fractures

Question 1

fracture

Answer 1

any break in continuity of bone that occurs when more stress is placed on bone than it is able to abs
amount of stress is dependent on what bone it is
causes: traumatic (massive muscle contraction, fall), fatigue (repeated prolonged stress), pathologic (infection, weak bone, possibly spont - elderly!)

Question 2

open

Answer 2

compound
fractured bone penetrates skin

Question 3

closed

Answer 3

simple
doesnt break skin

Question 4

orientations

Answer 4

transverse = straight line
spiral = twist
comminuted = more than 1 fracture line and more than 2 bone fragments, compression
impacted = compression
greenstick = bone bends, children

Question 5

cm

Answer 5

PED
at sight of bone disruption - pain, edema, deformity
pain = inflam, help splint
edema = splint
deformity = loss of function, abn mobility

Question 6

phases of bone healing

Answer 6

inflam: hematoma
reparative: fibrous cartilage, callous, ossification
remodeling
complications r/t fractures are often d/t healing process

Question 7

complications: delayed healing

Answer 7

freq x rays during healing to monitor
delayed union = bone pain and tenderness increase
- rf: tobacco, oa, anemia, uncontrolled DM, decreased vit D, hypothyroid, decreased nutrition, infection, complicated breaks
malunion = improper alignment
non union = no healing 4-6 mo post fracture, caused by poor blood supply, repetitive stress

Question 8

complications: impaired bone growth

Answer 8

pediatric consideration
fracture of epiphyseal plate, can delay future bone growth

Question 9

complications: compartment S

Answer 9

crush injuries, cast - too tight, swelling, bleed, assess
results from increase P w/n limited anatomic space
BV depressed -> decreased circ -> necrosis
nerves compressed -> pain, numb, uncomfy
tourniquet effect: edema at fracture site puts intense P on soft tissue, can lead to tissue hypoxia of muscle and nerves

Question 10

complications: compartment s - cm

Answer 10

edema (not pitting), loss or weak pulse (doppler), PAIN (out of proportion to injury; usually happens fast
fasciotomy -> bedside, for edema

Question 11

complications: fat embolism

Answer 11

fat molecule in lung after long bone fracture -> large trauma
fat molecule from bone marrow or traumatized tissue, released into BS and travels to lungs

Question 12

complications: fat embolism - cm

Answer 12

hypoxemia, LOC change, petechial rash (last S - occlussion of dermal capillaries by fat globules leading to extravasation of erythrocytes)

Question 13

complications: fat embolism - tm

Answer 13

supportive, will eventually be abs by body if pt can be stabilized long enough
vent, echmo

Question 14

complications: osteomyelitis

Answer 14

bone infection
osteo = bone; myelo = marrow cavity
acute or chronic pyogenic infection of bone (bacteria - staph A)
rf: recent trauma (open > closed), DM, hemodialysis, IVDU, splenectomy

Question 15

complications: osteomyelitis - direct

Answer 15

less common
open = open frature - gunshot, puncture (stab), sx (sternotomy)
sx/ insertion of metal plates or screws

Question 16

complications: osteomyelitis - indirect

Answer 16

bacteremia
from blood stream
BF brings bacteria to bone, infection -> inflam, bone destruction, pus/edema, increased pressure, ischemia, necrosis
osteoblasts lay new bone and infection becomes isolated

Question 17

complications: osteomyelitis - patho

Answer 17

pressure increases in bone and causes local arteries to collpase -> decreased O2, nutrition, immune cells, abx
therefore, it is hard to treat, impaired healing

Question 18

complications: osteomyelitis - cm

Answer 18

local = tender, warm, red, drainage, restricted movement (more than expected), spont fracture
systemic = fever, + blood culture, leukocytosis

Question 19

complications: osteomyelitis - pharm

Answer 19

weeks of IV abx, wound vac (infuse abx)
routes of contamination: direct and indirect
culture blood
empiric abx: nafcillin, cefazolin, vanc -> before culture and then bacteria specific therapy
continuous infusion or via wound vac