Fractures

Question 1

Fracture: Definition

Answer 1

any break in the continuity of bone that occurs when more stress is placed on the bone that it is able to absorb

Question 2

Fracture: Causes (3)

Answer 2

1. traumatic: fall
2. fatigue: repeated, prolonged stress
3. pathologic: weakened bone, possibly spontaneous (HIGHEST risk in elderly)

Question 3

Closed vs. Open Fracture

Answer 3

Closed (simple): does NOT break through the skin

Open (compound): fractured bone PENETRATES skin

Question 4

Fracture Orientations: (9)

Answer 4

*transverse
*spiral
*comminuted
*impacted
*greenstick
*stress
longitudinal
oblique
avulsion fracture of the patella

Question 5

Transverse Fracture

Answer 5

usually straight line, 90 degree angle to the length of the bone
most commonly in traumatic falls

Question 6

Spiral Fracture

Answer 6

twisting injury

Question 7

Comminuted Fracture

Answer 7

more than 1 fracture line, and more than 2 bone fragments
like a compression fraction

Question 8

Impacted Fracture

Answer 8

jumping from heights
usually less severe than comminuted

Question 9

Greenstick Fracture

Answer 9

incomplete break where the bone bends
most common type of break in children

Question 10

Stress Fracture

Answer 10

from repeated use of fatigue

Question 11

Fractures: CM: The P.E.D.

Answer 11

at site of bone disruption:
-Pain
-Edema
-Deformity
-loss of function
-abnormal mobility

Question 12

Three Phases of Bone Healing

Answer 12

1. inflammatory
2. reparative
3. remodeling

Question 13

The inflammatory phase consists of what step?

Answer 13

1. hematoma sets

Question 14

The reparative phase consists of what steps?

Answer 14

2. fibrous cartilage
3. callous
4. ossification

Question 15

The remodeling phase consists of what step?

Answer 15

5. remodeling

Question 16

Fractures: Complications (5)

Answer 16

delayed healing
bone growth impairment
compartment syndrome
fat embolism syndrome
osteomyelitis

Question 17

Fractures: Delayed Healing

Answer 17

1. delayed union: bone pain and tenderness increase
2. malunion: improper alignment
3. nonunion: no healing 4-6 months post-fracture

Question 18

Fractures: Delayed Healing: Risk Factors (9)

Answer 18

-tobacco use
-older age
-severe anemia
-uncontrolled diabetes
-low Vitamin D levels
-people with hypothyroid
-poor nutrition
-infection
-people w/ complicated breaks

Question 19

Fractures: Nonunion: Causes and Risk Factors

Answer 19

Causes: poor blood supply, repetitive stress

Particularly in people with diabetes and infection in the area

Question 20

Fractures: Impaired Bone Growth

Answer 20

*pediatric consideration
fracture through epiphyseal plate
can DELAY future bone growth

Question 21

Fractures: Compartment Syndrome

Answer 21

results from increased pressure w/in limited anatomic space
-seen with:
-crush injuries
-cast: put on too tight or
if swelling begins or
bleeding occurs
-“tourniquet” effect
-edema at fracture site
puts intense pressure
on soft tissue
-can lead to tissue
hypoxia of muscles and
nerves

Question 22

Fractures: Compartment Syndrome: Manifestations

Answer 22

edema
loss or weakened pulses
PAIN

Question 23

Fractures: Fat Embolism Syndrome

Answer 23

fat molecules in the lung following:
-long bone fracture
-major trauma

fat molecules come from bone marrow or traumatized tissue–> released into blood stream–> lungs

Question 24

Fractures: Fat Embolism Syndrome: Manifestations

Answer 24

hypoxemia
altered LOC
petechial rash

Question 25

Osteomyelitis

Answer 25

an acute or chronic pyogenic (pus producing) infection of the bone -"osteo": bone -"myelo": marrow cavity

Question 26

Osteomyelitis: Cause and Risk Factors

Answer 26

usual cause: bacteria (S. aureus) Risk Factors: -recent trauma -diabetes -hemodialysis -IV drug use -splenectomy

Question 27

Routes of Contamination: Types (2)

Answer 27

direct vs. indirect

Question 28

Direct Contamination

Answer 28

open wound: -open fracture -gunshot -puncture (stabbing) -surgery (sternotomy) surgery/insertion of meta plates or screws

Question 29

Indirect Contamination

Answer 29

from bloodstream (MOST common) bacteremia

Question 30

Contamination from Bloodstream: Patho

Answer 30

arterial blood flow brings bacteria into bone--> infection results in inflammation, bone destruction, and pus and edema--> pressure increases--> ischemia/necrosis--> osteoblasts lay new bone around old bone--> infection is isolated

Question 31

Contamination from Bloodstream: Common Areas (4)

Answer 31

femur (27%) tibia (22%) hands and feet (13%) humerus (12%)

Question 32

Osteomyelitis: Pathogenesis

Answer 32

-pressure increases w/in the bone -causes local arteries to collapse -decreases or eliminates supply of: -oxygen -nutrition -immune cells -ANTIBIOTICS -leads to impaired healing -difficult to treat

Question 33

Osteomyelitis: CM (9)

Answer 33

Local: -tenderness, warmth, redness -wound drainage -restricted movement -spontaneous fracture Systemic: -fever -positive blood culture -leukocytosis

Question 34

Osteomyelitis: Pharmacotherapy

Answer 34

-obtain culture -empiric antibiotic therapy -Nafcillin -Cefazolin -Vancomycin -sometimes continuous infusions, other times direct therapy such as infusing antibiotics through a wound vac -bacteria-specific therapy