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46 Cards in this Set
- Front
- Back
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Definition of Fracture
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*Break in the continuity of a bone
*Soft tissue damage |
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Soft tissue damage
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*depends on extent of fx
*Can involve muscles, ligaments, nerves and blood vessels |
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Biggest issues with soft tissue damage
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*Nerves and blood vessels
*If blood vessel is compressed it will decrease perfusion |
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Etiology of FX
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*Direct force (Trauma)
*Indirect force (runners) *Pathological |
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Pathological etiology of FX
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*Things can cause predisposition for FX
*Osteopenia *CA *Osteoporosis *PPL on steroids *Elderly (R/T falls) |
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Osteopenia
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*Weakend bones with other conditions
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CA and FX
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*Weakens the immune system as well as bone
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Osteoporosis
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*Decreased Calcium
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Stress fx
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*Runners that have a lot of impact on bone which weakens bone &/or sperates muscles
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Pathophysiology of Fractures
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*Injury
-Muscle spasm (Shorter) *Soft tissue damage -Bleeding, hematoma because body is compensating *Inflammatory response -Vasodilation, high WBC, edema to try and heal the bone |
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Stages of bone healing
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*Hmatoma formation
*Fibrocartilage *Ossification *Consolidation |
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Hematoma formation
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*First part of bone healing
*Starts with the inflammatory process *Last for the first couple of weeks |
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Fibrocarilage
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*2nd part of bone healing
*WBC's go to the site *Last for the first couple of weeks after fx |
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Callus formation
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*3rd part of bone healing
*Last for the first part of bone healing |
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Ossification
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*Callus gets harder to prepare for solid union of bone
*6 weeks after fx *remove cast |
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Consolidation
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*5th and last part of bone healing
*12 wks after fx *solid union of bone |
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Factors that affect bone healing
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*Comprimized blood flow
*Steroid therapy *FX with servere tissue damage *Multiple fx at one time |
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Open FX
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*Bone projecting through skin
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Closed FX
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*Bone not protruding through skin
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Angle line of FX
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*Transverse (strait across) easy to fix
*Oblique (slant) *Spiral (think abuse) |
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Incomplete FX
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*Doesn't go all the way through
*AKA Green Line |
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Comminuted FX
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*Multiple fragments
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Angulated FX
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*Bone tilted but not displaced
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Displaced FX
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*Bone parts are seperated
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*Angulated & Displaced FX
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*Bone is at an angle and also displaced.
*Increase tissue damage r/t sharp edges |
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What type pt could have issues with healing &/or growth if the end of the bone is FX?
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*Peds
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Initial assessment of FX
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*Extent of trauma?
*Airway *Bleeding *Stabilize *NPO status |
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Physical Assessment of FX
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*Deformity (external rotation)
*Swelling *Bruising *Spasm (shortening) *PAIN *Loss of function *Crepitus (bone on bone) *Neurovascular changes |
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What is crepitus r/t FX?
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*Bone on bone
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Neurovascular changes r/t FX
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*Cooler (decreased blood flow)
*Decreased amplitude or pulse (heart rate may be up) *Decreased sensation (tingles, parestesia)--means nerve damage |
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Reduction of FX
AKA Bone Setting |
*Gets bone back in alignment
*Can be closed or open |
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Closed Reduction
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*Manual traction
*Do ASAP if you wait you may not be able to reduce r/t edema *Will be placed in an immoilizer |
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Open Reduction
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*Surgery
*Often tx of choice |
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*Why is open reduction often tx of choice?
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*because you can visulaize pieces (best option for multi frag)
*Servere muscle damage *Nerve damage |
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Nursing considerations with open reduction
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*Infection
*possible pin care if a rod is for some reason sticking out *pain managment *possible sedation *emotional support |
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Internal Fixation
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*Used for clean breaks; can use with a few pieces but not many
*Nails, plates, screws |
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Advantages of internal fixation
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*Immediatly decreases deformity
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Disadvantages of internal fixation
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*Increased risk of infection
*Can't use with dirty wound *can lead to osteomylitis *Can't use with a shattered bone |
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Indication of external fixation
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*Multiple trauma
*pt has increase risk of infection *Multiple fx or fragments *increased soft tissue damage *unstable fx |
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Disadvantages of external fixation
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*pt will have bed rest b/c no (or very) weight baring
*pt will have trouble with adls such as getting dressed *pin infection (will need pin care 2-3 times a day) |
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Common sites of external fixation
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*Pelvis
*Jaw *Toes *fingers |
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Purpose of traction
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*If there will be a delay in surgery
*reduce and realign *Promote healing (long term only) *prevent contractures *expand a joint space (hip surg, adding prosthesis) *pain managment |
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Buck's Traction
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*Skin traction
*use 5-7lbs *usually on lower leg *isn't used often b/c not very effective. But does work well for pn control |
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Skeletal traction
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*Pins apply force to bone using a pully system with a weight on the end
*More common type of traction |
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Cervical skeletal traction
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*Cervical halo
*Gardner Wells *Crutchfield |
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Nursing considerations with traction
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*Can turn pt side to side (for bed pan) as unless pelvic fx
*Make sure pullies are always in line *do not put weights on the bed and make sure they are always out of the way of interference *Make sure pt is pulled up in bed |
