LEC 2: Fractures Flashcards by A Lee

Fracture

Break in continuity of the bone; can be complete or incomplete

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Pathological Fracture

May occur during normal activity or following minimal injury when a bone is weakened by a disease process

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Fatigue or Stress Fracture

Normal bone subjected to repeated stress without bone and muscle recovery

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How are fractures classified?

Classification by mechanism of the injury or the type of bone discontinuity

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Closed (simple) Fracture

Skin over site is intact

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Open (compound) Fracture

Skin over injury site is broken either by fracture fragments, piercing skin, or a penetrating outside force

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What are clinical manifestations (signs and symptoms) of fractures?

Edema
Pain and tenderness 
Muscle spasms
Deformity 
Ecchymosis 
Loss of function 
Crepitation

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What are diagnostic and lab test done for fractures?

History and physical exam
X-ray exam 
Computed tomography (TC) 
Magnetic resonance imaging (MRI) 
White blood cell count (WBC) 
Hemoglobin (HBG) 
Hematocrit (HCT)
Partial thromboplastin time (RR) 
International normalized ratio (INR)

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What are the six phases that bones goes through for self-healing?

Fracture hematoma
Granulation tissue
Callus formation
Ossification
Consolidation
Remodelling

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Fracture Hematoma

Semisolid clot

- Takes 72 hours

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Granulation Tissue

Osteoid

- Takes 3 to 14 days

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Callus Formation

Minerals deposited, strengthens bone

- Takes 14 days

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Ossification

Strength by helping create new bone and clinical union

- Takes 3 to 6 weeks

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Consolidation

Distance diminishes and radiological union

- Takes 6 months to a year

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Remodelling

Pre-injury shape and strength

- Up to 1 year

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What are the three goals of fracture management?

Anatomical realignment of bone fragments (reduction)
Immobilization to maintain alignment
Restoration of normal or near formal function to the injured part

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What are the three types of anatomical realignment?

Close reduction
Open reduction
Traction

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Anatomical Realignment: Close Reduction

Nonsurgical, manual realignment of bone fragments to previous anatomical position

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Anatomical Realignment: Open Reduction

Correction of bin alignment through surgical incision

Includes internal fixation with use of wires, screws, pins, plates, intermedullary rods, or nails

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Anatomical Realignment: Traction

Application of a pulling force to an injured or diseased part of body or extremity while counetrtraction pulls in opposite direction
Used for skeletal traction or skin traction

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What are the four types of fracture immobilization items?

Fixation
Splint
Cast
Traction

Fracture Immobilization: Fixation

Internal: pins, plates, rods, and screws
External: Metallic external device, is outside the body and still screwed into the bone

What do you look for in a neurovascular assessment for patients with fractures?

Colour 
Temperature 
Cap refill
Edema
Pulses
Movement 
Sensation 
Pain

*Check CSM

What are the pre-operative nursing management for patients with fractures?

Maintain adequate CSM, alignment
Pain management
Assess for and prevent early complications
Maintain skin integrity, hydration, NPO
Ins and outs, IV therapy
Prepare for surgery; physical, psychosocial, lab & diagnostic test, blood work

What are the post-operative nursing management for patients with fractures?

``` Monitor vital signs Aseptic dressing changes Promoting ambulation Monitoring wound drainage, drains Preventing complications Medications Pain assessment Neurocascular assessment; critical Oxygenation and respiratory status Hydration Urinary retention Bowles/ bladder Education Referrals Nutrition and diet ```

What do you need to do for cast care, post-casting?

Elevate limb for the first 24 to 48 hours Apply ice Avoid handling, especially the first 24 hours Neurovascular checks Don't get wet

Promotive and Preventative Management: What condition do you want to prevent?

``` Edema Compartment syndrome Infection Deep veins thrombosis Pressure injuries ```

Edema

- Commonly occurs after bone/ tissue injury - Prevention/ decrease in edema is key to preventing other dangerous conditions - Decreasing edema relieves pain

Compartment Syndrome

Increased tissue pressure within a limited space

What are signs and symptoms of compartment syndrome?

- Pain (pain on passive motion also) - Poikilothermia - Pallor - Paresthesia - Paralysis - Pulselessness

What are treatments for compartment syndrome?

- Want to elevate and ice to prevent - Is continues, may get orders to cut the cast off - If symptoms keep showing, you do NOT want to keep elevation and icing due to circulation

What are signs and symptoms of infection?

- Tenderness - Pain - Redness - Swelling - Local warmth - Elevated temperature - Purulent drainage - Delayed union or non-union of surgical site

How do you treat an infection?

Will give prophylactic antibiotics, three times

What are signs and symptoms of DVT?

Swelling Warmth Tenderness to area

How can you prevent DVT?

``` Anti embolic stockings (AES) PCS Mobility Bed exercise Prophylactic anticoagulants ```

How do you diagnos a DVT?

Doppler ultrasound

Pressure Injury

Prevention is key - Pressure relieving mattress - Early mobilization - Frequent turning and positioning - Keep body surface clean and dry - Use Braden Scale for risk assessment

Supportive/ Rehabilitative Care

- Prevent swelling m - Ambulate early - Maintain bowel function - Encourage self-care - Manage pain - Referrals to PT and OT

What are signs and symptoms of hip fractures?

- Leg is shortened and externally rotated - Pain - Unable to weight near

What are the two types of hip fractures?

1. Intracapsular hip fracture | 2. Extracapsular hip fracture

Intracapsular Hip Fracture

Femoral neck fracture Inside joint capsule Usually related to bone disease

Extracapsular Hip Fracture

Outside joint capsule | Usually related to a fall or trauma

What is the surgical management for intracapsular hip fractures?

Treated with insertion of a femoral head prothesis

What is the surgical management for extrcapsular hip fractures?

Treated with scres

When is a total hip arthroplasty done?

Severe trauma Osteoarthritis Failure of previous surgeries

Osteoarthritis

Degenerative joint disease

What is the post-operative nursing care?

- Similar to general post-op nursing management - Dressing change as ordered - Hemovac drain for 24 to 48 hours

In what position are patients in after a hip fracture surgery?

Patient in supine position or on their side with pillows between legs

What are special precautions you need to take after hip fracture surgery?

- Do not cross patients ankles or legs - Do not force hip inwards or outwards - Do not force hip into more than 90 degrees of flexion - Use abduction pillow or regular pillow between legs when turning - Sit patient in high seated chairs and toilet seats

How long do patients stay in the hospital after a hip fracture surgery?

Length of stay is 3 to 7 days and staples are removed by general practitioner in 14 days