Fractures/Ortho Surgery Flashcards
4 classifications for fractures?
- Extent of break
- Extent of soft tissue damage
- Cause
- Type
classifying fracture by extent
Complete versus Incomplete
Open vs Closed
complete vs incomplete fracture
Complete = broken in two Incomplete = not broken into two pieces, still connected
open versus closed fracture
closed = no bone sticking out of skin open = sticking out of bone - risk of infection and osteomyelitis!
classifications of fracture by cause
Pathologic or Spontaneous = osteoporosis
Fatigue/Stress = running /jumping
Compression = fall and land on feet
what is an example of a cause of pathologic fracture?
osteoporosis
example of cause of fatigue or stress fracture?
running/jumping
example of compression fracture cause?
fall and land on feet
fracture where bone broke and not aligned well
displaced
fracture that runs all the way around the bone
spiral
fracture in kids that is like incomplete
greenstick
fracture where there is still some connection b/w bone but also fragments
fragmented
fracture where there is shattering of bone in many pieces
comminuted
fracture runs up the bone length
oblique
fracture where two bones pushed together and leads to comminuted fracture
impacted
risk factors for fractures?
*Riding in cars -> car accident risk Falling Malnutrition -> over age on 30 need to take in enough Ca and Vit D Sports Osteoporosis
where do adults, young/middle aged, and older adults have most of their fractures?
Adults: Ribs
Young and middle-aged: Femoral
Older adults: Femur
health promotion education/interventions for fracture prevention
Seat belts Airbags Reducing driving while impaired Osteoporosis screening/ treatment Fall Prevention
3 things to get in history when assessing fracture
Type of Injury
Alcohol and drug use
Disease states
what do we prioritize with physical assessment of fracture
ABC!
what is indicator that we need to get imaging for fracture
pain
head to toe signs of fracture?
- Change in bone alignment
- Shortening
- Change in Shape
- Bruising & Swelling
C in CMS assessment
Circulation Color Pulse Capillary refill Temperature (warm, cool?)
-compare to other extremity, focus on distal end
M in CMS assessment for fracture
Motion : Movement distal to fracture?
S in CMS assessment for fracture
Sensation
Tingling? Pain? Numbness?
Check extremity distal to injury… Compare it to other extremity… Changes?
Change in CMS=
indication of compartment syndrome = priority assessment!
Diagnostics for fracture
H&H-bleeding WBC- infection ESR X-Ray CT-scan Hip Spine MRI
When do we immobilize fracture?
immediately to prevent damage
types of immobilization
Bandage
Splint
Cast
Traction
interventions for fracture
- ABC
- Pain
- Immobilize
- Sterile Gauze
- Reduction
- Elevation
- Ice
can nurses reduce bones?
no
what is most common way to manage a simple fracture
closed reduction
what happens in closed reduction?
Utilization of traction on bone and moving ends to position of realignment
what do we use to confirm proper placement of bone after closed reduction?
xray
when do we want to do complete a closed reduction?
ASAP to prevent nerve damage/promote proper bone healing
nurse role in closed reduction?
Administer medications
Monitor patient
when do we use splints? which is more goodly- splint or cast?
More commonly used on body parts that do not bear weight
–> preferred over cast b/c can adjust if swelling !
what do we use to immobilize ankle and foot id weight bearing is allowed?
orthopedic boot or shoe
*also preferred over cast
when do we use a cast?
- Typically reserved for complex fractures and LE fractures
- Also utilized for correction of deformities and when NWB
what material do we prefer to make casts out of
fiberglass!
can fiberglass cast get wet?
