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What is a fracture?
Happens when bone is not strong enough to support the energy applied to it
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How are fractures classified?
- Extent of break
- Extent of soft tissue damage
- Grade
- Cause
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Extent of break.
- Complete: Breaks accross entire width of bone-2 evident sections
- Incomplete: Break only through section of bone-not in 2 distinct sections
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Soft tissue damage.
- Open: skin over break not intact resulting in open wound
- Closed: skin intact
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Grade
- Grade I: least severe
- Grade II: open fracture
- Grade III: damage to skin, muscle, nerve- open fracture > 6-8 cm
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Cause
- Pathologic: trauma to bone that is weakened by disease
- Fatigue/stress: excessive stress/strain on bone
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Assessments
- Shoulder/upper arm: pt standing or sitting
- Distal arm: pt supine-elevate extremity to reduce swelling
- Lower extremities/pelvis: pt in supine position
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Diagnostics
- MRI: determine amount of soft tissue damage
- CT: more complex structures-pelvic fx
- X-ray:
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Complications
- Acute compartment syndrome
- Crush groove
- Hypovolemic shock
- Fat embolism
- Infection
- DVT
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Non surgical interventions
Reduction/immobilization: bandage, splint, cast, traction; NV assessments; monitor for complications, cast care
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Surgical interventions
- ORIF: open reduction c internal fixation-pins, screws, plates, rods, prosthesis
- External fixation: fx reduced, pins inserted into small incisions, held together by external frame; monitor for infammation/infection q8-12h
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Pre-op
- Pre-op: informed consent, pt understanding
- Post-op: VS, bowel sounds, TCDB, drainage, DVT/fat embolism, pain control
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