Lecture 5: Fractures and splint Flashcards
What is the definition of a fracture?
IS A DISRUPTION OR CHANGE IN THE CONTINUITY OF THE BONE
THE BREAK CAN OCCUR AT ANY POINT ALONG A BONE AND IN MANY
DIFFERENT TYPES OF PATTERNS
What are the 4 classification of fractures
closed
open
dispalced
non displaced
Explain a closed fracture
Occurs when forces on bone exceed the
bone’s ability to withstand forces applied
• May be complete or incomplete
Explain an open frracature
• Complete break in bone where bone ends
separate and break through skin
• Increased chance of wound and bone
infection
What type of classification has a greater risk of infection
open fracture
explain a non displaced fracture and give an example
Dispalcaced= normal allignment
ex: Hairline fracture
•Simple crack of the bone
•Maybe difficult to distinguish
from a sprain or simple contusion
explain a displaced fracture and give example
pull out of normal allignment
Produces actual deformity,
or distortion, of the limb by
shortening, rotating or angulating it
What are the 10 signs and symptoms of a fracature
1) deformities
2) point tenderness on palpation
3) guarding (muscle attempt to protect)
4) pain
5) swelling (rapid vs generalized)
6) bruising
7) crepitus (crushing sound)
8) false motion/free movement
9) exposed fragments
10) locked joint
Will a fracture always have a deformity?
no
True or false: the amount of energy affects the type of fracture>
TRUE
What are the different forces applied to a bone that can cause a fracture?
tension/compression bending shearing torsion combination loading
Tension forces mostly affect which tissues
muscles, ligaments, tendons
What are the 3 types of fractures for foreamr
forearm
colles fracture (bone of radius tilts us) FALL ON PALM
smiths fracture FALL ON WRIST
TRUE OR FALSE: fractures are always obvious>
False, sometimes you must do an X ray to ses a stress fracture
Why are open fractures dangerous
Higher risk of infection
What is important to ask when considering a fracutre>
fracture eval
What happened/pain scale
Where does it hurt
Did you hear any strange noises (cracking, snapping or popping)
Any strange senstations (tingling.numbness)
Previous injuries
(pain, moi, age/sex,
What are the tests you can perform when suspecting a fracture?
Tap Test
Tuning fork
Compression test
Explain the tap test and what consists of a positive test
TAP ON THE BONY PROTUBERANCES DISTAL AND PROXIMAL TO THE
SUSPECTED FRACTURE.
• POSITIVE TEST: PAIN THAT RADIATES TO THE FRACTURE SITE CAUSED BY THE VIBRATIONS OF THE TAPPING.
Explain the tuning fork test
APPLY VIBRATING TUNING FORK ON BONE DISTAL AND PROXIMAL TO THE SUSPECTED FRACTURE.
• POSITIVE TEST: PAIN THAT RADIATES TO THE FRACTURE SITE CAUSED BY THE VIBRATIONS OF THE FORK.
explain the compression test
COmpression and spreading can cause pain to am area
What is the ottawa ankle rule?
set of guidelines to help a physician decide if a patient with foot or ankle pain should have an xray done
Where are some areas of foot pain that the ottawa ankle rule would refer to a xray?
malleolar and midfoot zone
medial malleolus
navicular ]
base of 5th metatarsal
What are you looking for when suspecting a fracture?
SHARP swelling heat altered function redness pain
What to do when you find a fractue?
RICE rest ice cold elevate
What are the 10 principles of splinting
1) supprt injured
2) expose injury
3) cover open wounds/control bleeding
4) PRE check distal pulse PMSC
5) Apply splint
6) Stabilize (aabove below fracture, above below joint)7
7) Secure splint (triangular baandage, do not go over fracture site, expose fingers and toes)
8) recheck PMSC
9) apply cold if tolerate
10) elevate
Name types of splints and when is the best time to use them
Speed splint (can go through xray) quick splint (moldable for wrist) Vacuum splint traction splint for femer WHATEVER YOU HAVE AVAILABLE
How should you prepare your splint before
Have it built, lined with towels, triangular bandages together and tied
What are the 5 P’s of fractures?
Pain(severe/sharp) Pulses (distal/present) Parasthesia (any weird tingling feelings) Paralysis (partially or fully) Pallor (cyanotic)
What are fracture complications ?
1) non union
2) infection from open wounds
3) neural entrapment
4) blood vessel entrapment
5) shock
6) embolism
What is the process of normal healing vs lack of fusion
Normal: Blood clot formed, replaced by callous, normal healing and fusion occurs
lack of fusion: Fusion does not occur properly
explain fat embolism and when does it occur
Fat emboli (particles of fat) passes through blood stream and lodges into blood vessel
Which fractures have the most blood loss
Pelvic and femer…
call 911
What are the types of fractures
transverse linear oblique (displaced/non displaced) spiral greenstick comminuted impacted avulsion compression fracture
Know the difference between open/closed fracture and displaced/non displaced
.
explain a depressed skull fracture and cause
most often in flat bones/skull
how: striking head on hard immovable object or getting hit with hard object
results in; gross pathology of soft areas
explain a greenstick fracture and cause
incomplete break in the bone
(occurs in immature bone)
usually occurs on outer bend due to a hard blow
explain impacted fracture and cause
compression force
(falling on something)
REQUIRES TRACTION
explain a longitudinal fracture and cause
bone splits along its length
impacts force on long axis (compression)
explain a spiral fracture and cause
S shaped separtion
common in skiing, football
firmly planted foot with body rotation oppositve direction (TORSION FORCE)
explain an oblique fracture
occurs when one end of the bone is fixed while other end receives torsion/twisting
explain a serrated fracture what is is caused by and what can it cause
2 BONY FRAGMENTS HAVE A SAWTOOTH, SHARP-EDGED FX LINE
• USUALLY CAUSED BY DIRECT BLOW
• CAN CAUSE EXTENSIVE INTERNAL DAMAGE and SEVERANCE OF VITAL BLOOD VESSELS
AND NERVES
explain transverse fracture and cause
occurs in a straight line (More of less right agles to the bone)
direct outside blow
explain comminuted fracture and cause
break in bone where it shatters (3 or more pieces)
hard blow or awkward fall
explain ablow out fracture and cause
occurs to the wall of the eye as result of hard blow to the eye
avulsion fracture and cause
seperation of bone fragment from cortex at an attachment of a ligament or tendon
sudden powerful twist
explain a stress fracture
small incomplete break caused by (overuse,bad balance, weakness, malnutrition)
they are stresses greather than the body can compensate
what is an epiphyseal plate fracture>?
break in bone at growth plate
due to sports participation at younger ages
will an epiphyseal fracture show up on xrat?
no it is clear
what are the 5 subtypes of epiphyseal fractures (SALTER)
1) straight across
2) above oblique (most common)
3) lower or below (through growth plate and epi)
4) two or through (through all elements)
5) ER: erase or crush
What are the 3 types of elbow fractures and what are they caused. by?
type 1: through with no split
2) through with 1 split
3) through with 2 splits a
caused by: fall where force travels up to the elbow
