LEC 2: Fractures Flashcards
Fracture
Break in continuity of the bone; can be complete or incomplete
Pathological Fracture
May occur during normal activity or following minimal injury when a bone is weakened by a disease process
Fatigue or Stress Fracture
Normal bone subjected to repeated stress without bone and muscle recovery
How are fractures classified?
Classification by mechanism of the injury or the type of bone discontinuity
Closed (simple) Fracture
Skin over site is intact
Open (compound) Fracture
Skin over injury site is broken either by fracture fragments, piercing skin, or a penetrating outside force
What are clinical manifestations (signs and symptoms) of fractures?
Edema Pain and tenderness Muscle spasms Deformity Ecchymosis Loss of function Crepitation
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)
What are the six phases that bones goes through for self-healing?
- Fracture hematoma
- Granulation tissue
- Callus formation
- Ossification
- Consolidation
- Remodelling
Fracture Hematoma
Semisolid clot
- Takes 72 hours
Granulation Tissue
Osteoid
- Takes 3 to 14 days
Callus Formation
Minerals deposited, strengthens bone
- Takes 14 days
Ossification
Strength by helping create new bone and clinical union
- Takes 3 to 6 weeks
Consolidation
Distance diminishes and radiological union
- Takes 6 months to a year
Remodelling
Pre-injury shape and strength
- Up to 1 year
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
What are the three types of anatomical realignment?
- Close reduction
- Open reduction
- Traction
Anatomical Realignment: Close Reduction
Nonsurgical, manual realignment of bone fragments to previous anatomical position
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
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
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?
- 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
