fractures Flashcards
TYPES OF FRACTURES (the occult fractures)
OCCULT: Stress and Navicular Fx’s don’t show up right away.***
PATHOLOGIC: Occur without trauma (Ca, Osteoporosis, steroids)
COMMINUTED: (dont need to memorize)
COMMINUTED: > than 2 bone fragments, severe trauma
COMPRESSED (dont need to memorize)
Vertebrae
GREENSTICK (dont need to memorize)
Kids, bendable bone doesn’t break all the way
avulsion (dont need to memorize)
Fragment of bone tears off at the tendon insertion site
depression (dont need to memorize)
Blunt trauma to flat bone (Skull)
impacted (dont need to memorize)
Jammed into each other
ASSESSEMENT FOR FRACTURES
History: mechanism, force, and pattern of injury c/w causing a fracture.
Exam: Point tenderness, Deformity, Swelling, Discoloration, Ecchymosis, Open wounds
most important***5 P’s: Pulses, Pallor, Pain, Parasthesias, paralysis
Diagnostic Tests: X-rays, CT scans, MRI’s
COMPLICATIONS OF FRACTURES
INFECTION
COMPARTMENT SYNDROME
DVT (DEEP VENOUS THROMBOSIS)
FAT EMBOLISM
FAT EMBOLISM
Fat may be released from the bone marrow with a fracture.
Fat globules enter the circulation and lodge in tissues (lungs, brain, heart, kidneys, skin).
COMPARTMENT SYNDROME
Normally there is edema with a fx
Increasing edema can cause tissue ischemia
Muscle and nerve cells are destroyed
Delayed dx and tx can result in irreversible muscle and nerve damage.
SYMPTOMS Of COMPARTMENT SYNDROME
Throbbing pain, out of proportion to injury, not relieved by analgesia (consider ordered analgesia may not be adequate)
Inability to extend or passively stretch the digits
Firmness over compartment, numbness, tingling
Pallor, coolness, diminished or absent pulses may be present
TREATMENT of COMPARTMENT SYNDROME (the compartment is a fascist)
PROMPT DIAGNOSIS IS CRITICAL
Can check tissue pressure with Stryker (usually don’t use a stryker)
Prepare for Fasciotomy
COMPARTMENT SYNDROME - FASCIOTOMY
Releases pressure
ROUTINE PLASTER CAST CARE
Plaster casts give a better molding than other casts
1 -3 days to dry
While wet use palms of the hands to avoid making indentations
Report:
Increasing pain, or severe pain
Excessive swelling of extremity
Blueness or whiteness of toes or fingers
Burning or tingling of extremity
Sores or foul odor under the cast
Do not stick foreign objects inside the cast to scratch
Avoid crumbs falling inside the cast
FIBERGLASS CASTS
Dries within a few hours
Weight bearing within a few hours
Can be made waterproof
Fiberglass does not mold as well as plaster
NAVICULAR FX’S
ETIOL: Common Fx (scaphoid/navicular)
Fresh fx’s don’t show up well on X-rays
Usually from FOOSH: Fall On Out Stretched Hand
Delayed dx’s can lead to permanent disability
Cast in position of function (beer can)
Femoral shaft FX - tucky
Usually major trauma
Severe pain
Inability to bear weight
Swelling, Deformity, Angulation
Shortening of leg
TX of FEMORAL SHAFT FRACTURES (Rod into femur)
Intramedullary Rod into Femur Can start walking in a few days
NON-SURGICAL TX of Femur Shaft FX’s
Skeletal traction (Balanced suspension traction with Thomas splint and Pearson attachment)
NOT THE TREATMENT OF CHOICE: (IMMOBILITY, DVT)
PELVIC FRACTURES
Usually major trauma (MVC, falls, skiing)
Anticipate potential for massive bleeding.
Early stabilization helps control bleeding and ↓ post-op complications
Extreme caution in moving patients
MAX-FACE FRACTURES
Concern regarding patent airway
C-Spine Precautions
Suctioning and Tracheostomy may be necessary
orbital floor “blowout” fracture
clinical signs are enophthalmos (recessions of eyeball in socket) and diplopia (especially on upward gaze)
Treatment of Mandible Fractures
Surgery to immobilize the jaw. (Wiring jaw shut)
Wiring
Screws or plates
Post-op complications
Airway obstruction
Aspiration
Wire cutters or scissors (for rubber bands) at bedside incase of aspiration
ET or trach available.
Suctioning equipment at bedside
NG decompression, and anti-emetics
Long term liquid – pureed diet through a straw
EYE INJURIES
ORBITAL FX’S
Suspect eye injury with Orbit fx’s
Check EOMI
Extra Occular movements intact (6 cardinal fields)
IF A GLOBAL RUPTURE IS SUSPECTED STOP EXAM AND CALL OPTHO STAT. Cover gently with saline soaked gauze.
petechial rash ONLY with (fat rash)
fat embolism, not pulmonary embolism
fat embolism - s/sx
SX: Hypoxemia*, fever, petechial rash, restlessness
fat embolism - after what trauma to what bones?
Life threatening. (usually pelvic, tibial, femur fx’s).
High mortality rate.
femoral shaft fx - how much blood loss?
Blood loss 0.5- 1.5 L
fat embolism - when does it occur? (fat for 24 hours)
Occurs 24 – 48 hrs after trauma
