Orthopedics

• Will see this with Long bone fractures (femur)
• Pelvic fractures
• Crushing injuries

• S/S depends on where the emboli goes:
• Petechiae or rash over chest
• Conjunctival hemorrhages
• Snow storm on CXR

• Most common in young males as they are the risk takers
• Will occur in first 36 hours

Increased pressure within a limited space

Fluids accumulate in tissue and impairs perfusion.  The muscle becomes swollen and hard. Pt complains of severe pain not relieved by meds. 

• Pain is unpredictable and disproportionate to injury. If not detected, may result in nerve damage and possible amputation. 
• Common areas are forearm and quads. 

Prevention: elevate extremity, put on soft cast first, then hard cast

• Loosen the cast to restore circulation
• May need to do a fasciotomy

Elevation, cold packs, and analgesics!

If these do not relieve pain, think complication!

• Skin traction: Skin is not penetrated. This is when tape, a boot, splint, or other type of material is stuck to skin and weights pull against it. 
• Used until pt can get to surgery
• Common type: Bucks (used with hip and femoral fractures. 
• *Must do good skin assessments!

• Skeletal traction: Traction applied directly to bone with pins and wires. Used when prolonged traction is needed. 
• Types include Steinman pins, Crutchfield, Gardner-Wells tongs, and Halo vest

• Must monitor pin sites and do pin care:
• STERILE technique
• Remove crusts around pins to allow drainage and avoid infection
• Serous drainage is ok (clear is good, pussy fluid is bad!)

Bucks traction is used frequently pre-op

Will do regular neurovascular checks and monitor drains (want to avoid fluid accumulation in tissues)

Will need firm mattress (to support joints) and an over-bed trapeze to build upper body strength

• Positioning: Neutral rotation with toes to the ceiling.
• LIMIT flexion, what EXTENSION of the hip.  
• This means ABDUCTION! Don't want the ball to pop out of accetabulum. 

Can do isometric exercise while still confined to bed

Will use TROCHANTER ROLL to prevent external rotation.

Don't sleep on effected hip.