Fractures

Question 0

What is important to note about Colles’ fracture?

Answer 0

It is a fracture of the distal radius, common and adults, especially women over 50, usually results when trying to break the fall with in outstretched hand

Question 1

What are the types of fractures?

Answer 1

Colles' fracture
Fracture of the humerus
Fracture of the pelvis
For moral shaft fracture
Fracture of the tibia
Vertebral fracture
Facial fractures
Mandibular fracture

Question 2

What is important to note of the humerus fracture?

Answer 2

Fracture of the shaft are common in young and middle-aged adults

Question 3

What is important to note about the pelvis fracture?

Answer 3

It can be life-threatening depending on the mechanism of the injury and association to vascular insult
It has the highest mortality rate of all fractures
Can cause serious intra-abdominal injury
May die from sepsis, may develop a deep vein thrombosis or a fat embolism

Question 4

What is important to know about the femoral shaft fracture?

Answer 4

Common injury and young adults, related to soft tissue injuries maybe more serious than bone fractures

Question 5

What is important to note about the Fracture of the tibia?

Answer 5

Vulnerable injury because it has no anterior muscle covering it, common site for a stress fracture

Question 6

What is important to know about the vertebrL fracture?

Answer 6

Most are due to accidents, most are stable fracture, most common injury is a compression fracture

Question 7

What is important to note about facial fractures? I have

Answer 7

Primary concern is to maintain patent airway, treat all patients as though they have had a cervical injury, until proven otherwise

Question 8

Important to note about the mandibular fracture?

Answer 8

Usually require surgical immobilize a shit, wiring the jaws for up to six weeks

Question 9

Hip fractures and seniors

Answer 9

Almost 70% are related to osteoporosis
10 to 20% of seniors hospitalized for the hip fracture will die within six months
If the percent of seniors admitted to the hospital with a hip fracture will never walk again without assistance, and will need extensive homecare

Question 10

What is important to note about a hip fracture?

Answer 10

Is a fracture of the proximal third of the femur
Fracture occurring with the hip joint capsules are called intracapsular fractures
Usually due to osteoporosis and minor trauma

Question 11

Cwhat are the clinical manifestations of a hip fracture?

Answer 11

External rotation
Muscle spasm
Shortening of the leg
Severe pain and tenderness

Question 12

What is the diagnostic test done for a hip fracture?

Answer 12

X-ray

Question 13

What is the surgical repair for a hip fracture?

Answer 13

It is the preferred method of treating hip fracture
Allows for early mobilization, which decreases the risk of major complications
Intracapsular fractures are paired with an Endo prosthesis to replace the femoral head
Extracapsular fracture or repaired with plates and other devices

Question 14

what is the total hip replacement?

Answer 14

Significantly improved pain and functional use of affected joint
Implants may be cemented in place
Good for less active, older adults who have a less than ideal bone strength, and life expectancy of less than 25 years
Artificial hip components tend to loosen overtime and require revision surgery

Question 15

What is the collaborative care for an patient elderly patient with a hip fracture?

Answer 15

Elderly are most likely to have a hip fracture, that’s need to be aware of full medical history
Ensure patient knows their risk for displacement up to six or eight weeks postoperatively
Teach patient and family to avoid 90° flexion

Question 16

What is the general assessment of a fracture?

Answer 16

Neurovascular assessment of the effect of limb:
Color temperature, capillary refill, distal pulses, edema, sensation, movement, and pain
Cardio respiratory status:
Heart rate, blood pressure, respirations, and laboratory values

Question 17

What teaching to provide with amputation?

Answer 17

The goal is to prevent amputation from happening in the first place, teach the patient to manage risk factors for peripheral vascular disease, diabetes, pressure ulcers and osteomyelitis, and Traumatic injury at home, work and play

Question 18

What are the indications for amputation?

Answer 18

Circulatory impairment related to perform peripheral vascular disease, diabetes, pressure ulcers, osteomyelitis
Traumatic injury, thermal injury, cancer, widespread or uncontrolled infection, congenital disorder

Question 19

What is a closed amputation?

Answer 19

Perform to create a weight bearing residual limb
Anterior skin flap with dissected soft tissue padding covers the bone at the end of the stump and is sutured posteriorly to avoid being on the end

Question 20

What is an open amputation?

