Orthopedic Disorders

Question 1

fractures: definition and classification

Answer 1

disruption or break in the continuity of structure of a bone

open v. closed
open: breaks through the skin
closed: skin intact

complete v. incomplete:
complete: bone is broken all the way through
incomplete: bone is not broken all the way through

based on direction of fracture line: linear/longitudinal, oblique, transverse, spiral

Question 2

clinical manifestations of a fracture

Answer 2

localized pain, decreased function, immobility to bear weight or to use, guard against movement, may or may not be deformed

Question 3

What do you do with even the slightest suspicion of a fracture

Answer 3

IMMOBLIZE

Question 4

stages of fracture healing and goals for treatment

Answer 4

stages: fracture hematoma, granulation tissue, callus formation (soft), ossification, consolidation, remodeling

goals: anatomic realignment, immobilization, restoration or normal or near normal function

Question 5

open v. closed reduction

Answer 5

closed: non-surgical realignment, local anesthesia, traction/counter traction, immobilize after

open: surgical incision, internal fixation
risk for infection
early ROM of joint to prevent adhesions, early ambulation

Question 6

Traction
why
skin
skeletal

Answer 6

prevent or decrease pain and muscle spasm, immobilize joint or part of body

skin: short term, tape, boots, or splints, 5-10 lbs, skin assessment (assess for breakdown)

skeletal traction: long term pull to maintain alignment, pin or wire inserted into bone, 5-45 lbs, risk for infection, no weights on the floor, elevate foot of bed to maintain continuous traction

Question 7

Fracture immobilization:
casts, sling,

Vertebral immobilization:
body jacket brace

Answer 7

casts:
temporary
allows pt. to do many ADLs
incorporates joints above and below fracture, made of various materials

sling: support and elevate arm, ensure axillary area is well padded, no undue pressure on posterior neck, encourage movement of fingers and nonimmobilized joints
CONTRAINDICATED with proximal humerus fracture

body jacket brace:
immobilization and support for stable spine injuries
monitor for superior mesenteric artery syndrome (cast syndrome): assess bowel sounds and treat with gastric decompression

Question 8

lower extremity immobilization

Answer 8

long leg, short leg, cylinder casts, hip spica casts
robert jones dressing
elevate extremity above heart
do NOT put extremity in a dependent position

observe for sx/sx of compartment syndrome and increased pressure

spica cast: asses for problems same as body brace

Question 9

external fixation

Answer 9

metal pins and rods apply traction and compress fracture fragments.

assess for infection, pin site care

Question 10

nutritional therapy

Answer 10

increase: protein, vitamins, calcium, phosphorous, magnesium, fluid (2000-3000 ml/day), fiber

body jacket and spica cast: 6 small meals a day

Question 11

Neuros

Answer 11

peripheral vascular: color and temperature, cap refill, pulses, edema

peripheral neurologic: motor function, sensory function, decreased output

Question 12

post op care and cast care

Answer 12

monitor vitals
frequent neuro checks
minimize pain and discomfort
monitor for bleeding and drainage
aseptic technique
blood salvage and reinfusion

cast care: frequent neuro assessments
ice and elevate above heart for first 24 hours
exercise joints above and below
check with hcp, dry thoroughly before and after getting wet
report increased pain and swelling despite interventions or with movement and report discoloration, burning or tingling, sores or a foul odor

CAST CARE: DO NOT elevate if compartment syndrome, get plaster cast wet, bear weight for 48 hours, cover cast with plastic for prolonged period

Question 13

compartment syndrome

Answer 13

swelling and increased pressure within a confined space
compromises neurovascular function of tissues within that space
usually involves the leg but can occur in any muscle group

two types: decreased compartment size, increased compartment contents

arterial flow compromised leading to ischemia leading to cell death leading to loss of function

EARLY recognition and tx essential may occur initially or over several days
ischemia can occur within 4 to 8 hours after onset

tx: fasciotomy, NO elevation above heart, NO ICE

Question 14

6 P’s of Compartment Syndrome

Answer 14

Pain
Pressure
Paranesthesia
Pallor
Pulselessness
Paralysis

Question 15

what can death be the result of in ortho

Answer 15

complications of fracture and immobility
damage done to underlying organs/vascular structures

Question 16

Infection

Answer 16

high incidence in OPEN fractures and soft tissues injuries
devitalized and contaminated tissue an ideal medium for pathogens

prevention is key
can lead to chronic osteomyelitis

Question 17

VT’s

Answer 17

high susceptibility aggravated by inactivity of muscles
prophylactic anti-coagulants
antiembolism stockings
sequential compression devices
ROM exercise

Question 18

Fatty Embolism

Answer 18

presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic injury
contributary factor in fracture-associated deaths, but most common with fracture of long bones, ribs, tibia and pelvis

Question 19

Clinical manifestations and treatment–fatty embolism

Answer 19

early recognition crucial, as clinical course is rapid and acute, with symptoms appearing 24-48 hours after injury
fat emboli in lungs cause a hemorrhagic interstitial pneumonitis
can have respiratory and neurologic symptoms
petechiae: neck, chest wall, axilla, buccal membrane, conjunctiva

CLIENT MAY HAVE SENSE OF IMPENDING DOOM–BELIEVE THEM

skin goes from pallor to cyanosis
patient may become comatose

tx: directed at prevention, careful immobilization and handling of long bone fracture, management supportive (symptom management)

Question 20

Osteoporosis

Answer 20

chronic, progressive, metabolic bone disorder marked by low bone mass and deterioration of bone tissue

women more prone than men (lower Ca2+ intake, low bone mass, bone resorption)

risk factors: advancing age, female, low body weight, white/asian, smoking, prior fracture, sedentary lifestyle, estrogen deficiency, family hx, low Ca2+ and Vitamin D, excessive use of alcohol, low testosterone, diseases, drugs

Question 21

Osteoporosis treatment

Answer 21

supplemental Ca2+ (take in divided doses–carbonate, citrate is less dependent on stomach acid

weight bearing exercise to maintain muscle mass
exercises to increase balance and coordination: walking, hiking, weight training, stair climbing, tennis, dancing

Drug Therapy:
Calcitonin
inhibits bone resorption
IM form at night for less side effects
alternate nostrils when using nasal form
calcium supplementation is needed
QUIT SMOKING, DECREASE ALCOHOL INTAKE