Bone breaks part 2

Question 1

What factors influence fracture healing?

Answer 1

Displacement and site of fracture
Blood supply to area
Immobilization
Internal fixation devices
Infection or poor nutrition
Age 
Smoking

Question 2

What will decreased osteoblasts due to negative factors that influence healing lead to?

Answer 2

delayed union or non-union of fracture

Question 3

If a pt is a smoker what can we recommend for better healing?

Answer 3

-stop smoking for even 5-7 days prior to musculoskeletal surgery for better post-op healing

Question 4

What are some clinical manifestations of fracture?

Answer 4

Acute pain!
Bruising, swelling, deformity, crepitus
Loss of function
Shortening of the extremity
Diagnosis by symptoms and radiography
Patient usually reports an injury to the area

Question 5

What is the emergency management of a fracture?

Answer 5

• Immobilize the body part
• Splinting: joints distal and proximal to the suspected fracture site must be supported and immobilized
• Assess neurovascular status before and after splinting (cap refill, pulse, can pt wiggle fingers
• Open fracture: cover with sterile dressing to prevent contamination
• Do not attempt to reduce the fracture

Question 6

Restoration of the fracture fragments to anatomic alignment and positioning

Answer 6

fracture reduction

Question 7

Uses manipulation and manual traction

Traction may be used (skin or skeletal)

Answer 7

closed reduction

Question 8

Internal fixation devices hold bone fragment in position (metallic pins, wires, screws, plates)

Answer 8

open reduction

Question 9

External (cast, splints) or internal fixations

Answer 9

Immobilization

Question 10

What is external fixation used for?

Answer 10

an attempt to save extremities that otherwise might require amputation

Question 11

What is a critical part of an external fixation?

Answer 11

-Infection: signaled by exudate, erythema, tenderness, and pain. Meticulous pin care is very important.

Question 12

What is traction and what are the 2 most common types?

Answer 12

• pulling force to attain realignment - counteraction pulls in opposite direction
• 2 most common types: skin and skeletal traction

Question 13

• Short-term (48-72 hours)
• Tape, boots, or splints applied directly to skin
• weighs 5 to 10 pounds
• Skin assessment and prevention of breakdown imperative

Answer 13

skin traction

Question 14

• Long-term pull to maintain alignment
• Pin or wire inserted into bone
• Weights 5 to 45 lbs
• Risk for infection
• Complications of immobility

Answer 14

skeletal traction

Question 15

what should you do prior to casting?

Answer 15

-RICE for 24 to 48 hours

Question 16

What are the 6 P’s of a neuromuscular assessment for after a pt gets a cast.

Answer 16

pulse deficit
pallor
paresthesia (numbness)
paralysis 
pain
poikilothermia (skin temp issue)

Question 17

What are 4 potential complications following a fracture?

Answer 17

• Compartment syndrome (notify provider immediately)
• pressure ulcers
• disuse syndrome
• fat embolism syndrome

Question 18

• Especially in long bone fractures (ie: femur)
• 12-72 hrs after injury
• Classic triad – hypoxemia, neuro changes, petechial rash
• Prevention via immobilization, early surgery

Answer 18

fat embolism syndrome

Question 19

What is the classic triad for fat embolism? And a few other symptoms?

Answer 19

hypoxemia
neuro changes
petechial rash
-other symptoms: restless, agitated, tachypnea, dyspnea, crackles

Question 20

What is the management for a humeral (neck and shaft) fracture? And what is a risk?

Answer 20

-Management: slings and bracing, activity limitations
-Risk: frozen shoulder
(rehab doing pendulum exercises)

Question 21

How do you manage a Colles’ fracture?

Answer 21

• colles’ cast to immobilize undisplaced or reduced fracture
• below the elbow cast with either palmar flexion or ulnar deviation