Fractures Flashcards
Def: Fracture
Differentiate Complete vs Incomplete
Break in continuity of the bone. Complete: a break through the full thickness of the bone
incomplete: A break that is NOT through the full thickness of the bone
Def: Pathological fracture
May occur during normal activity or following minimal injury when a bone is weakened by a disease process
Def: Fatigue or stress Fracture
Normal bone subjected to repeated stress w/o bone and muscle recovery
Fracture Classifications
Closed (simple) Fracture
Open (compound) fracture
Def: Closed Fracture
AKA: Simple fracture - Skin in tact over fracture site
Def: Open Fracture
AKA: Compound fracture - Skin over injury site is broken, either by fracture fragments piercing skin or a penetrating outside force.
S&S of Fractures
Edema Pain and tenderness muscle spasms deformity ecchymosis loss of function crepitation
Important Lab tests for Fractures
x-ray
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI) (for tissue damage)
White Blood Cell Count (WBC)
Hemoglobin (HBG) and Hematocrit (HCT) - assess for blood loss
Partial Thromboplastin Time (PTT) and International Normalized Ratio (INR) - assess clotting abilities
name the 6 stages of Fracture Healing, the time frame they would be occuring in, and what the stage is characterized by.
- Fracture Hematoma- semisolid clot- 72hrs
- Granulation Tissue - osteoid (precursor to bone tissue formation) 3-14 days
- Callus formation - minerals deposited - 14days
- Ossification -Strength, clinical union - 3wks - 6months
- Consolidation - distance diminishes, radiological union - 6months-1year
- remodelling - preinjury shape and strength - up to 1 year
Fracture management goals
Realignment (reduction)
Immobilization
Restoration
Def: Closed reduction
Non surgical, manual realignment of bone fragments to previous anatomical position - includes traction
Def: Open reduction
Correction of bone alignment through surgical incision - includes internal fixation with use of wires, screws, pins, plates, intramedullary rods or nails
Def: Traction
Application of a pulling force to an injured or diseased part of body or extremity while counter traction pulls in opposite direction
Def: Skeletal Traction
Traction applied for days or weeks, more weighted and is screwed into bone itself
Def: Skin Traction
On for a max of 72hrs before surgery - traction applied to the surface by pulling on skin.
4 was to immobilize a fracture
Fixation (internal or external)
Splits
Casts
Traction
when are external fixators used?
Complex fractures and when there is tissue damage or a wound that requires cleaning.
Neurovascular Assessment
CSM
C- Circulation (colour, temp, cap refill, edema, pulses)
S- Sensation (includes pain)
M- movement
Pre Op Fracture management
- Maintain CSM and alignment
- pain management
Assess for and prevent early complications - maintain skin integrity, hydration, NPO
- Ins and Outs, IV therapy
- Prepare for surgery (Physical, psychosocial, Labs)
Post Op Fracture Management
Monitor VS Dressing changes promote ambulation monitor wound drainage, drains prevent complications Meds (analgesic, antibiotics, anticoagulants, bowel care, muscle spasms, antiemetic) Pain assessment Neurovascular assessment* Oxygenation And rest status Hydration Urinary retention education referrals (OT/Pt) Nutrition and diet (those with healing fractures need increased protein)
Cast care
- elevate limb
- apply ICE
- Avoid handling (before cast is completely dry)
- Neurovascular checks
- Don’t get it wet
Complications with Fractures
Edema Compartment syndrome infection Deep Vein Thrombosis Pressure injuries
treatment for Edema
- Elevation and Ice
S&S of Compartment Syndrome - which are early and which are late signs
- Pain on passive motion and unrelieved w/ narcotic medication (one of the earliest signs)
- Poikilothermia: decrease in temperature (early sign)
- Pallor
- Parethesia: numbness or tingling (Early sign)
- Paralysis: very late sign
Pulselessness: very late sign
