Specific Fractures and Osteomyelitis Flashcards
Pelvis
- 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
Hip
- 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
Clinical Manifestations of hip fractures (4)
- external rotation
- muscle spasm
- shortening of the affected limb
- pain at fracture site
Surgical Repair of Hip Fracture
- 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
Surgical Hip Fracture Repair: Indications for prosthesis dislocation are (4)
- 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
Femur
- 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
Vertebrae: Stable
- the fracture is unlikely to cause spinal cord damage
Vertebrae: Unstable
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)
Goal (stable #) and Treatment for Vertebral Fractures
Goal stable fracture: Keep good spinal alignment until union has been accomplished
Treatment: Pain management, mobilization, and bracing
Mandibular: surgery
Involves immobilization through wiring the jaws x 4-6 weeks
Mandibular Postop Care priorities (5)
- patent airway
- oral hygiene
- communication
- pain management
- adequate nutrition
Safety Considerations Mandibular Fracture
- 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
Amputation
- 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
Goal of Amputation
preserve extremity length and function while removing all infected, pathological, or ischemic tissues
Specific Joint Surgeries: Athroplasty
Definition
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
THA
provides significant relief of pain and improvement of function for patients with OA, RA ect
TKA
Unremitting pain and instability as a result of severe destructive deterioration of the knee joint is the main indication for TKA
Osteomyelitis
- what is it?
- most common organism?
- 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
Acute Osteomyelitis: clinical manifestations (3)
- 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
Chronic Osteomyelitis (4)
- 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
Osteomyelitis: Diagnostics
H&P, labs, cultures, biopsy, x-ray
Bone scan is the gold standard
Osteomyelitis: Treatment
- 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)
