Fractures Flashcards
Risk factors for hip fracture
○ Elderly ○ Osteoporosis ○ Fragile ○ Frequent falls ○ Co-morbidities and meds ○ Weak quadriceps muscles
What complications should we assess for in a casted fracture?
- Compartment syndrome
- pressure ulcer
- disuse syndrome (muscle is weakened and asymmetrical in size from absence of use)
Management of fractures reduction?
Closed- manipulation and manual traction
Open- surgical intervention (ORIF)- open reduction with internal fixation
How to diagnose a fracture
○X-Ray ○Bone scan ○Computed
tomography ○MRI- Precautions
Types of Immobilization of the fractures
External- traction, splints, braces, casting, external fixation
Internal- pins, screws, plates, rods, hemi arthroplasty (joint replacement only not socket)
Signs and symptoms of PE
○ Sudden onset of shortness of breath ○ Restlessness ○ Increased respiratory rate ○ Tachycardia ○ Chest pain ○ Fever
Health promotions and preventative measures for fractures
○ Calcium intake ○ Vitamin D/sunlight exposure ○ Osteoporosis screening ○ Weight-bearing exercise ○ Prevention of injuries
Clinical Manifestations of hip fractures?
Leg shortening ○ externally rotated ○ Pain ○ Usually cannot move without significant increase in pain ○ muscular spasms
S&S of fractures?
○ Pain ○ Muscle spasms ○ Loss of function ○ Deformity ○ Shortening ○ Crepitus ○ Swelling ○ Discoloration
What is treatment for compartment syndrome
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
Signs and symptoms of compartment syndrome?
○ Hallmark sign- pain that intensifies with passive ROM
○ Tight and full muscle
○ Unrelenting pain
What is compartment syndrome?
○ Increased pressure within a limited space (cast, muscle compartment)
○ Compression of blood vessels & nerves
○ Compromise to circulation and nerve transmission
Medical Management for hip fractures?
○ Skin or skeletal traction
○ Trochanter roll (an actual roll placed on outside of leg to prevent external rotation
○ Surgery ORIF - Arthroplasty ( hip replacement)
Two types of casts
Fiberglass- Water resistant and quick procedure
Plaster- old and traditional. Cannot get wet
Two common fractures amongst children?
- greenstick fractures (one side broken one side bent)
- spiral fractures (indicator of possible child abuse)
What is fat embolism syndrome?
○ Fat globules released from bone marrow into
circulation
-petechaie (small red dots that look like bites, but is a result of FES)
Nursing care for a fracture?
○ 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
What are fractures?
○ A break in the continuity of bone
○ Defined according to the bone involved
Immediate priorities for fracture?
○ Maintain ABCs ○ Immobilization ○ Assess neurovascular status ○ Maintain hemodynamic stability
Hypovolemic shock
Signs and symptoms ○ Elevate/ice ○ Infection prevention ○ Remove clothing or jewelry ○ Pain control
Early fracture complications
○ Shock ○ Fat embolism ○ Compartment syndrome ○ Thromboembolism ○ Disseminated Intravascular Coagulopathy (DIC)
Signs and Symptoms: Fat Embolism Syndrome (FES)
○ Rapid onset (24-72 hours after injury)
○ Change in behavior/disorientation
○ Hypoxia/Tachypnea/dyspnea
○ Tachycardia
○ Systemic effects: Pyrexia, Petechiae, Pale
What are the main fracture classifications?
○ 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.
What is venous thromboemboli?
-DVT and pulmonary emboli thats associated with reduced skeletal muscle contractions and bedrest. High risks for this are fractures of lower extremities and pelvis
Risk factors for fat embolism syndrome?
○ Risk factors
- Fracture of long bones or pelvic
- Multiple fractures
- Trauma
- Crush injuries
- 20-30 year olds, elderly with hip fracture