Answer 20

Performed when the site is infected or there is potential for the same
It is dressed and dressing changes as ordered
site will be sutured closed for the surgeon is satisfied with the status

Question 21

What is disarticulation?

Answer 21

Amputation perform through a joint

Question 22

What is the goal for amputation?

Answer 22

At the time of the surgery it is to preserve as much length and function as possible when removing all infected, diseased, or ischemic tissue
Postoperatively. It is important to manage pain, heal well, actively engage in rehab in order to restore as much function as possible, adopt a lifestyle changes and effectively cope with altered body image

Question 23

What is The collaborative care for amputation?

Answer 23

Patient and family will require much psychological support free and postoperatively, they will go through a grieving process and this is normal
Preoperatively the patient and family need to be informed about the types of prosthesis, postop exercises that will need to be performed there will also need to be aware of phantom limb sensation

Question 24

What is the collaborative care for postop amputation?

Answer 24

If it is a traumatic amputation monitor for posttraumatic stress disorder Be alert to possible hemorrhage Maybe fitted for a prosthesis during surgery, depending on the location Avoid flexion contracture, specially hip flexion Avoid dangling the amputated limb Teach patient how to transfer from bed to chair prior to discharge teach patient had a crutch walk

Question 25

What are common joint surgeries?

Answer 25

Synovectomy: removal synovial membrane Ostoteomy: correct deformity and relieve pain, involves removing or adding bone to change bone alignment and shift weight bearing Debridement: removal of diseased or damaged tissue, bone, cartilage Arthroplasty: reconstruction or replacement of a joint Athrodesis: surgical fusion of a joint

Question 26

What is musculoskeletal problems?

Answer 26

Most musculoskeletal problems are caused by injury from a traumatic event resulting in a fracture, dislocation, associated soft tissue injury, or some combination Most of these injuries are preventable Education about basic principles of safety an accident production is key in reducing MS injuries and

Question 27

Fractures

Answer 27

Most fractures are related to dramatic injury, but some are secondary to disease process Are described and classified according to: Type Whether their break exposes the bone to the external environment Anatomical location of fracture on the involved bone Weather stable or unstable

Question 28

What are the types of fractures?

Answer 28

Complete: Rick across the entire cross-section of the bone, bone is usually displaced from its normal position Incomplete or greenstick: Break is not completely through Impacted: bone ends are driven into one another Simple or closed: no break in the skin Compound, open, or complex: bone is exposed to the outside environment, maybe inside to out or can be outside to in Stress: result of repeated bone trauma from athletic activities Compression: involves compression of the vertebrae, most often due to osteoporosis Avulsion: is related to strong pulling effects of the tendons or ligaments on the bone Longitudinal, oblique, spiral, transverse: referred to angle or position of the fracture along the bone

Question 29

What are the clinical manifestations of fractures?

Answer 29

Immediate localized pain and decreased function in the affected area Inability to weight bear or use the affected limb Guarding and protecting of the affected area Bone deformity Abnormal position bruising, edema, swelling, crepitation, muscle spasm

Question 30

What is the diagnostic test done for fractures?

Answer 30

History and physical examination Any symptoms Neurovascular assessment which includes skin sensation, color, and temperature X-ray, CT, MRI

Question 31

If the fracture is suspected what should be done?

Answer 31

Immobilize extremity immediately in the position I just found Is the patient is treated by Dr. the patient might have skeletal or skin traction, cast or splint, crutches, sling,other forms of support, external fixation, internal fixation

Question 32

What is the process of fracture healing?

Answer 32

First is fracture hematoma, bleeding at the time of injury Second is granulation tissue, phagocytosis which absorbs products of necrosis, hematoma converts into granulation tissue Third is Californication, is composed of cartilage osteoblast, calcium, and potassium Fourth is ossification, newborn is built up as osteoclasts destroy the dead bone Fifth is bone remodeling, excess bone is reabsorbed

Question 33

What is important to note during the ossification stage of fracture healing?

Answer 33

If on skeletal traction, may be removed and displaced by cast If in a cast, same may be removed and replaced by crutches

Question 34

What are factors that influence healing time with fractures?

Answer 34

Age, initial displacement, and inadequate reduction and immobilization, excessive movement, infection, poor nutrition, presence of other diseases

Question 35

What are the treatment goals with fractures?

Answer 35

Anatomical realignment of bone fragment, immobilization to maintain realignment, restoration of normal function of injured parts

Question 36

What are the treatment options for fracture?

