Fractures

Question 0

What are the predisposing factors for a fracture?

Answer 0

Age, sex, pathological

( alcohol, smoking, osteoporosis )

Question 1

Definition of a fracture?

Answer 1

A break in the continuity of bone seep rating it into two or more parts. Either from direct or indirect violence/impact.

Question 2

Fracture Classification: types?

Answer 2

Simple/closed

Compound/open

Question 3

Types of breaks?

Answer 3

Get to f*** oisic

Greenstick - bone is bent. mainly in kids (soft bones)
Transverse - straight across, right angle to bones axis
Fracture dislocation
Oblique - the break is at an ange to bones axis, eg diagonal
Impacted - ends are driven into each other - common in arm in children
Spiral
Intra articular - fracture goes straight into the joint
Comminuted - fracture in which the bone fragments into several pieces.

Question 4

Clinical diagnosis? Tests?

Answer 4

Loss of function
Pain 
Position. (Eg foot rotation in hip fracture)
Type of injury and violence/impact
X-ray

Question 5

Fracture healing, 3 phases?

Answer 5

1. Reactive phase: fracture and inflammatory phase, granulation tissue formation
2. Reparative phase: callus formation, lamellar bone deposition
3. Remodelling phase: remodelling to original bone contour

Question 6

Factors delaying bone healing

Answer 6

Poor position
Lack of mobility 
Poor nutrition
Poor circulation
Drug therapy

Question 7

Fracture care.
Principles of fracture care and fixations?
Cast types?

Answer 7

• reduction
• immobilisation ( internal and external)
• restoration of function

Internal fixation -surgical fixation eg plates and pins
External fixation - screws placed into bone above & below fracture - then device is attached from outside skin ( to enable adjustment)

Types of casts: plaster of Paris and fibreglass

Question 8

Spinal fractures immediate effect?

Answer 8

Injury could result in:
Temporary bruising of spinal column, or complete transaction of cord at level of injury
All spinal injuries should be treated as unstable until proven otherwise

Question 9

Spinal fracture types

Answer 9

C3, 4 or 5 -paralysis of diaphragm & reduced repiratory function

T1 - 4 -sympathetic nerve supply - drop in blood pressure and reduced Kinsey function

Bleeding can take place at site of injury, could result in spinal shock which can last a few hours to months

Question 10

Aims of management of spinal fracture?

Answer 10

Protect spinal cord from injury, or further damage
To aid healing of the injured vertebral column - to achieve stability
Rehabilitation as early as possible

Question 11

Principles of management of spinal fracture.

Answer 11

Stabilise patient for example, reduced respiratory function, prescribe oxygen or may require ventilation.
Reduction of dislocation, usually by careful positioning rather than surgery.
Halo traction

Question 12

Post operative care in fracture patients.

Answer 12

Observations: NEWS charts. Routine obs (15 minutes for 1 hour, half hourly for 2 hours)
Ensure patient is in appropriate ward or place.

CSM - circulation/palmate to check colour and blood flow etc. sensation/use of touch (ask patient if they can feel touch). movement/ physio exercise

Oxygen therapy if required
IV fluids & fluid balance chart
Urine output, ensure patient is passing urine. Catheterise if in retention.
Bowel management, constipation due to lack of mobility etc.
Wound management. Dry and intact?
Pain management. Slow release morphine, regular paracetamol 4 hourly, oromorph breakthrough medication usually.
Pressure areas. Intact? Appropriate mattress if required. Pressure equipment
Physio & early mobilisation - prevent DVTs & chest/urine infections

Extra nursing care: 
elevation of affected limb
Nutrition important for bone healing
Use of ice packs
Prioritise adls: physical, psychological and social