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64 Cards in this Set
- Front
- Back
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Blowout Fx
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orbital
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Stress Fx
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Osteoporosis
Bone Cancer Arthritis |
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Emergency care for Fx's
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ABC
Assess other injuries Cover Splint Transport |
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Open Fractures require
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Tetanus Toxoid
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Deformity
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Alignment
Contour (Swelling from fluid) Length (muscle spasms) |
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Swelling/Bruising
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Edema
Subcutaneous bleeding |
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Muscle Spasms
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Involuntary over fracture site
(Causes shortening) |
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Tenderness
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Diffuse vs. Point
(Sprain vs. Fx) |
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Impaired sensation
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nerve damage
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Loss of normal function
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instability
abnormal mobility |
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Crepitus
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Air bubbles in subcutaneous tissue
(popping noise, tells u Fx has been displaced) |
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Shock
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Blood loss
severe pain |
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X-Ray
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Anterior/posterior views
Immediate During 6 weeks post Fx |
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Stages of bone healing
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Hematoma Formation
Cellular Proliferation Callus Formation Ossification Consolidation |
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Wolfe's Law
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Bone structure determined by its function and the stressors placed upon it
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Healing Factors
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Weight bearing vs. Not
General health Age Nutritional Status Circulation - People w/ PVD take longer |
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Healing Times for ages
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Children 4-6
Adolescents 6-8 Adults 10-18 |
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Treatment goals
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Return to normal function
Prevent Complications Obtain good cosmetic results |
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Treatment methods
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(Relining Fx)
Manipulation - Closed (manual) Surgical - Open (screws/wires) Traction - Skin, Skeletal (not used often) |
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Treatment Complications
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Arterial Damage
Infection Thromboemboli Fat emboli Compartment Syndrome |
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Infection
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Gas Gangrene...
↑ Hgb ↑ Temp ↑ Pulse Pain watery, foul drainage |
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For thromboemboli
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Use Lovenox
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Compartment Syndrome
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46 in human body
38 in extremeties normal pressure= 9-20mm Hg This is >20-55mm Hg ↑ compartment contents: Edema, hemorrhage Can disallow blood supply For casts: test for circulation, sensation, motion |
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Compartment Syndrome
External Pressure |
tight casts
tight dressings air splints anti-shock garments - waste down pressure |
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Trauma
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Fractures
Surgery Hematomas Snake, Spider bites Crush injuries Electrical injuries Vascular injuries |
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ASSESS pain
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Passive Stretching
(From ischemia, being deprived of blood) Deep, throbbing, unrelenting, unrelieved by medication |
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ASSESS hypoaesthesia
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weak movement, flexion, extension
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ASSESS ↓ Pulses
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Coolness
Pallor Unreliable |
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Fat emboli
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20-40yr old males = Acute Resp Insufficiency
Most Common: Fx of long bones Multiple Trauma Pelvic Injuries |
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Fat emboli S/S
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Occur Suddenly!
Mental Confusion Respiratory Distress..Diffuse rales Tachypnea Tachycardia > 140 Temp > 103 Petechia: arms/chest/ab/conjuctiva/ palate Hypoxemia: PO2< 80mmHg |
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Fat Emboli Lab
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Thrombocytopenia
↓ Hgb Fat in urine, blood ↑ ESR (inflammatory response) |
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Fat Emboli Prevention
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NO CURE!
Proper Immobilization of fractures Adequate Hydration O2 |
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Fat Emboli Management
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O2
Fluid Replacement - Crystalloids MV with PEEP - mechanical ventilation, keep aveoli open Corticosteroids - d/t inflammatory response ↑ Hgb |
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Pins
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Kirschner Wires
Tongs |
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Pins
Before insertion |
Establish neurovascular baseline
Is there good circulation/sensation at pin site |
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Pins
After insertion |
check pinsites
odor / redness / drainage measure- pin length for dislodge |
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Pin Care
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Controversial
Betadine vs N/S vs Soap/water vs. no interventions less intervention = less bacteria Go w/ hospital policy |
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Casts
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provide immobilization
Support, protect Prevent deformity Abdomen cast can lead to compartment syndrome |
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Casts
Types |
Short Arm
Short Leg Long Leg Body |
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Plaster of Paris
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1-3 hrs
For weight bearing, never gets wet |
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Fiberglass
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15-30 min
not for weight bearing |
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Polyeter Cotton Knit
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7-15 min
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ASSESS Casts
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Odors
CSM Pressure Areas Petalling - tape edge of casts Swelling,Discoloration- too tight or edema Parasthesia |
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Cast Syndrome
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(Mainly body casts)
Prolonged N/V Abdominal distention ...> Illeus (Watch for loss of bowel function) |
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Orthopedic Surgery
complications |
Shock, Hemorrhage
Immobility Delayed Healing Illeus |
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Orthopedic Surgery
Post Op |
VS
fluid volume Respiratory Pain Management - bone healing is quick w/ pain |
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Orthopedic Surgery
Hips |
Abduction Pillow - prevents rotation (inbetween legs)
Trochanter rolls - prevents outward Position changes pre-op = affected side post-op = surgeon prefer HOB @ 45 - prevent forward flexion |
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Hips
When ambulatory |
↑ Toilet Seat
Legs Extended, Supported, elevated Hips even with knees 0 leg crossing |
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Hips exercises
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Quadriceps/gluteal setting
ROM, Active and passive |
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Hot Packs
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Fibrous Tissue Softening
Pain reduction ↑ bloody supply (dry or moist) Requires order wrapped in 16 thickness of towels Moist better for reducing inflammation |
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Cold packs
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Vasoconstriction
↓ Metabolic Activity ↓ Pain, muscle spasm |
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Hunting or Lewis Reaction
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Apply cold not < 10 min
> 30 min Wait 30-60 min between produces vasodilitation - not good |
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Hematoma stage
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Protective mechanism
24hrs |
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Cellular Proliferation stage
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Fibrolasts
osteoblasts phagocytosis early soft tissue callus 2 days |
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Callus formation stage
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Temporary splint
maximum size 14-21 too early for weight bearing 6-10 days |
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Callus ossification
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true rigid bone formation
calcium deposition |
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Consolidation and remodeling stage
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extra bone chiseled away
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Deep peroneal nerve
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Runs thru anterior compartment of lower leg
innervates toe extensors supplies sensation to web between 1st and 2nd toes |
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Superficial Peroneal nerve
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Runs thru lateral compartment of leg
Autonomous zone at base of 3rd, 4th, 5th toes supplies sensation to dorsolateral aspect of foot |
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Tibial Nerve
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Runs through posterior compartment of leg
Supplies sensation to base of toes and sole of foot |
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Pathological Fx
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Caused by Metastatic cancer
osteoporosis Pagets disease |
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Open Fx grading scale
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1 - minimal skin damage
2 - skin + muscle contusion 3 - skin, muscles, nerves, blood vessels |
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Diagnostic procedures for Fx
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CT imaging scan
MRI bone scan - determine fx complications / delayed healing |
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Care for Fx
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maintain ABC
assess neurovascular status of extremity Place in Supine Elevate / Ice Assess for bleeding/apply pressure Remove jewelry/clothing |
