3-05-08 Mrs.

Banks

March 26th UMC lunch

April 1st-pictures-wear white uniform top for pictures

Fractures
• A break in continuity of bone occurring when bone is subjected to stress
greater than what it is able to absorb

• Due to direct blow, crushing force, sudden twisting motion, or extreme

muscle contraction

• Force may result in vascular/neurological system damage and disruption of

usual function of bone movement

Types of fractures

• Complete

• Incomplete

• Simple (closed)

• Compound (open)

o Think infection

• Define by degree of break and skin integrity

Specific Types

• Greenstick-Breaks on one side, splintered on otherside

• Transverse-straight across

• Oblique-angle

• Spiral-twisted around shaft of bone

• Comminuted-splinters-three or more fragments

• Depressed- skull

• Compression-spinal column

• Pathological-as a result of underlying disease

• Avulsion-pulled away from tendon

 • Epiphyseal-fracture across the growth plate

Clinical Manifestations

• Pain

• Loss of function

• False motion

• Deformity/shortening

• Crepitation

• Swelling discoloration

Emergency Management

• Immobilize body part immediately, supporting extremity above and below

• Cover open fracture with sterile or available materials

• Palpate distal pulses to determine adequate tissue perfusion

• Immobilizing an extremity before transport when a fracture is suspected not

only may prevent addition injury, but also will minimize the amount of
bleeding at the site of fracture

Goals of Fracture Treatment

• Reduction-restoring fracture fragments to normal anatomical position (to

“reduce” the fracture is to set the bone)

o Closed reduction(closed manipulation)-ends of bone brought together

through manual traction

o Traction-reduces (realigns) the fracture and provides immobilization

 Buck’s traction weight should be around 5.5 lbs

• You can take them out to bathe as long as someone

supports that extremity

• When pulling them up in bed have someone support the

affected extremity

o Open reduction and internal fixation- fracture fragments are surgically

3-05-08 Mrs. Banks

reduced with internal fixation devices, also referred to as ORIF

• Immobilization-maintaining reduction in place until haling occurs

o Essential for bone healing or callus formation

o External devices- splint, brace, cast, bandage, or traction

o Internal devices, nails, plates, screws, wires, or rods

o Physiologically splinting-holding extremity to you

o Traction

• Rehabilitation-regaining normal functioning and strength of affected part

o Elevate to decrease swelling

o Maintain reduction and immobilization

o Frequent neurovascular checks

o Control anxiety and pain

o Isometric and muscle setting exercises

o Resume activities gradually

Fracture Healing

• Location and severity of fracture

o Arm-3 months

o Leg-6 months

• Blood supply to body part

o Edema impedes healing

• Age

o Osteoblast build

o Osteoclasts break down

• Presence of infection

o Slows healing
 • General condition

o Diseases?

o Nutritional status-are they taking in enough protein, etc.

• Medications

o Corticosteroid therapy

• Flat bones heal quickly

o Sternum, pelvis, scapula

• End of long bones heal more quickly than mid-shaft due to spongy tissue and
vascular supply

Fracture Healing Stages

• Inflammation or hematoma formation

• Cellular proliferation

o Fibroblasts and osteoblast build collagen matrix

• Callus formation

• Ossification

• Remodoling

o New bone reorganized into formal structural arrangement

Complication

• Hypovolemic shock

o See HR increase first then a drop in blood pressure

• Fat embolism syndrome

o Happens 24-72 hours in femur fractures or multiple fracture crush

injuries

o Fatty marrow goes into the blood stream, clumps with the platelet and
form a clot and cause stroke, pulmonary embolism

o Monitor high risk patients (men 20-30)

o Look for triad of FES

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 Behavior (restlessness, agitation)

 LOC

 Respiratory status (shortness of breath)

o Treatment

 Call MD

 Stat ABG’s

 Support respiratory system

 Give heparin

 Vaso-active meds to support cardiovascular function

(dobutamine)

o Prevention

 Immobilization

• Compartment syndrome

o Too much pressure put on the muscle causes numbness, tingling,

paralysis

o Calf and forearm are common areas to develop this

• Other complications

o Thromboembolism, infection, disseminated, intravascular coagulation

(DIC)

• Delayed complication

o Delayed union, non-union, mal-union, avascular necrosis, reaction to

internal fixation devices

Things to remember

• Make sure after back surgery they don’t have a trapeze bar over their bed,
because it could cause damage

• In hip fractures they should not be adducted or greater than 90 degrees

• Should go on prophylactic antibiotic if having dental work done after having

hip replacement or any kind of replacement (lifelong)
• Handle casts with the palms of your hand so that you don’t make indentions
into the casts

o Keep cast dry

o Can ice casting extremity

o External fixator for convannuted