Fractures Flashcards
What is a fracture?
A disruption or break in the continuity of bone structure, mainly from traumatic injury, sometimes secondary to disease processes (e.g. Cancer, Osteoporosis)
What are the signs and symptoms of a fracture?
Localised pain and tenderness
Possible swelling and/or bruising
Decreased function
Inability to bear weight or use the limb
Guarding against movement
+/- deformity
What is a transverse fracture?
A fracture straight across the bone
What is a spiral fracture?
A fracture that spirals around the bone
What is an oblique fracture?
A fracture that is at an angle to the length of the bone
What is a comminuted fracture?
What is a segmental fracture?
Comminuted fracture: A fracture with three or more bone fragments
Segmental fracture: One bone fractured in two places, leaving a “floating” segment of bone
What is a buckle fracture?
A compression fracture which is characterised by the bulging of the bone cortex
What is a greenstick fracture?
A fracture on one side of the bone causing a bend in the other side of the bone (More common in small children due to their more flexible bones)
What is a stress/hairline fracture?
What is an avulsion fracture?
Stress/hairline fracture: A fracture resulting from overuse/overworking the bone over time
Avulsion fracture: A fracture resulting from a tendon pulling on the bone
What is the difference between a complete and incomplete fracture?
A complete fracture has the break going all the way through the bone, whereas an incomplete fracture only has the break going part way through the bone
What is the difference between a displaced and non-displaced fracture?
A displaced fracture has the bone fragments out of alignment with each other whereas a non-displaced fracture has them still aligned
What is the difference between an open and closed fracture?
An open fracture breaks the skin whereas a closed fracture doesn’t break the skin
What are the six stages of bone healing?
- Fracture hematoma
- Granulation tissue formation
- Callus formation
- Callus ossification
- Consolidation
- Remodelling
What happens during a fracture hematoma?
How long after a fracture does this occur?
Inflammatory processes occur and bone bleeding creates a hematoma
This occurs within the first 72 hours of a fracture
What happens during the granulation tissue formation stage?
How long after a fracture does this occur?
Phagocytosis occurs, and the hematoma is organised into a fibrous network of granulation tissue by fibroblasts and osteoblasts (osteoid)
This occurs within 3-14 days after the fracture
What happens during the callus formation stage?
How long after a fracture does this occur?
Chondroblasts and osteoblasts form a collagen-rich soft fibrocartilaginous callus
This occurs within 10-14 days after the fracture
What happens during the callus ossification stage?
How long after a fracture does this occur?
New bone is built up by osteoblasts, and the callus begins to calcify and turn into a hard callus (Weight bearing is introduced)
This occurs within 3 weeks to 6 months after the fracture
What happens during the consolidation and remodelling stages?
The distance between bone fragments closes, excess bone tissue is resorbed by osteoclasts, and the union is complete
This occurs at least 17 weeks after the fracture
What complications can occur during bone healing?
Mal-union: Fracture healing in the expected time but in an unsatisfactory position resulting in deformity and/or dysfunction
Non-union: Fracture failing to heal despite treatment and no x-ray evidence of callus formation
Delayed union: Fracture healing progresses more slowly than expected but eventually heals
Venous thromboembolism due to muscle inactivity
Infection
Fat embolism
Compartment syndrome
What factors can influence bone healing?
Age
Obesity
Endocrine conditions
- Diabetes
- Parathyroid disease
Menopause
Steroids
Malnutrition
Smoking
What can infection lead to in relation to bone healing?
Osteomyelitis
What is compartment syndrome?
What can happen as a result of compartment syndrome?
Swelling and increased pressure within a confined fascia compartment happening initially or within several days
Compartment syndrome can lead to impaired arterial flow, leading to ischaemia within 4-8 hours, tissue and cell death and the possible need for amputation
What are the signs and symptoms of compartment syndrome?
Pain
- Disproportional to the injury
- Worse with passive stretch
- Doesn’t resolve with pain relief
Pressure (early sign)
Paresthesia (early sign)
- Numbness and tingling
Pallor (late sign)
Paralysis (late sign)
Pulselessness (late sign)
How is compartment syndrome relieved?
With a fasciotomy
What are some nursing assessments to perform for a fracture patient?
Neurovascular assessment (especially distal to the fracture)
- Colour
- Warmth
- Movement
- Sensation
- Capillary refill
- Pulses
- Deformities
- Oedema
- Pain assessment
Vitals
Did they hit their head?
What can be used to immobilise fractures?
Casts: Plaster and fibreglass
Buddy strapping (e.g. fingers)
Moon boots/square-toed shoes
Splinting
What is fracture reduction?
Realignment of displaced bones
What is a closed reduction?
Nonsurgical, manual realignment of bone fragments under local or general anaesthesia, followed by immobilisation
What is an open reduction?
A surgical procedure that includes the insertion of metal plates, pins, rods, wires and/or screws to internally fixate the bones in place
What is external fixation?
A surgical treatment where rods are screwed into bone and exit the body to be attached to a stabilising structure on the outside of the body
What is traction?
Use of weights, pulleys and ropes to gently realign broken bones back into position prior to or while waiting for corrective surgery
