trauma and fractures- adult barriers

what occurs in the body in response to trauma

inflammatory response, vascular system wants to mobilize and transport the bodys defenses like WBCs *ambulance example carrying the WBC and the vessels want to help facilitate this by widening

what do WBCs do?

decrease spread of toxins and bacteria by adhering to damaged capillaries

what are the positive changes that happen to the blood vessels specifically during inflammation

vasodilation occurs within the local blood vessels to increase permeability and blood flow and let more WBCs through

what are the negative changes that happen to the blood vessels specifically during inflammation

because of the vasodilation, increased fluid build up and when the healing process goes on for too long this fluid can build up turning into edema, affecting tissues and joint

what are the 4 cardinal signs of inflammation?

heat (vasodilation and increase BF), redness/erythema (vasodilation and increase BF), edema (fluid and cells leaking from vessels into extra vascular spaces), pain

what are intrinsic factors that could cause a trauma injury

tissue weakness, inflexibility, lack of conditioning, over pronated or flat feet, tendonitis etc

what are extrinsic factors that could cause a trauma injury

faulty equipment or surfaces, weather, or lack of coaching/conditioning

what are acute injuries the result of?

sudden tissue overload and tension/stress on a particular joint or muscle or tendon or ligament

what are chronic injuries a result of?

insidious slowly progressing or waxing/waning injuries with exacerbations that can be acute

what is a greenstick fracture?

fx of an epiphyseal growth plate in the LE or UE

what does it mean if a fracture is in a state of mal-union?

bony endings of each side of the fx do not line up anymore

what does it mean that a fx is reduced?

when bony endings are aligned and can be put back together, this could be done by a cast with a hairline fracture or could be popped back together by dr, or surgery

what is the difference between x-ray and MRI?

MRI shows soft tissue, x-ray shows only bone and not soft tissue

what is a closed or simple fracture?

fracture that does not have an open wound in the skin

what is a comminuted fx

bone is shattered into multiple fragments here creating multiple fx’s which often requires surgery to reduce

what is a fatigue fracture?

fx that results from repeated minor stresses

what is an impacted fx

fracture whose ends are driven into each other, happens in CVAs often as the hip and knee are smashed together and could be driven into each other bc of steering wheel

what is a intraarticular fx

fracture that involves the joint surface of a bone

what is an open/compound fx?

fx in which there is an open wound of the skin and soft parts that lead into the fx, the bone will protrude out creating an open wound. infection is a big concern here

what is a pathologic fx

fracture occurring bc bone is weakened by an abnormal condition like osteoporosis, osteogenesis imperfecta and cancer

what does apposition describe in terms of a fx

amount of end-to-end contact of the fx

what is exudate

internal or external fluid leakage caused by build up of fluid this can pour out after a fx

why is it important to diagnose a fx early?

mineralized bone and callous can occur if fx is left alone for too long which all prevent healthy bone from growing

at what % of alignment requires surgery

0% apposition requires a surgery, especially if there is no alignment of there is rotation of either of the bony ends

what is required for a successful healing process from a fx

bony endings must be in apposition, blood supply must be sufficient, bone fragments must be immobilized, compression used to stimulate healing

what are some fx locations where tx is not possible?

ribs, toes, sacrum, coccyx

what is a closed reduction

when the fx has little or no displacement of bony segments, this can be done under local anesthesia and manually to reduce fx, followed by immobilization

what is open reduction internal fixation (ORIF)

a surgical reduction method in a more severe fx or when closed reduction does not work where artificial joints, screws, plates, pins, glue, nails, or buttons are used

what is traction?

another (rare) way to reduce a fx, which could also be done due to infection from hardware, this helps to maintain reduction of bony ends and is usually done is fx is comminuted or unstable

what is external fixation?

outriggers (screws) are used through the fx so they can be tightened by a wire on the outside to get the bones back together, used often in compound fx’s or nerve and soft tissue injuries

what are external immobilization methods

casts, splints, cast paddings. it is important to watch for edema, decreased sensation/circulation and skin breakdown

what are some general rules for casting?

one joint above and one below fx, encouraging movement and sensation after the cast is taken off so pt can “own it”

what are the most common fx sites

wrists, ankles, hips, shoulders, ribs, vertebrae, collarbone