Orthopedic Disorders Flashcards
fractures: definition and classification
disruption or break in the continuity of structure of a bone
open v. closed
open: breaks through the skin
closed: skin intact
complete v. incomplete:
complete: bone is broken all the way through
incomplete: bone is not broken all the way through
based on direction of fracture line: linear/longitudinal, oblique, transverse, spiral
clinical manifestations of a fracture
localized pain, decreased function, immobility to bear weight or to use, guard against movement, may or may not be deformed
What do you do with even the slightest suspicion of a fracture
IMMOBLIZE
stages of fracture healing and goals for treatment
stages: fracture hematoma, granulation tissue, callus formation (soft), ossification, consolidation, remodeling
goals: anatomic realignment, immobilization, restoration or normal or near normal function
open v. closed reduction
closed: non-surgical realignment, local anesthesia, traction/counter traction, immobilize after
open: surgical incision, internal fixation
risk for infection
early ROM of joint to prevent adhesions, early ambulation
Traction
why
skin
skeletal
prevent or decrease pain and muscle spasm, immobilize joint or part of body
skin: short term, tape, boots, or splints, 5-10 lbs, skin assessment (assess for breakdown)
skeletal traction: long term pull to maintain alignment, pin or wire inserted into bone, 5-45 lbs, risk for infection, no weights on the floor, elevate foot of bed to maintain continuous traction
Fracture immobilization:
casts, sling,
Vertebral immobilization:
body jacket brace
casts:
temporary
allows pt. to do many ADLs
incorporates joints above and below fracture, made of various materials
sling: support and elevate arm, ensure axillary area is well padded, no undue pressure on posterior neck, encourage movement of fingers and nonimmobilized joints
CONTRAINDICATED with proximal humerus fracture
body jacket brace:
immobilization and support for stable spine injuries
monitor for superior mesenteric artery syndrome (cast syndrome): assess bowel sounds and treat with gastric decompression
lower extremity immobilization
long leg, short leg, cylinder casts, hip spica casts
robert jones dressing
elevate extremity above heart
do NOT put extremity in a dependent position
observe for sx/sx of compartment syndrome and increased pressure
spica cast: asses for problems same as body brace
external fixation
metal pins and rods apply traction and compress fracture fragments.
assess for infection, pin site care
nutritional therapy
increase: protein, vitamins, calcium, phosphorous, magnesium, fluid (2000-3000 ml/day), fiber
body jacket and spica cast: 6 small meals a day
Neuros
peripheral vascular: color and temperature, cap refill, pulses, edema
peripheral neurologic: motor function, sensory function, decreased output
post op care and cast care
monitor vitals
frequent neuro checks
minimize pain and discomfort
monitor for bleeding and drainage
aseptic technique
blood salvage and reinfusion
cast care: frequent neuro assessments
ice and elevate above heart for first 24 hours
exercise joints above and below
check with hcp, dry thoroughly before and after getting wet
report increased pain and swelling despite interventions or with movement and report discoloration, burning or tingling, sores or a foul odor
CAST CARE: DO NOT elevate if compartment syndrome, get plaster cast wet, bear weight for 48 hours, cover cast with plastic for prolonged period
compartment syndrome
swelling and increased pressure within a confined space
compromises neurovascular function of tissues within that space
usually involves the leg but can occur in any muscle group
two types: decreased compartment size, increased compartment contents
arterial flow compromised leading to ischemia leading to cell death leading to loss of function
EARLY recognition and tx essential may occur initially or over several days
ischemia can occur within 4 to 8 hours after onset
tx: fasciotomy, NO elevation above heart, NO ICE
6 P’s of Compartment Syndrome
Pain
Pressure
Paranesthesia
Pallor
Pulselessness
Paralysis
what can death be the result of in ortho
complications of fracture and immobility
damage done to underlying organs/vascular structures
Infection
high incidence in OPEN fractures and soft tissues injuries
devitalized and contaminated tissue an ideal medium for pathogens
prevention is key
can lead to chronic osteomyelitis
VT’s
high susceptibility aggravated by inactivity of muscles
prophylactic anti-coagulants
antiembolism stockings
sequential compression devices
ROM exercise
Fatty Embolism
presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic injury
contributary factor in fracture-associated deaths, but most common with fracture of long bones, ribs, tibia and pelvis
Clinical manifestations and treatment–fatty embolism
early recognition crucial, as clinical course is rapid and acute, with symptoms appearing 24-48 hours after injury
fat emboli in lungs cause a hemorrhagic interstitial pneumonitis
can have respiratory and neurologic symptoms
petechiae: neck, chest wall, axilla, buccal membrane, conjunctiva
CLIENT MAY HAVE SENSE OF IMPENDING DOOM–BELIEVE THEM
skin goes from pallor to cyanosis
patient may become comatose
tx: directed at prevention, careful immobilization and handling of long bone fracture, management supportive (symptom management)
Osteoporosis
chronic, progressive, metabolic bone disorder marked by low bone mass and deterioration of bone tissue
women more prone than men (lower Ca2+ intake, low bone mass, bone resorption)
risk factors: advancing age, female, low body weight, white/asian, smoking, prior fracture, sedentary lifestyle, estrogen deficiency, family hx, low Ca2+ and Vitamin D, excessive use of alcohol, low testosterone, diseases, drugs
Osteoporosis treatment
supplemental Ca2+ (take in divided doses–carbonate, citrate is less dependent on stomach acid
weight bearing exercise to maintain muscle mass
exercises to increase balance and coordination: walking, hiking, weight training, stair climbing, tennis, dancing
Drug Therapy:
Calcitonin
inhibits bone resorption
IM form at night for less side effects
alternate nostrils when using nasal form
calcium supplementation is needed
QUIT SMOKING, DECREASE ALCOHOL INTAKE
