Fractures

Question 0

In which 4 ways can a fracture be classified?

Answer 0

1) Type
2) Communication or non-communication with the external environment
3) Anatomic location or bone involved
4) Stable or unstable

Question 1

Give 3 examples of stable fractures and 2 examples of unstable fractures.

Answer 1

1) Stable Fractures - Transverse, spiral and greenstick fractures
2) Unstable Fractures - Comminuted and oblique fractures

Question 2

Name three examples of classifying a fracture according to it’s communication with the external environment.

Answer 2

1) From within to without
2) From without to within
3) Closed fracture

Question 3

What are the 6 stages of Fracture Union?

Answer 3

1) Day 0-3 (Hematoma)
2) Day 3-14 (Granulation Tissue) osteoid
3) 2 Weeks (Callus Formation)
4) 3 Weeks to 6 Months (Ossification)
5) 6 Months - 1 Year (Consolidation)
6) 1 Year (Remodeling)

Question 4

What 7 signs could indicate a closed fracture (since we are unable to see open wound with exposed bone)?

Answer 4

1) Deformity or unnatural position of affected limb
2) Edema and Ecchymosis
3) Muscle spasms
4) Tenderness and pain
5) Loss of function
6) Numbness, tingling and loss of distal pulses
7) Crepitus (grating sound of bone on bone)

Question 5

What is “closed reduction”?

Answer 5

Closed reduction - Nonsurgical, manual realignment of bone fragments to previous anatomic position. Traction and countertraction are manually applied to bone fragments to restore position, length, and alignment.

Question 6

What is “Open Reduction”?

Answer 6

Open Reduction - Correction of bone alignment through surgical incision. Includes internal fixation with use of wires, screws, pins, plates, intramedullary rods, or nails.

Question 7

Why does an open reduction have a quicker recovery than a closed reduction?

Answer 7

Because an open reduction uses screws and plates that help to stabilize the bones.

Question 8

What three types of metals are used as fixation devices for fractures?

Answer 8

1) Stainless steel
2) Vitallium
3) Titanium

Question 9

What is traction? What can it be used for?

Answer 9

The application of a pulling force to an injured or diseased part or extremity while counter traction pulls in the opposite direction. Can be used to expand a joint space during surgery.

Question 10

What are the 4 reasons Traction is used?

Answer 10

1) To prevent or ⬇ muscle spasms
2) To immobilize a joint or part of the body
3) To ⬇ a fracture or dislocation
4) To treat a pathologic joint condition

Question 11

The acronym TRACTION is used to remember what to assess when caring for a patient in traction. What does each letter stand for?

Answer 11

1) T - Temperature of patient and their extremity
2) R - Ropes hang freely
3) A - Alignment
4) C - Circulation checks
5) T - Type and location of fracture
6) I - Increase fluid intake
7) O - Overhead trapeze
8) N - No weight on bed or floor

Question 12

What are the 2 most common types of traction?

Answer 12

1) Skin traction

2) Skeletal traction

Question 13

What are the 3 characteristics of Skin Traction?

Answer 13

1) Used for short-term treatment until skeletal traction or surgery is possible.
2) Tape, boots or splints applied directly to skin to maintain alignment, assist in reduction, and help diminish muscle spasms in injured extremity.
3) Traction weights are 5-10 pounds

Question 14

Give 4 examples of Skin Traction.

Answer 14

1) Buck’s
2) Russell’s
3) Pelvic
4) Cervical

Question 15

What are the 3 characteristics of Skeletal Traction?

Answer 15

1) In place for longer periods
2) Used to align injured bones and joints or treat joint contractures and congenital hip dysplasia.
3) Skeletal traction weight ranges 5-45 pounds

Question 16

What 4 things should the nurse remember about Casts?

Answer 16

1) during drying periods use palms, not your finger tips because this could leave and impression and possibly cause skin breakdown.
2) Edges may need to be petaled.
3) Plaster sets in 15 mins and synthetic casts dry in 15 mins
4) Casts are not strong enough for weight bearing until 24-72 hours
5) Fresh plaster should never be covered with a blanket because this impedes drying.

Question 17

What are the 6 Dos of Cast Care?

Answer 17

1) Do apply ice directly over the fracture site for the first 24 hours
2) Do check with MD before getting fiberglass wet
3) Do dry cast after exposure to water
4) Do elevate extremity onto pillows above heart level for first 24 hours
5) Do observe for sign of pressure
6) Do move joints above and below cast regularly

Question 18

What are the 6 Don’ts of Cast Care?

Answer 18

1) Don’t get plaster cast wet
2) Don’t remove any padding
3) Don’t insert any objects inside the cast
4) Don’t bear weight on new casts for 24-72 hours
5) Don’t cover casts with plastic for prolonged periods because heat will build up
6) Don’t place casted extremity in a dependent position because of the possibility of edema

Question 19

From which food source might a patient obtain their daily requirements of ascorbic acid?

Answer 19

Cranberry Juice

Question 20

Define Compartment Syndrome

Answer 20

Elevated intracompartmental pressure within a confined myofascial compartment that can compromise neurovascular function of tissues within that space

Question 21

Describe the two basic types of Compartment Syndrome?

Answer 21

1) ⬇ Compartment Size - Results from restrictive dressings, splints, casts, excessive traction, or premature closure of fascia.
2) ⬆ Compartment Size - Related to bleeding, edema, chemical response to snakebite, or IV infiltration

Question 22

What SxS associated with the 6 P’s are characteristics of impending compartment syndrome?

Answer 22

1) Paresthesia - Numbness and tingling
2) Pain - Distal to injury that is not relieved by opioid analgesics and pain on passive stretch of muscle traveling through compartment.
3) Pressure - ⬆ in compartment
4) Pallor - Coolness, and loss of normal color of extremity
5) Paralysis - Loss of function
6) Pulse - Diminished or absent peripheral pulses

Question 23

What is the surgery to relieve compartment syndrome called?

Answer 23

Fasciotomy

Question 24

When does a fat embolism usually occur?

Answer 24

Within the first 36 hours of skeletal injury

Question 25

Fat Embolisms are usually caused by fractures involving which particular bones?

Answer 25

1) Long bones (i.e., femur and tibia)
2) Ribs
3) Pelvis

Question 26

Fat Embolisms have been known to happen especially after which 5 particular procedures/incidence?

Answer 26

1) Total joint replacement
2) Spinal fusion
3) Liposuction
4) Crush injuries
5) Bone marrow transplant

Question 27

What are the 7 SxS of Acute Respiratory Distress Syndrome (ARDS) brought on by a Fat Embolism?

Answer 27

1) Chest pain
2) Tachypnea
3) Cyanosis
4) Dyspnea
5) Apprehension
6) Tachycardia
7) ⬇ Partial pressure of arterial oxygen

Question 28

What are the 4 characteristics of Fat Embolisms?

Answer 28

1) Happens rapidly
2) Patient impending doom
3) Skin color changes from pallor to cyanosis quickly
4) Patient may become comatose

Question 29

What is the difference in the reason for using Skin Traction Vs. Skeletal Traction?

Answer 29

1) Skin Traction - Used in assisting reduction & ⬇ muscle spasms
2) Skeletal Traction - Used to align injured joints and bones & treat contractures and congenital hip dysplasia