
- clot
- granulation
- fibrous tissue callus stabilises # & cartilage develops
- callus slowly replaced by mature bone (osteoclasts)
- remodelling
Describe the primary healing (or direct healing) of a fracture?
- bone edges so close together that a callus doesn’t form
- not much movement but does need surgery as bones will move further apart
What are some factors that will influence the healing times of fractures?
- Immature animals heal quicker but have growth plate issues
- geriatric heal slower - may have other systemic diseases that impact healing e.g. OA
- Systemic disease e.g. kidney or hormone failures
- Osteomyelitis (inflammation)
- Whether the fracture is cancellous or cortical bone - cancellous has red bone marrow and many pores. It is weaker and easier to fracture than cortical bone, but heals quicker.
What is sequestrum?
Necrosis/decay of the bones
What is a
- comminuted
- avulsed
- impacted
- torus
- greenstick fracture?
- Multiple crack lines
- end tip broken off
- end tip got a pressure crack around a joining
- bent
- chip
What affects the type of fixation selected?
- classification of fracture
- age
- size of patient
- temperament
- underlying diseases
- cost
- expectation of owner/willingness to aftercare commitment
What is external coaptation? What is its aim?
- casts, splints etc
- aim to limit motion at fracture site by immobilising the joint above and below the fracture
What are the advantages of external coaptation?
- technically simple
- economical
- non-invasive
What are the disadvantages of external coaptation?
- limited applications ( e.g. if the fracture is above the knee, we cannot immobilise the hip joint)
- insufficient stabilisation ( if swelling reduces will be able to move inside cast)
- can rub and cause decubitus ulcers
- slow healing rate and greater callus formation
- fracture disease ( tendency to re-fracture after remove the cast due to muscle wastage)
- some won’t tolerate
What are the nursing considerations for a patient with an external coaptation?
- after care sheets
- provide a protect cover/ anti-chew device
- Monitor for swelling/chaffing/staining/smell/slipping
- Medications - pain relief
- Exercise to minimal/assisted
What is internal fixation?
Pins, Plates, Screws, Wires…
What are pins for? What are their advantages and disadvantages?
- placed into fractured medulla
+ cheap, quick, minimal surgical exposure, easier than plates
- not most stable, slow return to function, greater aftercare, not suitable for unstable fracture
What are the different types of plate?
- either Venables (heavy, strong rectangles with holes) or Sherman ( narrower holes, lighter, weaker
- most common plate is a Dynamic Compression Plate which forms a bridge across the fracture and can be bent to shape the bone
What are wires used for?
Can circle bones to compress pins and fractures to create a tension band to get bones to heal together
What are the advantages of internal fixation?
- can use on any closed fracture on any bone
- accurate reduction
- rigid fixation - no chance bone can move
- early return to full function so minimises risk of fracture disease
What are the disadvantages of internal fixation?
- expensive/time-consuming
- skill required
- equipment required
- risks of surgery
- cannot use on an open wound or open fracture (open source of infection
What are the nursing considerations for a patient with an internal fixation?
- care plans
- X-rays taken post-op to check placement and after 6w to check healing
- appropriate aftercare advice (no jumping/stairs/sofa)
What is External Skeletal fixation?
Pins are inserted through a small stab incision into the skin then into the bone. They are fixed on the outside of the limb with bar and clamps
What are the advantages of ESF?
- minimum instrumentation/reusable
- minimal disruption to soft tissues
- less foreign materials
- can manage open wounds
- complements other techniques well
- Adjustable and easy access
- easy to remove
What are the disadvantages of ESF?
- Soft tissue issues ( can get infection around pins)
- Skill/difficult to apply to proximal limbs
- X-rays can be hard to view due to frame
- Premature pin loosening
What post-op care is required for an ESF?
- open wound care
- compression bandages to reduce swelling for 2-3 days (daily change)
- cover the pins to avoid sharps damage
- cage rest
- leave any scabs
- prevent patient interference
- clean any excess exudate
- written instruction and care plan
