L15

Question 1

Diagnostic test for osteoporosis

Answer 1

1. Blood test: serum calcium, phosphorus, alkaline phosphatase, and vitamin D
2. Bone mineral design entry:
   - Dual-energy x-ray absorptiometry (DEXA)
   - Quantitative ultrasound (QUS)

Question 2

Drug therapy for osteoporosis

Answer 2

1. Bisphosphonates:
   - inhibit osteoclast-mediated bone reabsorption
   - increase bone mineral density and total bone mass
   - take with full glass of water
   - take 30 mins before meal or other medication
   - keep upright for 30 mins after taking
2. Estrogen therapy
   - increase risk of heart disease, uterine and breast cancer

Question 3

Type of fracture

Answer 3

1. Transverse: cross-section or smaller than 30 degree
2. Oblique: larger than 30 degree
3. Spiral: torque (twist/rotate)
4. Greenstick: incomplete, on one side
5. Comminuted: several or more bone fractures
6. Close fracture: overlying skin intact
7. Open fracture: fracture bone protruding through the broken skin; high risk of infection

Question 4

Colles’ fracture (outward)

Answer 4

• Transverse fracture of distal radius
• Dorsal displacement of the distal fragment

Question 5

Smith’s fracture (inward)

Answer 5

• Reverse Colles’ fracture
• Distal radius fracture
• Ventral displacement of the distal fragment
• Fall on the outstretched hand with wrist in flexed position

Question 6

Intracapsular

Answer 6

Involve the head and neck of femur

Question 7

Extracapsular

Answer 7

Outside joint capsule

Question 8

Avascular necrosis

Answer 8

Disruption to femoral head blood supply
Caused by intracapsular fracture

Question 9

Diagnostic test of hip fracture

Answer 9

1. Swelling and pain at the site of injury
2. Positive tenderness and crepitus (sound) at the site
3. X-ray, CT scan, MRI, bone scan

Question 10

S/s of fracture

Answer 10

1. Swelling
2. Bruising
3. Pain, worsen with movement or pressure
4. Deformity or shortening
5. Impaired movement
6. Loss of function over the affected area
7. Crepitus (sound)

Question 11

Assessment of 5P for fracture

Answer 11

1. Paresthesia: sensation of tingling, burning, etc
2. Pallor: loss of normal colour, cold
3. Pulse: decreased or absent pulse
4. Paralysis: loss of muscle function
5. Pain

Question 12

Complications of fracture

Answer 12

1. Risk of infection
2. Compartment syndrome (over accumulation of pressure around muscles)
3. Venous thromboembolism
4. Fat embolism

Question 13

Reduction principle in fracture

Answer 13

Restore fracture fragment into anatomical alignment

Question 14

Fixation principle in fracture

Answer 14

The fracture fragments are immobilised and held in position until union occurs
- closed: without opening the skin; under analgesic
- open: surgical incision

Question 15

External fixation

Answer 15

For fracture that have significant bone or soft tissue loss, weakened muscle, complex fracture
- holding of bone with metal pins
- pin site care
- monitor s/s of infection

Question 16

Internal fixation

Answer 16

When external fixation cannot maintain reduction
Used in multiple fractures

Question 17

Strain

Answer 17

Extensive stretching of muscle, its fascial sheath, or a tendon

Question 18

Sprain

Answer 18

Injury to the ligamentous structure

Question 19

S/s of strain and sprain

Answer 19

Pain, edema, bruising, decreased range of motion, contusion瘀傷

Question 20

Interventions for strain and sprain

Answer 20

1. RICE
   - restrict movement and rest
   - ice application for vasodilation and reduce muscle spasms; don’t apply more than 30 mins each time
   - compression: to prevent edema and encourage fluid return
   - elevate above heart level to encourage fluid return
2. Heat application
   - apply after acute inflammatory phase (24-72 hours after injury)
   - encourage vasodilation, absorption, and repair
3. Depend severity, active and passive exercise may begin in 2-5 days; severe cases may require 3-6 weeks of immobilisation
   (Long healing period cuz ligaments and tendon have minimum blood supply)
4. Splinting may be used to maintain stability at injury site

Question 21

Nursing care for cast immediately after apply

Answer 21

1. Apply ice directly over fracture site for the first 24 hours
2. Dry the cast immediately if incidentally get wet
3. Elevate extremity above heart level for the first 48 hours
4. Regular move joints above and below the cast

Question 22

Cast nursing care

Answer 22

1. Assess the site, characteristic and intensity of pain; administer analgesic if needed; elevate and immobilise the affected limb
2. Encourage range of motion exercise over the joints of the casted extremities
3. Perform neurovascular assessment; compare with the unaffected limb
   - circulation: temperature, capillary refill, inspect edema, pallor, pulses
   - motor: paralysis
   - sensation: assess pain level; Parasthesia

Question 23

Compartment syndrome

Answer 23

Develop within 24 hours after injury due to edema
Intracompartment pressure > 30mmHg

Question 24

Complications of compartment syndrome

Answer 24

1. Limb ischemia
2. Acute renal failure
3. Rhabdomyolysis (break down of muscle)

Question 25

Clinical manifestations of compartment syndrome

Answer 25

1. Severe pain, Paresthesia, decreased sensation 2. Pulsenessless, pallor 3. Paralysis 4. Swelling, firmness of the compartment, Increased intra-compartment pressure 5. Temperature change

Question 26

Management for compartment syndrome

Answer 26

1. Bivalving the cast (cutting) 2. Fasciotomy: fascia is split open to allow swelling to occur and lower the pressure