Answer 36

Closed reduction is nonsurgical, manual realignment of the parts Open reduction is surgical realignment of bone parts

Question 37

What is traction?

Answer 37

Apply a pulling force to the injured part at the same time that counter traction pulls in the opposite direction More often used in children because want to minimize the damage to the growth plates Less often used today because of surgical advances

Question 38

Why is traction used?

Answer 38

Reduce and immobilize fracture or dislocation Reduce or eliminate muscle spasm Regain normal length and realignment of extremity Prevent joint deformity Reduced pain Expand joint space

Question 39

What is skin traction used for?

Answer 39

Use for fractures of the hip, femur, knee, and back | Used up to 72 hours, until skeletal traction her surgery can be performed

Question 40

What is skeletal traction?

Answer 40

Provide longer-term pull to keep injured bones and joints aligned Pin or wire is inserted into the bone and weights are attached Major disadvantage is infection Other disadvantage is delayed union or nonunion or if excessive weight is applied

Question 41

What is the collaborative care for a patient who has traction?

Answer 41

Proper body alignment and physician to promote constant traction forces and avoid external hip rotation Not interrupt or interfere with the weights applied Monitor for signs of infection Bed exercises as patient is able to

Question 42

What are casts?

Answer 42

Immobilize and ensure stability Generally incorporate joints above and below the fracture Some casts are made of fiberglass

Question 43

Collaborative care for a patient who has a cast?

Answer 43

Support The casted extremity by elevating Encourage active range of motion unaffected joist remote blood flow and reduce stiffness and contractures Monitors cannot cast edges Monitor sites distal to the cast for signs of pressure necrosis

Question 44

What is external fixation?

Answer 44

And external fixator is a medical device composed of metal pins that are inserted into the bone and attached to the external rods to stabilize the fracture Can be used to apply traction, compressed fracture fragments, and immobilize

Question 45

What is the collaborative care for external fixation?

Answer 45

Monitor for infection Aseptic technique when cleansing pins Protect protrusions from getting caught in clothing, bed linens

Question 46

What is the general neurovascular assessment?

Answer 46

This is done post traction, cast, external or internal fixation, and is important to regularly assess It includes skin sensation, color, temperature, and pulses Ask patient to rate pain on a scale of 1 to 10

Question 47

What is the general collaborative care for fractures?

Answer 47

Observed dressing or cast for any signs of bleeding or drainage Monitor volume and types of drainage Monitor for pressure ulcers, deep vein thrombosis, and pulmonary emboli Know the weight-bearing limitations Teach patient how to reduce risk of falling Teach patient about moderate exercise and good nutrition

Question 48

What are complications of fractures?

Answer 48

If death occurs it is usually the result of damage to an underlying organ or complications of fracture or immobility Direct complications are osteomyelitis, nonunion a bone fragments, and a vascular necrosis Indirect complications are blood vessel or nerve related damage, compartment syndrome, fat embolism, venous thrombosis, Trumatic or hypovolemic shock Majority heal without complication

Question 49

What is compartment syndrome?

Answer 49

Upper and lower extremities have 38 mile Fatio compartments, but contain my phone, blood supply and nerves, and are bounded by the fascia Occurs when the pressure within a confined myofascial compartment they become greater than that of the blood vessels in the same compartment. Blood vessels and nerves become compressed. Circulation and nerve transmission in the affected extremity is affected This requires immediate attention to prevent tissue death and potential loss of affected limb

Question 50

Acute compartment syndrome

Answer 50

Medical emergency Sudden severe decrease in blood supply to tissue distal to the area of injury Necrosis of muscle tissue can happen quickly if not treated immediately

Question 51

What are the causes of acute compartment syndrome?

Answer 51

Causes are trauma, fractures, severe burns, crush injury, venomous snakebite, extensive soft tissue damage

Question 52

What are the symptoms of compartment syndrome?

Answer 52

Assess the extremity using the six P's: | Paresthesia, pain distal to the injury, poikilothermia, pallor, paralysis, pulselessness

Question 53

What is the treatment for compartment syndrome?

Answer 53

Remove, loosen, or split the cast or bandages Reducing traction wait may be helpful Usually require surgical decompression If caught late, usually will require amputation

Question 54

What is fasciotomy?

Answer 54

Left open for several days to ensure adequate soft tissue decompression, potential for infection at the site is high