Fractures and Scoliosis

Mobility

The state or quality of being mobile or moveable

from a big trauma or child abuse

When are fractures seen in infants?

distal forearm

Most common fracture

cartilage growth plate

weakest part of long bones

can affect growth

if bone is broken near epiphyseal plate, what happens?

Periosteum is really thick and bones are vascular

Why do kids bones heal faster?

They have a more cartilaginous bones

why are kids less prone to severe fractures?

Complete fracture

When bone breaks into two completely

incomplete fracture

fracture where part of the bone is still touching

transverse

fracture line at a right angle, across the bone

oblique

fracture line at a slant

Spiral fracture

fracture that results from bone twist, frequent sign of abuse (not always)

Simple fracture

Fracture where skin intact

compound/open

fracture where bone pierces skin

complicated fracture

fracture when bone fragments damage another organ

communicated fracture

fracture when bone stays in surrounding tissue but not affecting anything

greenstick injury

fracture when part of the bone is still together

periosteal hinge

when fractures are held together by periosteum

45 degrees

kids bones can bend how far before they break?

crepitus

Crunching sound, boen on bone grating

1. pain and tenderness

2. swelling, bruising

3. decreased use

4. crepitus

5. neurovascular signs

clinical manifestations of fractures, [5]

immobilize the joints above and below

How to immobilize a bone:

1. upper extremety

2. lower extremety

3. spinal and cervical

4. spica

four categories of casting: [4]

10-72h

how long do plaster casts take to dry

1. cheaper

2. can mold to broken bone

benefits of plaster casts: [2]

10-20 minutes, can get hot when drying

how long do fiberglass casts take to dry?

1. lighter

2. easier to clean

3. waterproof

benefits of fiber glass cast: [3]

1. lay it on plastic pillow

2. palm handle to avoid indents

how to let plaster cast dry [2]

Shadowing

when wound is draining and the drainage is outlined to keep track.

1. reduce swelling

2. bring back veinous return

why elevate affected casted limb?

hair drier on cool

how to deal with itchy cast

uses a saw that cant cut skin

how is cast removed?

sit in the bath, let soak. moisturize

how to treat dry skin after cast removal

1. pain

2. pallor

3. pulse

4. paresthesia

5. paralysis

6. pressure

six Ps for compartment sydrome (neurovascular assessment)

compartment syndrome

when a limb swells inside a cast. Compresses nerves, bloood supply, and muscles.

eventually everything becomes ischemic

how can someone lose limb from compartment syndrome

1. cut off cast

2. may need fasciotomy

how to treat compartment syndrome:

1. fatigue muscle to reduce spasm for realignment

2. align bone fragments

3. immobolize fracture until realignment

4. allow for preoperative and postoperative positioning and alignment

Main purposes of traction: [4]

traction

forward force produced by attaching weight to distal bone fragment

•Adjust by adding or subtracting weights

how to adjust traction

countertraction

: backward force provided by body weight

elevate foot of bed

how to increase countertraction

frictional force

force provided by patient’s contact with bed

manual traction

if bones are not aligned completely, bones are pulled with hands

Skin traction

traction where weight is attached to skin, or boot/dressing on skin

Skeletal traction

traction where traction is attached to bone

1. make sure weights are hanging

2. pulleys are free

3. skin around traction is clean

4. child is taken care of and not playing with pulleys

nurse’s job when caring for traction

cervical traction

traction fatigues the neck muscles and takes pressure off vertebral column

bone dislocation and have to start all over again

what happens if weights are removed from traction when theyre not supposed to??

•Counter traction with weights.

•Make sure all ropes and pulleys are aligned and weights are hanging freely.

•Do not remove weights unless instructed to do so – you do not want to displace the fracture.

•Traction must be applied at all times.

•Physician order should include amount of weight to be applied.

principles of traction: [5]

1. get wrinkles out of sheets

2. get crumbs out of bed

how to prevent skin breakdown for child on traction:

deep breathing exercises (incentive spirometer or balloon games)

How to prevent pulmonary issues for child on traction

1. clean pin sites

2. support limb

3. patient education

Nursing care for skeletal traction:

•Eat calcium rich foods such as milk

•Exercise several times a week, muscle strengthening, balance

•Shoes with good traction

•Keep rooms free from clutter

How to prevent fractures [4]

idiopathic

meaning that we don’t know why they have it

1. congenital

2. infantile

3. ideopathic (most)

classifications of scoliosos [3]

Everybody used to be screened, lots of false positives and tests they didn’t need

why is scoliosis screening controversial?

scoliosis

lateral curvature of the spine, uneven waist, and lumber area is more prominent

•Note any asymmetry of shoulder height, scapular or flank shape or hip height and alignment

things to monitor for scoliosis:

Considered a postural variation

curvature less than 10 degrees:

mild scoliosis and no treatment is required

curvature less than 25 degrees

Risser scale

Scale to determine the maturity of bones

Cobb technique

technique that helps determine degree of curvature

xray

how is scoliosis diagnosed:

low back pain and pain radiates to legs, shoulder pains

where would people with scoliosis feel pain?

1. decreased lung capacity

2. shortened life span

3. arthritic changes in spine

4. neurologic sequlae and paralysis

severe s+s of scoliosis

hard plastic brace prevents the curve from getting worse

how would brace treat scoliosis

sports that pur pressure on spinal column

1. horseback

2. gymnastics

3. hockey and rugby

Sports to avoid with scoliosis:

if it is causing issues (lung, heart, pain)

at what point would someone have scoliosis surgery:

1. cbc with differential

2. blood type and screen

3. electrolytes

4. bleeding times

5. pregnancy test

6. covid test

7. urinalysis

bloodwork before scoliosis surgery: [7]

PCA pump (autonomy)

how is pain managed after scoliosis surgery

log roll

how to move scoliosis surgery patient post op