Fractures Flashcards
(32 cards)
What is a fracture?
Break in continuity of bone Direct blow Crushing force Sudden twisting motion-usually in abuse Severe muscle contraction Disease that has weakened bone
What does the acronym RICE stand for and how does it apply to strains or sprains?
RICE=Rest, Ice, Compression, Elevation
Want to immobilize as much as possible and take NSAIDs for inflammation
What are the different types of fractures?
- Transverse=Straight across
- Oblique=down at angle
- Spiral=twisting fracture
- Comminuted=Crushing fracture
- Segmental=2 or more breaks
- Avulsed=break of head of bone
- Impacted=Bone crushes into other part of bone
- Torus=ends of bone have compressed. Outside of bones haven’t broken, but inside are compressed
- Greenstick=1 side of bone is broken the other side is not
How does a fracture heal and what factors influence bone healing?
Three phases-Inflammatory stage, Reparative phase, Remodeling phase
What are risk factors for broken bones?
Bone cancer Osteoporosis Lack of vitamin D, calcium, phosphorus Aging Lifestyle choices
What is involved in the prevention of bone fractures?
Safe living environment
Good lifestyle habits=exercise and plenty of calcium and vitamin D
What diagnostic tests are used for broken bones?
History
Initial assessment
X-rays-DUH
Blood chemistries, CBC, coagulation studies
Clinical manifestations of fractures?
may see deformities of longbones Crepitus-can feel crunchy, rubbing together of bones Ecchymosis Swelling Numbness Pain/tenderness Guarding affected side
What must be done in the emergency management of a fracture?
Need to immobilize the body part by any means necessary
DO NOT attempt to reduce the fracture. Will be very painful, and can cause more damage
Use a sling, or something to support limb.
Open fracture-cover with sterile dressing
What rehabilitation is related to specific fractures: Clavicle?
Clavicle fracture- use a strap to have arm up right.
Pendulum exercise to strengthen clavicle post-break.
Clavicle fractures are common at birth
What is important to remember when wearing a sling?
When in a sling, depending on where the break is, it can be very close to the brachial artery, so tight sling ensures humerus doesn’t severe brachial artery
What rehabilitation is related to specific fractures: Pelvis?
Pelvic-stable and unstable
Stable=everything is in line treated with days of rest, everything in place
Unstable=may need to go in and repair
Early mobilization reduces problems related immobility-(DVT, Pneumonia)
Early ambulation=anticoagulants and blood thinners care is similar to that of other orthopedic surgery
Unstable Pelvic fractures binders and treatment?
ORIF= Open reduction internal fixation-fixates from the inside of the body
External binding almost like a girdle or binder that is typically open at the bottom
Femoral artery damage is a big risk, 10% of unstable fractures die to due to bleeding from femoral bleeding
What is involved in a femoral fracture?
Femur is the strongest bone in the body.
Falling from height, trauma like car accident
X-ray to confirm
Doppler to make sure vessels in place. Check distal pulses
Measure thigh every hour. If continues to get bigger, concern for internal bleeding
Probably ORIF
What is important to assess in the patient who has suffered a hip fracture?
Osteoporosis is the most common cause of hip fractures
Falling and breaking hip is a 15% risk after age 50
Mortality rates=1/3 of patients die within 1 year after breaking hip
Assess VS, Respiratory status, LOC, bowel and bladder elimination, skin condition, Pain
Assess effected extremity and frequent neurological assessment
What are complications of fractures?
Fat embolism=primarily in long bones and likely the femur=fat globules will leak into vascular system and can get into small blood vessels and cause occlusion
Compartment syndrome can cut off nerves and supply to effected areas
Pin Care-depends on doctor
DVT
Hemorrhage or shock
Avascular necrosis-tissue dies from lack of blood supply
What is compartment syndrome?
Sudden and severe decrease in blood flow distal to the injury
Pain is much greater than the injury, flexing area causes extreme pain
5 P’S=pain, pallor, paresthesia, pulselessness, paralysis
Permanent damage can happen within 4 hours
Complications continued
1 early stabilization will keep bone marrow where it needs to be
Petechial rash- rash that appears that is sign of fat embolism
Treatment is respiratory support
Typically don’t hear abnormal lung sounds
Can give 2 liters without doctors order
Is infection another complication of a fracture?
Yes
Osteogenesis-brittle bone syndrome in which simply falling can break bones
Infection is a big risk for open fractures
Contamination at time of injury or during surgery
Hardware infections, good pin care
What is important to remember about children, athletes, and elderly that suffer from fractures?
Children have more porous bones-longbone fractures from sports and play
Athletes tend to get stress fractures and prolonged healing times
Older adults suffer from osteoporosis
Medical management of a patient who has suffered a fracture?
Closed-no incision to worry about Internal-Pins, bars rods Always on antibiotic May get Tetanus shot Clean and debride wound to make sure wound doesn’t get infected
What are external fixation devices used for?
Typically manage open fractures
Tell patient what to expect
May have minimal discomfort
How effective are casts in treatment of fractures and are there different types?
Casts are gold standard
Casts aren’t completely tight at first. Swelling occurs after incident
Check for 5 P’s in extremities
Fiberglass-can get wet but shouldn’t go swimming
Want to make sure boney prominences are protected to prevent pressure ulcers
Don’t put anything in the cast
Very warm spot in the cast could be a sign of an infection
Fiberglass very difficult to mold=used on simpler breaks
What is important to teach the patient in regard to casts?
What to expect from process
Want them to stay mobile-moving fingers and toes
Don’t use objects to scratch inside cast
Cast removal is with saw that vibrates instead of just cuts
Checking cast every hour if in the hospital
