Fractures

Question 1

What are the types of fractures?

Answer 1

Transverse, Spiral, Greenstick, Comminuted, Oblique, Pathologic, Stress

Question 2

Fractures: Emergency care

Answer 2

Assess: Airway, Breathing, Head injury
Splint fracture
Immobilization
Maintain body alignment
Elevate body part
Apply cold pack 1st 24 hours

Question 3

What are the three goals of fracture treatment?

Answer 3

Reduce
Immobilize
Restore function

Question 4

What does it mean to reduce a fracture?

Answer 4

Replace bone fragments in the correct anatomical position

Question 5

What are the two types of reduction

Answer 5

Closed reduction and Open reduction

Question 6

What is a closed reduction?

Answer 6

Non surgical, manual realignment of bone fragments

Local anesthesia is used

Question 7

What is open reduction?

Answer 7

Surgical reduction. Nails, screws and plates often used

Also called “Open reduction with internal fixation”

Question 8

What is the purpose of immobilization?

Answer 8

To hold broken bones together until healing takes place.

Question 9

What are the different types of external immobilization devices?

Answer 9

Cast 
Splint
Brace 
Traction
External Fixators

Question 10

What are the different types in internal immobilization devices?

Answer 10

Metal plates
Pins 
Screws
Nails
With or without bone grafts

Question 11

What are casts?

Answer 11

Temporary circumferential immobilization device

Common treatment after closed reduction

Question 12

What are common cast materials?

Answer 12

Most common = fiberglass

Plaster of Paris not used much anymore

Question 13

What are the different types of casts?

Answer 13

Arm
Leg
Body/Spica

Question 14

Cast care (Plaster of Paris)

Answer 14

1- heat is felt. 2 - Handle with palms while wet. 3 - petal edges

No covering (blankets)
Reposition q 1-2 hours until set
Neurovascular checks q 1 hours X 24 hours
Be able to stick a finger or two inside the cast to make sure there is room
Ice first 24 - 36 hours to reduce swelling

Question 15

Peripheral neurovascular assessment

Answer 15

Assess for 5 Ps
Pain
Pallor
Pulselessness
Paresthesia
Paralysis 

First sign is Pain
Late signs are Pallor, Pulselessness, Paralysis

Question 16

Complications of casts

Answer 16

Infection r/t pressure necrosis
Circulation Impairment
Peripheral nerve damage
Complications of immobility

Question 17

Splints and Immobilizers are?

Answer 17

Removable

Question 18

Braces are?

Answer 18

Adjustable

Question 19

Traction

Answer 19

Applies pulling force on fractured extremity

Pulling force must be continuous (unless ordered intermittent)

Question 20

Skin traction

Answer 20

Short term (skin cant tolerate very long)
5-10 lbs

Question 21

Skeletal traction

Answer 21

5 - 45 lbs

Pins used to immobilize part

Question 22

Running vs Countertraction

Answer 22

Running - pulling force goes one way. Unidirectional. If on leg pt will be slipping down toward foot of bed.

Countertraction - pulling force in different directions

Question 23

What is bucks traction?

Answer 23

Simplest form of skin traction
Provides straight pull on affected extremity (running)

Used: Relieve muscle spasm or temporary immobilization before ORIF (surgery)

Question 24

What is Russell traction?

Answer 24

Skin traction
Permits pt to move, somewhat, in bed. (due to countertraction)
Permits flexion of knee joint

Used: Relieve muscle spasm/ back pain

Question 25

Balanced Suspension traction (skin or skeletal)

Answer 25

Provides countertraction
Prevents pt from sliding to end of bed
Pulling force of traction is not altered when bed or pt is moved
Allows for increased pt movement and facilitates care
Nurse must maintain constant traction, no interruption in weights

Question 26

The line of pull

Answer 26

Must never be interrupted

Question 27

External fixators

Answer 27

Screws are placed above and below the fractures and a device is attached to the screws on the outside of the skin

Question 28

Pins: Nursing implications

Answer 28

Assess for pin loosening
Assess for infection

Meticulous pin care

• 1/2 and 1/2 (peroxide and saline) followed by normal saline
• Avoid ointments

Teach to avoid touching

Question 29

Internal devices: Types

Answer 29

Pins
Screws
Plates

Question 30

Related nursing problem: Risk for peripheral neurovascular dysfunction

Answer 30

Elevate extremity above heart level
Apply ice compress
Notify provider immediately if increase of pain unrelieved by meds
Teach signs of NV dysfunction

Question 31

Related nursing problem: Acute pain

Answer 31

ATC medication
Non-drug measures

Sudden inability of pain medication to relieve pain? Compartment syndrome

Question 32

Compartment syndrome

Answer 32

Swelling out of control in only a few hours

Fasciotomy procedure done to relieve

Question 33

Related nursing problem: Risk for infection

Answer 33

Assess pin insertion sites for indicators of infection
Aseptic technique
Culture site PRN
Administer antibiotics
Monitor temp
Monitor WBCs

Question 34

Related nursing problem: Risk for impaired skin integrity

Answer 34

Examine potential pressure areas q4 hours (Braden scale daily)
Petal cast edges (if plaster of paris)
Do not insert items into cast to scratch
Instruct pt to report increased pain, warmth, or foul odor
Moisture contributes to breakdown
Turn if permissible. avoid friction/shearing

Question 35

Related nursing problem: Impaired Physical mobility

Answer 35

Pain control before ROM
AROM/PROM physical therapy
Weight bearing or non weight bearing (are they allowed to bear weight)
Instruct use in assistive devices

Question 36

These patients are at increased risk for what?

Answer 36

Venous thromboembolism
Fat embolism  (Long bone fracture)

Monitor for CP, tachypnea, cyanosis, apprehension, tachycardia, hypoxemia