Tibia and fibula fracture complicated with

compartment syndrome in patients with

early observation and nursing care
Posted:2010-9-16 10:03:00 Browse:2375

[Abstract] Objective To summarize the tibia and fibula fracture and compartment syndrome in
patients with early clinical and nursing observation points. Methods 30 cases of tibia and fibula fracture with
compartment syndrome in patients with dynamic observation of preoperative, early postoperative
rehabilitation care. Results of 28 cases were cured, 2 cases of limb necrosis amputation. Conclusions of the
tibia and fibula fracture patients, nurses should enhance local early limb observation and care, the timely
detection of compartment syndrome complicated with aura symptoms and notify the physician to give
effective treatment and care, to avoid bone limb compartment syndrome caused by the occurrence of neural
muscle necrosis, and promote early recovery of patients.
[Keywords:] tibia and fibula fracture with compartment syndrome nursing
Tibia and fibula fracture is a common disease of orthopedic fractures complicated by compartment syndrome
is a common early stage of its serious complications, such as diagnosis and treatment is not timely, can
quickly develop into muscle necrosis, nerve palsy, renal failure, and even life-threatening. so early
observation confirmed, early stage compartment open decompression treatment of compartment syndrome is
an important means to take. I Division of the May 2002 ~ October 2008 were treated tibia and fibula fracture
and bone ribs membrane compartment syndrome of 30 patients with care, to obtain some experience, are as
follows.
1 Clinical data
1.1 General Information The group of 30 patients, 25 males and 5 females, aged 18 to 55 years, mean age 36
years, of which 18 cases the right side, left side in 12 cases, site of injury: 8 cases of tibia and fibula fracture of
the upper, middle fracture 7 cases, 15 cases of fracture of the lower, 25 cases of blunt trauma, open 5 cases,
causes of injury: traffic accident in 24 cases, landslides crush injury in 6 cases.
1.2 Methods used in this group, 28 cases of early lifting of plywood, plaster external fixation, dehydration and
decompression combined therapy observed in 5 cases the symptoms disappeared in 23 patients anesthetized
with a hard outer compartment completely open decompression in the decompression at the same time
reduction and fixation of fractures. including 16 regular external fixator in 7 cases, the locking pin fixation
Sui, and 5 cases internal fixation.
1.3 Results Of the 28 cases because of detection, diagnosis, treatment in a timely manner, the symptoms
disappeared, function returned to normal, no complications, 2 patients to the hospital occurred when the calf
muscle necrosis, missed decompression time, and ultimately amputation.
2 Observation and nursing care
Early observations with the doctors nurses and intensive care is an important part. Nursing observation
indicators are: skin color and temperature, the distal pulse and capillary filling time, the pain changes,
changes in skin sensation [1].
2.1 The post-traumatic limb pain, burning pain, aggravated and sexual transmitted to a remote, out of
proportion to pain and injury, which is osteofascial indoor nerve compression and ischemia of the early
signals [2]. Nursing care to seriously listen to patients complaints of pain, pain caused by a careful analysis of
the reasons is the primary cause or a muscle injury caused by ischemia. such as fracture reduction, fixation
gradually reduce pain caused by the primary injury, such as increased passive stretch toe pain, or oral Town
valid for the latter due to pain medicine. suddenly disappeared when the patient complaint of pain, should be
on high alert due to the late loss of sensory nerve function. The 28 cases accounted for 93.33% of the patients
showed persistent severe limb pain, limb toe was buckling, passive stretch caused when the toe can not bear
the pain. of which 5 patients were discharged limb external fixation, 20% mannitol 250ml rapid intravenous
infusion of 30min, losers, applied 3 ~ 5d, 2 ~ 4 times / d, etc. symptoms improved with conservative treatment,
23 patients with conservative treatment fails, epidural anesthesia immediately compartment open
decompression, the pain quickly eased.
2.2 acral blood circulation have proved: nerve ischemia can occur in 30min, neurological dysfunction, global
ischemia can occur 12 ~ 24h after the permanent loss of nerve function, muscle ischemia and 2 ~ 4h, there
may be functional changes, lack of Blood 4 ~ 12h to place a permanent loss of function [3]. Therefore the
early observation of limb blood circulation is essential for early detection of nerve muscle ischemia, early
treatment.
Limb compartment syndrome in the early end of skin flushing, skin temperature slightly higher, with the
contralateral skin temperature difference of 2 ??. When the room pressure continued to increase blood
circulation disorder caused when the skin temperature compared with the contralateral lower limb, or even
