Orthopedics Flashcards
Fractures S/sx
pain and tenderness unnatural movement (limping) deformity shortening of extremity (caused by muscle spasm) creptius swelling discoloration worry about compartment syndrome
Fractures Treatment
immobilize bone ends plus adjacent joints
support fracture above and below site
move extremity as little as possible
splits help prevent fat emboli and muscle spasms
open fractures = cover with sterile or clean
neurovascular checks (most important)
- pulses, color, movement, sensation, cap refill, temp
Fractures Complications
Shock (hypovolemic)
Fat embolism
Compartment syndrome
Shock with Fractures
hypovolemic
depends on amount of trauma and type of injury
most likely with pelvic fractures, crushing fractures, multiple long bone fractures
Fat embolism with fractures
Most common with long bones, pelvic fractures, and crushing injuries
first 36 hrs after injury
S/Sx:
petechiae or rash over chest
conjunctival hemorrhages
snow storm on CXR (patchy infiltrate)
Compartment Syndrome
try to prevent
- fluid accumulates in tissue and impairs perfusion
- muscle is swollen and hard and pt has severe pain not relieved w pain meds
- disproportionate pain to injury
- if not treated = nerve damage and amputation possible
Compartment Syndrome Treatment
loosen cast to restore circulation (not remove, just loosen)
cast cutters
cast saws
fasciotomy - cuts tissue to relieve pressure and restore circulation
Plaster Casts
place ice packs on side of cast for first 24 hours, because cast is stell wet
- if you place on top, it will indent the plaster
palms of hands for first 24 to 72 hours (not fingertips)
keep cast uncovered for drying
do not rest on hard surfaces or sharp edges
rest cast on soft pillow / no plastic
mark breakthrough bleeding (circle area / date and time site)
cover cast close to groin with plastic once its dry
neurovascular checks with 5 Ps (esp if they report pain)
- if elevation, cold packs, and analgesics don’t fix pain, think complication
Fiberglass Cast
dry within 30 min lightwt, waterproof, stronger X-ray's better allow client to bear weight earlier disadvantage = its difficult to mold and contour bc it dries faster used for simple fractures
Traction
uses pulling force to reduce (put bone back in place) and immobilize fractures
* * reduces muscle spasms, pain, realigns bones and prevents deformites
CONTINUOUS / wts should hang freely
keep client pulled up in bed and centered with good alignment
exercise non-immobilized joints
ropes should move freely and knots should be secure
special mattress overlays such as air filled or high density foam
prevent foot drop with foot drop boot
Skin Traction
short term to relieve muscle spasms and immobilize until surgery
tape, boot, splint, etc is applied to skin and wts pull against it
Bucks - used with hip and femoral fractures
skin assessments 3x a day
ankle and achilles tendon area are likely to have problems
Skeletal Traction
pressure applied directly to bone with pins and wires
used when prolonged traction is needed
Ex. Steinman pins, Crutchfield, Gardner-wells tongs, halo vest
monitor pin sites q8 hrs
pin care begins 48 to 72 hours after insertion then perform daily
- sterile technique
- serous drainage is expected
Total Hip Replacement Pre-Op
Buck’s traction used to immobilize fracture
Total Hip Replacement Post-Op
neurovascular check
monitor drains
firm mattress (joints need support)
over bed trapeze to build upper body strength
Positioning
- neutral rotation (toes to ceiling)
- limit flexion (want extension)
- abduction (away)
isometric exercises
trochanter roll to prevent external rotation
no wt bearing until prescribed
avoid crossing legs or bending over
can't sleep on operated side
keep hydrated
no pain meds in operative hipTotal Hip Replacement Complications
Dislocation
Infection
Avascular Necrosis
Immobility Problems