Can get wet (but padding underneath cannot)
can use _____ to waterproof but it cannot be fully submerged in water
gore-tex
fiberglass vs plaster cast
fiberglass = most common, dries quick, reduces skin breakdown, need stockinette and padding underneath plaster = need stockinette and padding underneath, 24 hours to dry
when do we use bivalve in cast?
for swelling, whole top and bottom come off
why put a window on a cast?
if open wounds and need to do wound care
cast intervention assessment
Increased pain
Increased drainage
Fowl smell
Circulation
______ is risk for compartment syndrome
cast
running vs balanced traction
Balanced: Fractured extremity is suspended with two opposing forces
–> can move limb w/o changing the traction
Running: Force exerted in one plane only (fractured limp is the opposing force)
–> if move limb they change traction
if move limb they change traction: balanced or running
running
skin vs skeletal traction
Skin: Force is applied to the fractured limp with use of bandage or splint
Skeletal: Force is applied to fractured limp with use of pins inserted into bone
it is important to make sure the weights for traction are not ____ ____ _____
on the floor
who do we contact if changes in weight w/ traction?
provider
what is buck’s traction? what kind of pain is it particularly helpful for?
Buck’s Traction
- Running, skin traction
- Used for pain reduction specifically - esp. for hip fracture until repaired surgically
what is halo traction used for?
- cervical fracture
- used for pain reduction
Open Reduction with Internal Fixation (ORIF) uses what to reduce fracture?
- Metal pins, rods, prostheses or plates are used for fixation in open surgery
- Affected area is kept immobile during healing process
how quickly can you become mobile again after ORIF?
immediately! and no traction
do you need traction with ORIF!
no!
post op ORIF care
- Pain Management : need to be able to move, breathe, what pain goal can get you there?
- Ambulation right away
- Prevent Complications
- PT
- NV Compromise
benefits of external fixation?
Less Blood Loss
Early Ambulation
Promotes Healing
complications from fixation surgery
Acute Hypovolemic shock Hypovolemic Shock Fat Embolus Syndrome VTE (PE) Infection (Including osteomyelitis) Avascular Necrosis Delayed Union
what is acute compartment syndrome?
- muscles are in fascia compartments but with swelling the fascia prevents expansion and get compression in blood vessel and nerves
- –> ischemia of muscle
- —> damage to vessel, nerves, septic, amputation
acute compartment syndrome prevention
> Avoid tight dressings and casts
Perform frequent CMS assessments for EARLY detection
—6 P’s changes
volkmann’s contracture
- forearm fracture as a result of acute compartment syndrome
- -> muscles necrosed and becomes misshapen
fat embolism syndrome –> what is it and when do you see it?
-Fat globules released with all long bone fractures
(also hip and knee arthroplasty)
-Small percentage of people will develop FES
–>24-72 hours after trauma
FES triad of sxs
- Lungs (low O2, Dyspnea, tachypnea)
- Brain (Confusion, headache, seizure, altered LOC)
- Skin (Petechia on neck, chest and arms)
FES treatment
- Prevention
- > Early fixation
- > Surgical technique
- Supportive
- Oxygen
- Fluids
- Albumin: bind to fatty acid
define surgical site infection
=If site becomes infected within 30 days of surgery
=If hardware becomes infected in the 1st year
surgical site infection can lead to ….
osteomyelitis
systemic vs local signs of infection
*consideration for elderly
systemic = fever, elderly have depressed immune response and may not have a fever with infected fracture local= red, hot
upper extremity fracture interventions
- Remove jewelry ASAP!
- Perform NV assessment
- Immobilize
- Elevate
- Apply Ice
- Manage Pain
hip fracture interventions/risks (things to consider for elderly)
- High mortality rate
- *Osteoporosis is the biggest risk factor
- IV Morphine/ PCA
- Avoid Demerol can contribute to delirium
- Delirium
- Mobility important
biggest risk factor for hip fracture
osteoporosis + elderly
avoid ______ in elderly with fracture b/c it can contribute to delerium
demerol
chest and pelvis fracture interventions/assessment
- -Potential for heart and lung damage (and other organs)
- ABC First
-Pelvis Fractures can quickly lead to death (loss of blood)
Look for blood in the urine, stool
*****Abdominal rigidity????
Abdominal swelling
spine fractures
-Associated with osteoporosis, cancer, MM
Causes pain, deformity and Neuro compromise
Non-surgical
Surgical
Kyphoplasty
Vertebroblasty
