Specific Fractures and Osteomyelitis

Question 1

Pelvis

Answer 1

• associated with highest mortality
• often associated with intra-abdominal injury
• treatment depends on severity of injury
• can be extremely painful
• pelvis fractures are not operated on

Question 2

Hip

Answer 2

• common in older adults r/t falls
• 70-90% caused by osteoporosis
• require the longest hospital stays
• timely access to care is critical in reducing mortality
• refers to a fracture of the proximal third of the femur

Question 3

Clinical Manifestations of hip fractures (4)

Answer 3

• external rotation
• muscle spasm
• shortening of the affected limb
• pain at fracture site

Question 4

Surgical Repair of Hip Fracture

Answer 4

• If femoral head prosthesis (posterior approach), measures to prevent dislocation must be used x 6 weeks
• avoid extreme flexion
• avoid crossing legs/feet
• avoid sitting up more than 90 degrees
  Elevated toilet seats and chair alterations
  Foam abduction pillow or pillows between legs
  Avoid turning the patient on her affected side until the surgeon approves

Question 5

Surgical Hip Fracture Repair: Indications for prosthesis dislocation are (4)

Answer 5

• sudden, severe pain
• a lump in the buttock
• limb shortening
• external rotation of the affected limb
  Treatment for dislocation involves closed reduction under conscious sedation OR open reduction

Question 6

Femur

Answer 6

• Occurs with severe, direct force
• Usually associated with damage to the adjacent soft tissue structures
• Displacement of fracture fragments often results in considerable blood loss (1-1.5)
• Clinical manifestations are usually obvious

Question 7

Vertebrae: Stable

Answer 7

• the fracture is unlikely to cause spinal cord damage

Question 8

Vertebrae: Unstable

Answer 8

Ligamentous structures are significantly disrupted, dislocation of the vertebral structures may occur, leading to instability and injury to the spinal cord
- unstable fractures usually require surgery
- all spinal injuries are initially considered unstable until diagnostics confirm stability (hard collars)

Question 9

Goal (stable #) and Treatment for Vertebral Fractures

Answer 9

Goal stable fracture: Keep good spinal alignment until union has been accomplished
Treatment: Pain management, mobilization, and bracing

Question 10

Mandibular: surgery

Answer 10

Involves immobilization through wiring the jaws x 4-6 weeks

Question 11

Mandibular Postop Care priorities (5)

Answer 11

• patent airway
• oral hygiene
• communication
• pain management
• adequate nutrition

Question 12

Safety Considerations Mandibular Fracture

Answer 12

• WIRE CUTTERS SHOULD ALWAYS BE WITH THE PATIENT
• if pt vomits/chokes the pt should:
  bend his head over to the side to allow the vomitus to flow out of the mouth/nose and allow the nurse to suction to clear the nose/mouth

Question 13

Amputation

Answer 13

• highest in mid-older age groups
• linked to PVD, atherosclerosis and vascular changes r/t diabetes
• amputation in younger patients usually r/t trauma
• vascular studies: arteriography, doppler studies and venography
• phantom pain very common
• prosthesis fitting not possible until all edema is gone
• compression bandaging worn at all times

Question 14

Goal of Amputation

Answer 14

preserve extremity length and function while removing all infected, pathological, or ischemic tissues

Question 15

Specific Joint Surgeries: Athroplasty
Definition

Answer 15

The reconstruction or replacement of a joint to relieve pain, improve or maintain ROM, and correct deformity
- Common complications: infection r/t aerobic streptococci and VTE

Question 16

THA

Answer 16

provides significant relief of pain and improvement of function for patients with OA, RA ect

Question 17

TKA

Answer 17

Unremitting pain and instability as a result of severe destructive deterioration of the knee joint is the main indication for TKA

Question 18

Osteomyelitis
- what is it?
- most common organism?

Answer 18

• Severe infection of the bone, bone marrow and surrounding soft tissue
• most common organism is staph aureus
• direct vs indirect entry
• very difficult to treat. hard to get WBC and antibiotics into the bone.
• high risk in pts with rods or screws

Question 19

Acute Osteomyelitis: clinical manifestations (3)

Answer 19

• Less than one month in duration
• Systemic: fever, chills, night sweats, nausea, restlessness
• Local: unrelieved pain - worse with movement, swelling, warmth at site, limited ROM

Question 20

Chronic Osteomyelitis (4)

Answer 20

• Longer than one month - either a continuous problem or series of remissions and recurrences
• less systemic signs - continued local signs
• scar tissue forms (impenetrable to antibiotics)
• Risk of septicemia, septic arthritis and unhealed fractures

Question 21

Osteomyelitis: Diagnostics

Answer 21

H&P, labs, cultures, biopsy, x-ray
Bone scan is the gold standard

Question 22

Osteomyelitis: Treatment

Answer 22

• Vigorous and prolonged IV antibiotic therapy (only if bone ischemia has not occurred) - for 4-6 weeks at home, or up to 3-6 months (PICC or central line)
• Surgery - debridement, irrigation and suction
• Amputation indicated in refractory cases (if antibiotics don’t work)