Osteomylitis & fractures Flashcards
what is a fracture
Any break in continuity of bone that occurs when more stress is placed on bone than it is able to absorb
Causes of Fractures
++Traumatic (direct/indirect)
Direct – fall
Indirect – muscle contraction that breaks bone
++Fatigue
When bone subjected to repeated, prolonged stress
++Pathologic
Weakened bone
May break spontaneously
Highest risk population - elderly
Describing a fracture in 5 areas
Name of bone
Location on bone
Orientation of fracture
Example: spiral
Alignment of fracture
Displaced vs. aligned
Condition of overlying tissue
Open vs. closed
9 orientations of fracture
transverse
spiral
longitudal
oblique
comminuted
impacted
greenstick
stress
avulsion of the patella
Clinical Manifestations of Fractures
++Pain
++Edema
++Deformity
Loss of function
Abnormal mobility
Complications of fractures
Delayed healing
Bone growth impairment (peds)
Compartment syndrome
Fat embolism syndrome
3 areas of delayed healing
Delayed union
Bone pain and tenderness increase
Risk factors? smoking
Malunion – unequal stresses
Improper alignment
Nonunion
No healing 4-6 months post-fracture
Causes: Poor blood supply, repetitive stress
comparment syndrome seen in
Crush injuries Cast Long bone injuries (tibia, radius, ulna) Severe thermal burns Animal bites
comparment syndrome results from
increased pressure whithin limited anatomic space
comparment syndrome creates what effect
“Tourniquet” effect
Edema at fracture site puts intense pressure on soft tissue
Can lead to tissue hypoxia of muscles and nerves
Manifestations of comparment syndrome
Extreme pain
5 P’s
Rapid onset
what is fat embolism syndrome
Fat molecules in lung following:
Long bone fracture (femur)
Major trauma
Typically occur 24-48 hrs after injury
how does the fat get to the lung
Fat molecules from bone marrow or traumatized tissue
Released into blood stream travels to lungs
Triad of manifestions in fat embolism
hypoxemia
altered LOC
petechiae
what is osteomyelitis
An acute or chronic pyogenic (pus producing) infection of bone
usual cause of osteomyelitis
Bacteria – Staphylococcus aureus (S. aureus)
Where does osteomyelitis happen in teens and adults
Teens – long bones
Adults- vertebrae and hips
RF of osteomyelitis
Recent trauma Diabetes* Hemodialysis IV Drug abuse Splenectomy Peripheral Vascular Disease*
route of DIRECT contamination
\++Open wound Open fracture Gunshot Puncture Surgery
Insertion of metal plates or screws
route of INDIRECT (hematogenous) contamination
From bloodstream Most common type Bacteremia Usual location: long bones Highest risk: children under 16
patho of hematogenous route
Arterial blood flow brings bacteria into bone / Infection results in Inflammation Bone destruction Pus and edema / Pressure increases / Ischemia/necrosis / Osteoblasts lay new bone around old bone / Infection is isolated
What happens when pressure within bone increases to that of arterial blood flow?
Local arteries collapse! No supplies of Oxygen Nutrition Immune cells Antibiotics
What does arterial collapse result in?
impaired healing
Clinical manifestations Osteomyelitis
Local Local tenderness, warmth, redness Wound drainage Restricted movement Spontaneous fractures
Systemic
Spiking fevers
Positive blood culture
Leukocytosis
Pharmacotherapy of Osteomyelitis
Obtain culture
Empiric therapy
Nafcillin
Cefazolin
Vancomycin
Bacteria-specific therapy
Osteomymelitis Complications
Chronic osteomyelitis
Local spread of infection
Reduced limb or joint function
