EXAM 4: Bone Injury/Trauma

parathyroid hormone (PTH)

important regulator of calcium and phosphate levels in the blood

• prevents drop in calcium levels

• prevents rises in phosphate levels

vitamin D

must be converted to be physiologically active and metabolized to compounds that mediate its activity

variety of metabolites with different function

dislocation

the displacement or separation of the bone ends of a joint with loss of articulation

result of trauma

dislocation manifestations

• pain

• deformity

• limited movement/range of motion

dislocation diagnosis

history, physical assessment, radiologic findings

dislocation treatment

depends on site, mechanism, and degree of injury

• reduction

• immobilization

• surgery

fractures

any break - partial or complete

occurs when more stress is placed on the bone that it can absorb

fracture categories

• sudden injury (most common)

• fatigue or stress (repetitive stress or force)

• pathologic

  • osteoporosis

  • cancer

  • bone cyst

spiral fracture

results from twisting motion

impacted fracture

fragments become wedged together

comminuted fracture

> 2 pieces

compression fracture

2 bones that are crushed/squeezed together

fractures clinical manifestations

• pain, tenderness at the site

• inflammation

• loss of function

  • loss of nerve function

    • local shock

• abnormal mobility

• deformity

  • long bones: angulation, shortening, rotation

fractures diagnosis

• history - mechanism, time of injury

• physical assessment

• XR

fractures treatment

• reduction

• immobilization

• preservation and restoration of function

compartment syndrome

• condition of increased pressure within a limited space that compromised the circulation and function of the tissues

• increased pressures can lead to death of nerve and muscle cells

• acute: can occur after fracture or crushing injury

• chronic: develops from exertion in long-duration of activity

Amount of pressure required to produce compartment syndrome depends on:

• duration of pressure elevation

• metabolic tissue rate

• vascular tone

• local BP

compartment syndrome clinical manifestations

• severe pain that is out of proportion to injury

• paresthesias, diminished reflexes, loss of motor function

compartment syndrome diagnosis

• compartment pressure

• history and physical assessment

  • pain score

  • sensory assessment

  • motor function testing

  • peripheral vascular assessment

compartment syndrome treatment

removal of restrictive devices (casts)

elevate extremity

fasciotomy

• incision of the fascia to separate it to allow for compartment to decompress

  • re-established blood flow

Thromboemboli

risk factor: lower extremity fracture

DVT/PE

Fat Embolism Syndrome (FES)

• refers to multiple life-threatening manifestations resulting from the presence of fat droplets in the small blood vessels of the lung, kidneys, brain after a long bone or pelvic fracture

• pathogenesis

  • result from fat droplets that are released from marrow or adipose tissue at the fracture site into the venous system

FES Clinical Manifestations

• respiratory failure: chest pain, SOB, tachycardia, cyanosis

• cerebral dysfunction: confusion, change in behavior, disorientation, seizures

• skin and mucosal petechiae: chest, axillae, neck, shoulders

FES diagnosis

arterial blood gas (ABG)