Unit 8 - Fractures

Types of Fractures

Extent of Break

• Incomplete - break only through part of bone

• Complete - break through entire width of bone

Extent of Tissue Damage

• Open - bone pierces through skin

• Closed - no break in skin

Fracture Causes

Fragility or Pathologic Fracture

• May occur during normal activity or following minimal injury when a bone is weakened by a disease.

Fatigue or Stress Fracture

• Normal bone is subjected to repeated stress without bone ans muscle recovery.

Compression Fracture

• Force applied to the long axis of a cancellous bone (i.e., vertebrae).

Bone Healing

1. Hematoma - semisolid clot forms (24-72 hours)

2. Granulation Tissue - fibrocartilage (3-14 days)

3. Callus Formation - minerals deposited (within 6 weeks)

4. Osteoblastic Proliferation - callus reabsorbed, transformed into bone, distance diminishes (3-8 weeks)

5. Bone Remodeling - preinjury shape and strength (up to 1 year)

Venous Thromboembolism (VTE)

• Deep Vein Thrombosis (DVT)

  • Signs & Symptoms: edema, warmth, tenderness.

• Pulmonary Embolism (PE)

  • Signs & Symptoms: SoB, chest pain, diaphoresis, sense of impending doom.

• Prevention: anti-embolic stockings, pneumatic compression devices, mobility, bed exercises.

• Diagnosis: ultrasound, D-dimer blood test.

• Treatment: anticoagulants.

Wound Infection

• Signs & Symptoms

  • tenderness, pain, redness, swelling, local warmth

  • purulent drainage

  • delayed union or non-union of surgical site

• Prevention

  • prophylactic antibiotics and/or post-op antibiotics

  • sterile technique during dressing changes

• Treatment

  • antibiotics

Acute Compartment Syndrome

Increased tissue pressure within a limited space l/t reduced perfusion.

Signs & Symptoms: pain, paresthesia (burning or prickling sensation), poikilothermia (inability to maintain body temp), pallor, paralysis, pulselessness.

Prevention: minimize swelling.

Treatment: remove cast/bandage, fasciotomy (cut connective tissue to reduce pressure), do not ice or elevate.

Fat Embolism Syndrome (FES)

Fat globules released from bone marrow into bloodstream after injury l/t reduced perfusion.

Signs & Symptoms: hypoxemia, dyspnea, tachypnea, headache, lethargy, agitation, loss of consciousness, vision changes, red-brown petechiae (rash).

Prevention: immobilize long bones (i.e., fractures).

Treatment: symptom management.

Neurovascular Assessment

C - circulation (colour, temperature, cap refill, pulses).

M - movement.

S - sensation (includes pain).

Hip Fractures

• Intracapsular

  • femoral neck fractures, inside joint capsule.

  • usually related to bone disease (osteoporosis, bone cancer).

  • treated with insertion of a femoral head prosthesis.

• Extracapsular

  • outside joint capsule.

  • usually related to a fall or trauma.

  • treated with screws and pins.

• Signs & Symptoms

  • leg is shortened and externally rotated (pointed outward).

  • pain/unable to weight bear.

  • muscle spasms common.