Fractures

Question 1

Risk factors for hip fracture

Answer 1

○ Elderly 
○ Osteoporosis 
○ Fragile 
○ Frequent falls 
○ Co-morbidities and meds 
○ Weak quadriceps muscles

Question 2

What complications should we assess for in a casted fracture?

Answer 2

• Compartment syndrome
• pressure ulcer
• disuse syndrome (muscle is weakened and asymmetrical in size from absence of use)

Question 3

Management of fractures reduction?

Answer 3

Closed- manipulation and manual traction

Open- surgical intervention (ORIF)- open reduction with internal fixation

Question 4

How to diagnose a fracture

Answer 4

○X-Ray ○Bone scan ○Computed

tomography ○MRI- Precautions

Question 5

Types of Immobilization of the fractures

Answer 5

External- traction, splints, braces, casting, external fixation

Internal- pins, screws, plates, rods, hemi arthroplasty (joint replacement only not socket)

Question 6

Signs and symptoms of PE

Answer 6

○ Sudden onset of shortness of breath 
○ Restlessness 
○ Increased respiratory rate 
○ Tachycardia 
○ Chest pain 
○ Fever

Question 7

Health promotions and preventative measures for fractures

Answer 7

○ Calcium intake 
○ Vitamin D/sunlight exposure 
○ Osteoporosis screening 
○ Weight-bearing exercise 
○ Prevention of injuries

Question 8

Clinical Manifestations of hip fractures?

Answer 8

Leg shortening 
○ externally rotated 
○ Pain 
○ Usually cannot move without significant increase in pain 
○ muscular spasms

Question 9

S&S of fractures?

Answer 9

○ Pain ○ Muscle spasms ○ Loss of function ○ Deformity ○ Shortening ○ Crepitus ○ Swelling ○ Discoloration

Question 10

What is treatment for compartment syndrome

Answer 10

Fasciotomy: “surgical procedure in which the skin
and affected compartments fascia are opened” (used when pressure is 750mmhg and more)
○ Post op care:
- sterile dressing
-ROM
-Elevation and assessment

Question 11

Signs and symptoms of compartment syndrome?

Answer 11

○ Hallmark sign- pain that intensifies with passive ROM
○ Tight and full muscle
○ Unrelenting pain

Question 12

What is compartment syndrome?

Answer 12

○ Increased pressure within a limited space (cast, muscle compartment)
○ Compression of blood vessels & nerves
○ Compromise to circulation and nerve transmission

Question 13

Medical Management for hip fractures?

Answer 13

○ Skin or skeletal traction
○ Trochanter roll (an actual roll placed on outside of leg to prevent external rotation
○ Surgery ORIF - Arthroplasty ( hip replacement)

Question 14

Two types of casts

Answer 14

Fiberglass- Water resistant and quick procedure

Plaster- old and traditional. Cannot get wet

Question 15

Two common fractures amongst children?

Answer 15

• greenstick fractures (one side broken one side bent)

- spiral fractures (indicator of possible child abuse)

Question 16

What is fat embolism syndrome?

Answer 16

○ Fat globules released from bone marrow into
circulation
-petechaie (small red dots that look like bites, but is a result of FES)

Question 17

Nursing care for a fracture?

Answer 17

○ Determine physician order for
-activity
-need for assistive devices 
-sling
○ Patient teaching-
-Allow cast to dry completely
-Ice as ordered /elevation of extremity
-Do not insert objects down the cast or scratch skin
- Self-care
- What to report

Question 18

What are fractures?

Answer 18

○ A break in the continuity of bone

○ Defined according to the bone involved

Question 19

Immediate priorities for fracture?

Answer 19

○ Maintain ABCs ○ Immobilization ○ Assess neurovascular status ○ Maintain hemodynamic stability
Hypovolemic shock
Signs and symptoms ○ Elevate/ice ○ Infection prevention ○ Remove clothing or jewelry ○ Pain control

Question 20

Early fracture complications

Answer 20

○ Shock 
○ Fat embolism 
○ Compartment syndrome 
○ Thromboembolism 
○ Disseminated Intravascular Coagulopathy (DIC)

Question 21

Signs and Symptoms: Fat Embolism Syndrome (FES)

Answer 21

○ Rapid onset (24-72 hours after injury)
○ Change in behavior/disorientation
○ Hypoxia/Tachypnea/dyspnea
○ Tachycardia
○ Systemic effects: Pyrexia, Petechiae, Pale

Question 22

What are the main fracture classifications?

Answer 22

○ Closed (simple)- does NOT break the skin surface
○ Open (compound)- disrupts skin integrity, causing open wound, broke through the skin barrier.
O complete- broke through whole bone, dividing it into separate pieces
O incomplete- goes only through part of bone, not separating it.

Question 23

What is venous thromboemboli?

Answer 23

-DVT and pulmonary emboli thats associated with reduced skeletal muscle contractions and bedrest. High risks for this are fractures of lower extremities and pelvis

Question 24

Risk factors for fat embolism syndrome?

Answer 24

○ Risk factors

• Fracture of long bones or pelvic
• Multiple fractures
• Trauma
• Crush injuries
• 20-30 year olds, elderly with hip fracture