the patient Flashcards
Fractures
‘A break or crack in the continuity of something’
Bone Fractures – Main Causes
Trauma
Disease (pathological)
Overuse
Bone Fractures – Signs & Symptoms
*Pain
*Swelling
*Deformity
History taking is important as it can be
difficult to tell in some circumstances
Bone Fractures – Diagnosis
*Clinical presentation/Examination
*X Ray
*CT Scan
*MRI
*Bone Scan (bone scintigraphy)
Bone Fractures - Triage
questions to ask
Questions to ask depends on the setting you are in
Consider the common presentations discussed:
Pain, Swelling & Deformity
- Questions to ask (Pharmacy):
When (relationship to presentation)
Symptoms
How did it happen (nature of the injury)
Range of motion
Nature of the pain
Other factors to consider – Age of the patient
Bone Fractures – Treatment (First Aid)
If a fracture is suspected - two aims:
Prevent movement at the site of injury
Signpost to next stage of care
Closed fracture:
Immobilise - ask the patient to remain still
Support - above and below the injured area with hands until a sling or
bandage available, padding for further support
Sign post – Arm injury may be transferred to a urgent care centre or A &
E by car, leg injury may require an ambulance
Advice and monitor – if in shock elevate only the uninjured limb, advise
do not eat or drink. If bandages used monitor. Remove any jewellery if
safe to do so. Use ice for up to 20 mins every few hours.
Open fracture:
Cover the wound with a dressing or clean pad. Apply pressure around
the injury to control bleeding. Do not press on a protruding bone use
pads to build up until possible to bandage. Secure the dressing.
Immobilise - ask the patient to remain still and immobilise as per closed
fracture.
Sign post – Will require transport to hospital
Advice and monitor – as per closed fracture
Bone Fractures – Treatment (Drugs)
Paracetamol is suitable as a central analgesic for mild pain
* Add a weak opioid if appropriate for moderate pain e.g.
codeine
* In a secondary care setting IV therapy may be needed
* NSAIDs can be used as a supplement but not in frail or
older adults
* Regional anaesthesia may be needed for reduction
* NSAIDs – role in bone healing to give or avoid
Bone Fractures – Treatment (Casts/splints)
Not always necessary, some bones can use
immobilisation and gravity only
* Splints may be used
* Back slab casts until swelling gone down
* Full cast later
Bone Fractures – Treatment (Surgery)
Usually necessary for hip fractures
*May be required for complex breaks, open
fractures, comminuted or extreme instability
*May require external fixations initially
*Decision can be delayed
Bone Fractures – Treatment (Rehabilitation)
- Keep the immobilised limb raised to reduce
swelling - Exercise to prevent stiffness, flexing fingers and
toes - Eat well, protein and vitamin C
- Physiotherapy may be needed once a cast is
removed to try to recover movement and tone - Recovery time is bone specific 6-8 weeks for a
simple arm or wrist break. Severe leg break may
take 3-6 months
Bone Fractures – Fragility Prevention
A number of factors increase your risk of fractures:
Age
Sex
Smoking
Alcohol consumption
Medicines
Co morbidities
Low BMI
Long immobilisation
Falls risk
Bone Fractures – Warning Signs
Affected limb is numb, tingling or has pins and
needles
* Open Fracture
* Involvement of spine, neck or head
* Heavy bleeding
* Clear deformity
* Severe pain
* Age (FRAX score)
* PMH
Sprain V’s Strain
Sprain: Overstretching or twisting ligaments
(abnormal movement)
Strain: Tearing of the muscle fibres/tendons
(overexertion)
Sprain & Strains – Main Causes
- Trauma (accidental)
- Overuse (Physical activity)
- Fatigue
Sprain & Strains – Signs & Symptoms
- Pain
- Swelling
- Bruising (sprain)
- Difficulty moving/limited weight bearing
- Muscle spasm*s and cramps (strain)
History taking is important as it can be difficult to tell
in some circumstances
