exam 3 - fractures

  1. extent of break of bone (fracture)
    • complete - break across entire width of bone (bone divided in 2)
    • incomplete - break is through only part of bone
  2. extent of associated soft tissue damage
    • open (compound) - skin surface is disrupted causes external wound
    • closed (simple) - skin surface is not disrupted

    • *further graded to extent of tissue damage:
    • grade I
    • grade II
    • grade III
  3. open fracture aka
  4. closed fracture aka
  5. what's the difference between a CLEAN fx versus an INCOMPLETE fx?
    • clean - broken in 2 (cleanly)
    • incomplete - (self explanatory)
  6. when does a pathological fx happen?
    with disease (ca)
  7. chronic emtabolic disease in w/c bone loss causes decreased density and possible fx

    "silent disease"
  8. low bone mass
  9. bone RESORPTION
  10. a break or disruption in teh continuity of a bone
  11. grade I fracture
    • damage to skin is minimal
    • least severe injury
  12. grade II fracture
    • open fracture
    • skin and muscle contusions
  13. grade III fracture
    • damage to:
    • skin
    • muscle
    • nerve tissue
    • blood vessels
  14. trauma to weakened bones d/t disease
    pathologic fracture

  15. fatigue (stress) fx
    excess strain and stress on bone

    *common in rec and prof athletes
  16. compression fracture
    loading force applied to long axis of cancellous bone

    *commonly occur in vertebrae of pts w/ osteoporosis

    *extremely painful
  17. name stages of fracture healing
    • 1. hematoma formation (24-72 hrs)
    • 2. reorganization of hematoma into fibrocartilaginous network (3 days - 2 wks)
    • 3. formation of callus (2-6 wks)
    • 4. bony callus formation (3 wks - 6 m)
    • 5. remodeling (6 wks - 1 yr)
  18. what is unique about the bone
    bone healing forms new bones, not scar tissue
  19. which of the stages of fracture healing is the BEGINNING OF NONBONY UNION
    3rd stage - formation of callus (2-6 wks)
  20. w/c stage of fracture healing does a clot serve as a framework for deposition of new bone

    *key word: clot
    1st stage - hematoma formation (24-72 hrs)
  21. w/c stage of fracture healing is the CALLUS REABSORBED AND TURNED INTO BONE
    4th stage - bony callus formation (3wks-6m)

    *osteoblast forma permanent callus of rigid bone by depositon of calcium and other minerals
  22. w/c stage of fracture healing does the osteoblasts continue to form new bone & osteoclasts remove dead or excess bone
    5th stage - remodeling ( 6wks - 1 y)
  23. w/c stage of fracture healing do cells and new capillaries invade the hematoma.

    in this stage granulation tissue replaces the hematoma
    2nd stage - fibrocartilaginous network (3d - wks)

    *osteoblasts migrate to the site to form carilage at the fx line
  24. the time required for healing fractures depndds on these factors:
    • age
    • type of fx
    • type of bone injury
  25. what factors may increase healing time of bones?
    • older age
    • larger bones
    • complex fractures
  26. what can cause delayed healing of fracture
    • callus dislodged
    • edema impairs blood flow
    • infeciton
    • poor nutrition
    • chronic disease
  27. what may cause NON-UNION in fracture healing
    • excessive bone loss
    • necrosis
    • chronic disease
    • disease process that affects bone
  28. what assessment should be made with bone fractures
    • edema/swelling
    • pain
    • deformity
    • lossof funciton
    • crepitus
    • muscle spasms
    • bleeding thru open wound
    • ecchymosis (later)
  29. what dx tests are done to verify bone fracture
    • xray
    • routine lab work
  30. what are the primary goals for bone fracture

    *hint: 4 goals
    • realignment of bone fragments
    • maintainence of realignment
    • prevention of complications
    • resoration of function
  31. what are the "6 Ps" to assess the extent of orthopedic injury
    • pain & point of tenderness
    • pulselessness distal to fx site
    • pallor
    • paresthesia
    • paralysis
    • pressure
  32. how is acute compartment syndrome treated
    fasciotomy - to relieve pressure
  33. where do fat embolisms originate
    95% from fx of the long bones

    *occasionally seen in pts w/ total joint replacement

    *usually occurs w/in 48 hrs
  34. s/s of fat embolism
    • altered mental status
    • increased pulse, resp, temp
    • cp
    • dyspnea
    • crackles
    • decrase sa02
    • petechiae (50-60%)
    • retinal hemorrhage
    • mild thrombocytopenia
  35. treatment for fat emolism
    • bedrest
    • gentle handling
    • o2
    • hydration IV fluids
    • possible steriod tx
    • fracture immoblizaiton
  36. what is the earliest manifestation of fat embolism syndrome
    altered mental status
  37. how is a fracture managed (emergent situation)

    #1 thing to watch for
    SHOCK!!! assess and manage shock!!
  38. what do we want to do with the extremity that is suspected to be fracture?
    • immobilize!
    • apply traction
    • elevate
  39. if the skin is broken with a fracture, what do we do''?!??
    • stop bleeding!!! prevent shock!
    • neurovascular assessments
  40. what is the most common fixation device (open or closed reduction) of fractures
    the cast... duh!
  41. what is the #1 complication of a TIGHT CAST?
    compartment syndrome

    *important to assess the 6 ps
  42. what are some complications that come with having a cast
    • compartment syndrome
    • infection
  43. the application ofr pulling force to a part of the body to provide


    *also used to decrease muscle spams and prevent/correct deforimity and tissue damage
  44. 5 types of traction
    • 1. skin traction - 5-10lbs (bucks or russel)
    • 2. skeletal traction - 15-30 lbs (pins, wires, or tongs surgically inserted into bones)
    • 3. plaster traction - combination of skeletal traction and plaster cast
    • 4. circumferential traction - use of body belt, pelvic, or low back
    • 5. brace traction - correction of alignment deformities
  45. nurse interventions for traction use
    • nurse may set up or assist ONLY if specially educated
    • wts are not removed w/o rx
    • should NOT be lifted manually
    • should NOT allow to rest on floor
    • SHOULD freely hang at all times
    • check CHECK check pt's alignment
  46. with traction use, what might it indicate if pt reports severe pain from muscle spasms?
    • wts may be too heavy
    • pt may need realignment
  47. what is one of the most common ways of reducing and immobilizing a fracture
    open reduction w/ internal fixation (ORIF)
  48. what is an advantage to getting and ORIF (open reduction w/ internal fixation)
    • permits early mobilization
    • surgeon gets a direct view of the fracture site
  49. how does open reduction w/ internal fixation (ORIF) done?
    uses metal pins, screws, rods, plates, or prostheses to immobilize the fx during healing

    *after bone achieve uion, the metal hardware may be removed depending on the location and type of fx
  50. external fixation w/ closed reduction, where do the pins and screws attach to?
    external frame
  51. under what circumstances might an external fixation w/ closed reduction be used"?
    when pts have soft tissue injruy (open fracture)
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exam 3 - fractures