cold. Limbs distal posterior tibial artery and dorsalis pedis arterial pulse is normal or reduced. This set of 4
cases of the distal dorsalis pedis artery and posterior tibial artery pulse properly accounted for 13.33%, 22
cases accounted for 73.33% less than the healthy side, accounting for 4 cases pulse disappeared 1.33%.
2.3 swelling and paresthesia after fracture, usually manifested different degrees of swelling of the limbs, care
should be closely observed in the
The severity of swelling, compared with the healthy side, and regularly measured compartment pressure.
Mild swelling, the limb striae not disappear, tenderness and tenderness not obvious, does not affect the
function of physical activity, moderate swelling , the limb striae disappeared, the skin shiny, swollen joints
affected limb, pain was significantly affected limb functional activities, severe swelling, the local severe
tenderness, blister formation of visible tension, no hard elasticity of limb and muscle into the hard beam strip,
and even showed a cylinder-like hard, seriously affecting the activities of limb function [4]. At this point raise
the bogey, bogey massage, avoid heat and timely determination of Compartment interior pressure, the
pressure exceeds 25 ~ 30mmHg immediately notify a doctor and make preparations for decompression.
paresthesias after the patient severe pain following another early symptoms appear. The group of 10 patients
had skin, numbness, 7 cases involved patients with impaired sensory nerve distribution area, 2 patients distal
sensory loss, difficulty or inability to toe flexion and extension, suggesting a small indoor leg fascia tissue
ischemia, hypoxia and nerve, they should immediately inform your doctor without delay. reposted elsewhere
in the Free Papers Download Center http://www.hi138 . com 3 nursing intervention after decompression
3.1 decompression illness after close observation close observation of body color, swelling, pain without relief
or disappearance, whether the remote ability to improve physical activity, such as that toe wet, cyanosis,
numbness, pain, and may be less pressure is not complete, the physician should be reported immediately, in
time.
3.2 Incision care full compartment decompression incision, wound with Vaseline gauze plug, plus a dressing
bandage or exposed, closely observe the situation of the wound exudate, dressings should be replaced
penetration, such as exudate and the range for the bright red expanded rapidly, taking active bleeding should
be immediately reported to a doctor and deal with the bleeding. infection is the most serious postoperative
complications, in the event will come to naught, it is very important for prevention of postoperative wound
infection on exudation susceptibility testing done , sensitive antibiotics, ventilation, and strictly control access,
the protection of isolation, cut off as soon as possible such as free skin grafting is an effective measure to
prevent infection.
3.3 tibia and fibula fracture complicated exercise guidance function of compartment syndrome after
decompression of the line cut should be set in the function of limb position, Taigaohuanzhi. Early guidance of
patients do isometric quadriceps exercises and ankle joints and toe extensor music activities to promote
venous and lymphatic flow, reduce the adhesion between the muscles, prevent muscle atrophy, joint stiffness
and other complications. In order to prevent the occurrence of pressure ulcers, but also guide the patient to
do chin-Taitun practice. but Note that the early exercise should be gradual, not fatigue as the degree of each
time, gradually increase activity levels, and promote early recovery of limb function.
4 Experience
Tibia and fibula fracture complicated with compartment syndrome is more common early complications of
trauma. Mostly occurs after injury 4 ~ 12h, the key is the early observation of treatment, early diagnosis,
timely and thorough decompression. Clinical nursing often there are two errors: ?? that Taigaohuanzhi help
reduce the degree of limb swelling, which is wrong. limb limb arterial blood pressure elevation, will accelerate
the closure of small arteries, so that increasing tissue ischemia, limb should be flat , ?? that the presence of
arterial pulse distal limb as absolute safety indicators, it is not. physically injured, the affected area well
outside the range, communicating branch of the blood circulation there, so even if the affected area have
occurred muscle ischemia, necrosis distal pulse still exists. thus requiring care workers, to have a solid
technical expertise, high sense of responsibility and strict control of compartment syndrome occurring risk
factors, to accurately identify the early onset of the signal to coincide with the early diagnosis grasp the
timing of surgery and postoperative care and observation of the disease, guiding the correct functional
exercise is an important guarantee for rehabilitation of patients.