Fractures Flashcards
what are fractures
Disruption or break in continuity of structure of bone
Majority of fractures from traumatic injuries
Some fractures secondary to disease process (pathologic)
Cancer or osteoporosis
types (classifications) of fractures
Communication with environment
– Open—skin broken, bone exposed
—- Usually from severe external forces
– Closed—skin intact
Extent of break
– Complete—completely through bone
– Incomplete—partly across bone shaft
Based on direction of fracture line: Linear, oblique, transverse, longitudinal, spiral
Displaced or nondisplaced
– Displaced: two ends separated from one another
—- Often comminuted or oblique
– Nondisplaced: periosteum is intact and bone is aligned
—- Usually transverse, spiral, or greenstick
Spiral and greenstick = abuse
manifestations of fractures
Edema and swelling
Pain and tenderness
Muscle spasm
Deformity: classic sign of fracture
Bruising
Loss of function
Crepitus/Crepitation
factors influencing fracture healing
Displacement and site of fracture
Blood supply
Other local tissue injury
Immobilization
Internal fixation devices
Infection
Poor nutrition
Age
Smoking
complications of fracture healing
Delayed union
Nonunion
Malunion- not lined up properly
Pseudoarthrosis (Type of nonunion occurring at fracture site in which a false joint is formed with abnormal movement at site.)
Refracture
Myositis ossificans (Deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury
overall goal of fracture treatment
Anatomic realignment (reduction)
Immobilization to maintain alignment
Restoration of normal or near-normal function
diagnostic assessment of fractures
History and physical assessment
X-ray
CT scan, MRI
closed reduction fracture
Nonsurgical, manual realignment of bone fragments
Traction and countertraction applied
Under local or general anesthesia
Immobilization afterwards – Traction, cast, splint, or brace
open reduction fracture
Surgical incision
Internal fixation
— Wires, screws, pins, plates, rods, or nails
Risk for infection
Facilitates early ambulation
Reduced risks related to immobility
Pulling force applied to injured or diseased body part or extremity
traction
purpose of traction
Prevent or reduce pain and muscle spasm
Immobilize joint or part of body
Reduce fracture or dislocation
Treat a pathologic joint condition
Provide immobilization to prevent soft tissue injury
Promote active and passive exercise
Expand a joint space during arthroscopy
Expand a joint space before reconstructive surgery
why do we do traction
Pulling force to attain realignment; countertraction pulls in opposite direction
two most common types of traction
Skin traction
Skeletal traction
purpose and process of skin traction
Short-term (48 to 72 hours)
Tape, boots, or splints applied directly to skin to reduce muscle spasms
— For example, Buck’s traction (Figure) for hip, knee, or femur fracture
Traction weights 5 to 10 pounds
Skin assessment and prevention of breakdown imperative
Can lead to skin breakdown
skeletal traction
Align injured bones and joints or treat joint contractures and congenital hip
dysplasia
Long-term pull to maintain alignment
Pin or wire inserted into bone
Weights 5 to 45 pounds
Risk for delayed union, nonunion, or infection at pin sites
Complications of immobility
balanced suspension skeletal traction
Requires correct patient positioning and alignment with constant traction forces
Maintain countertraction, typically the patient’s own body weight
— Elevate end of bed
— Maintain continuous traction
— Keep weights off the floor and moving freely through pulleys
Fracture Immobilization: Cast
Temporary after closed reduction
Incorporates joints above and below fracture for stabilization during healing
Allows patient to perform many normal ADLs while maintaining immobilization
Two most common materials
— Plaster of Paris
— Fiberglass
application of a cast: fracture immobilization
Cover affected part with stockinette and padding
Immerse plaster of Paris material in warm water, wrap and mold it
— Sets in 15 minutes but need 36 to 72 hours before weight bearing
— Do not cover: risk for burn and delayed drying
— No direct pressure: petal edges
components of Synthetic casting materials
Lightweight, stronger, more waterproof
Early weight bearing
Activated by submersion in cool or tepid water, then molded to fit body part
Fracture Immobilization: External Fixation
Metal pins and wires attached to external rods
Applies traction, compresses fragments and immobilizes reduced fragments
Used for complex fractures with extensive soft tissue damage, congenital bone defects, nonunion or malunion, and limb lengthening
Attempt to save extremity that may have required amputation
Assess for pin loosening and infection
Patient teaching
Pin site care
— Chlorhexidine
— One cotton swab is designated for each pin to avoid cross-contamination
Fracture Immobilization: Internal Fixation
Surgical realignment of bony fragments using devices such as pins, plates, intramedullary rods, and bioabsorbable screws
Stainless steel, vitallius, or titanium
X-ray evaluation of alignment and healing
drug therapy for fractures
Analgesics: opioid and non-opioid
Central and peripheral muscle relaxants
— Carisoprodol (Soma)
— Cyclobenzaprine (Flexeril)
— Methocarbamol (Robaxin)
Tetanus and diphtheria toxoid
— Given for open fracture when immunization is unknown
Bone-penetrating antibiotics
— Cephalosporins – prophylactically preop**
A nurse is teaching a client how to manage an external fixation device upon discharge. Which of the following by the client indicates understanding?
a. I will clean pins more often if drainage from pin sites.
b. I will use separate cotton swab for each pin.
c. I will report loosening of the pins to my doctor.
d. I will move my leg by lifting the device in the middle.
E. I will report increased redness at the pin sites.
a, b, c, d, e
nutrition therapy for optimal soft tissue and bone healing
Increase protein (1 g/kg of body weight)
Increase vitamins (B, C, D)
Increase calcium, phosphorus , and magnesium
Increase fluid (2000 to 3000 mL/day)
Increase fiber
— Body jacket and hip spica cast patients: six small meals a day – avoid straining*
nursing fracture assessments
Obtain brief history of
— Traumatic episode
— Mechanism of injury
— Patient position when found
Transport to ED ASAP
— Thorough assessment
— Treatment started
subjective data for assessment of fractures
Health history
Medications
Surgery or other treatments
Functional health patterns
— Health perception–health management
— Activity–exercise
— Cognitive–perceptual
objective data for assessment of fractures
General
Cardiovascular
Musculoskeletal
Neurovascular
Skin
Possible diagnostic findings: X-ray, bone scan, CT scan, or MRI
neurovascular assessment of fractures
Musculoskeletal injuries can alter the neurovascular status of an extremity
— Especially important distal to injury
Assess and document before and after treatment
— Peripheral vascular assessment
— Peripheral neurologic assessment
Compare bilaterally
peripheral vascular assessment
Color and temperature
— Pallor and cool/cold indicates arterial insufficiency
— Warm and cyanotic indicates poor venous return
Capillary refill
— Greater than 3 sec indicates arterial insufficiency
- Pulses (rate, quality; compare bilaterally)
— Decreased or absent indicates arterial insufficiency
Edema
— Pitting with severe injury
peripheral neurologic assessment
Motor function
– Upper extremities
—– Abduct fingers (ulnar nerve), oppose thumb and small finger (median
nerve), flex and extend wrist (radial)
– Lower extremities
—– Dorsiflexion (peroneal nerve) , plantar flexion (tibial nerve); touch web
space between great and 2nd toe; stroke plantar surface
Sensory function
– Paresthesia or paralysis
—– Numbness/tingling, hypersensation, hyperesthesia
