fractures and osteomyelitis Flashcards
fracture
any break in continuity of bone that occurs when more stress is placed on bone than it can absorb
causes of fx
traumatic (direct/indirect)
fatigue
pathologic (weak, high risk elderly)
how do you describe a fx
name of bone location orientation of fx (spiral) alignment of fx (displaced or aligned) condition of overlying tissue (open vs. closed)
what is another name for a open fx
compound
bone penetrates skin
what is another name for a closed fx?
simple
does not break skin
types of fx orientation
transverse ( straight across) spiral (twist) longitudinal (longways) oblique (side) impacted (overlapping) greenstick (kids, not complete) stress (elderly) avulsion (bone pulled away from tendon)
what does P.E.D stand for with fx
P- pain
E- edema
D- deformity (loss of function, abnormal mobility)
complication of delayed union
bone pain and tenderness increase
complication of malunion
improper alignment
complication of nonunion
no healing 4-6 months post fx
causing poor blood supply, repetitive stress
what types of injuries is compartment syndrome seen with?
crush injuries cast long bone injuries severe thermal burns animal bites
what causes compartment syndrome?
increased pressure within limited anatomic space
causes a tourniquet effect
puts intense pressure on soft tissue
can lead to tissue hypoxia of muscles and nerves
what is the cycle of compartment syndrome?
initial injury tissue swelling increased compartment pressure decreased perfusion pressure local hypoxia cell membrane damage
what is fat embolism syndrome
fat molecules in the lung following a long bone fx, major trauma
typically occurs 24-48 hrs after injury
where do fat embolisms come from?
fat molecules from bone marrow or traumatized tissues
released into blood stream and travels to lungs
traid of manifestations of fat embolisms
hypoxemia
altered LOC
petechiae
osteomylitis
an acute or chronic pyogenic (pus producing) infection of the bone
usually caused by bacteria (s. aureus)
risk factors for osteomylitis
recent trauma DIABETES hemodialysis IV drug abuse splenectomy PVD
types of direct route of contamination in osteomyelitis
open wound open fx gunshot puncture surgery insertion of metal plates or screws
types of hematogenous (indirect) routes of contamination in osteomylitis
most common type
from blood stream
bacteremia
hands, feet, femur, humerus, fibula
hematogenous route pathogenesis
arterial blood flow brings bacteria to bone
infection results (inflammation, bone destruction, pus and edema)
pressure increases
ischemia/necrosis
osteoblasts lay new bone around old bone
infection is isolated
what happens when the pressure inside the bone is the same as arterial flow?
local arteries collapse
meaning no oxygen, nutrition, immune cells, ANTIBIOTICS
what happens when local arteries collapse due to bone pressure?
impaired healing
clinical manifestations of local osteomylitis
local tenderness, redness
wound drainage
restricted movement
spontaneous fractures
clinical manifestations of systemic osteomylitis
spiking fevers
positive blood culture
leukocytosis
empiric therapy of osteomylitis
nafcillin
cefazolin
vancomycin
*bacteria specific
osteomyelitis complications
chronic osteomyelitis
local spread of infection
reduced limb or joint function
