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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
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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
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open fracture aka
compound
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closed fracture aka
simple
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what's the difference between a CLEAN fx versus an INCOMPLETE fx?
- clean - broken in 2 (cleanly)
- incomplete - (self explanatory)
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when does a pathological fx happen?
with disease (ca)
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chronic emtabolic disease in w/c bone loss causes decreased density and possible fx
osteoporosis
"silent disease"
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bone RESORPTION
destruction
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a break or disruption in teh continuity of a bone
fracture
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grade I fracture
- damage to skin is minimal
- least severe injury
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grade II fracture
- open fracture
- skin and muscle contusions
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grade III fracture
- damage to:
- skin
- muscle
- nerve tissue
- blood vessels
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trauma to weakened bones d/t disease
pathologic fracture
*spontaneous
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fatigue (stress) fx
excess strain and stress on bone
*common in rec and prof athletes
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compression fracture
loading force applied to long axis of cancellous bone
*commonly occur in vertebrae of pts w/ osteoporosis
*extremely painful
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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)
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what is unique about the bone
bone healing forms new bones, not scar tissue
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which of the stages of fracture healing is the BEGINNING OF NONBONY UNION
3rd stage - formation of callus (2-6 wks)
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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)
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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
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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)
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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
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the time required for healing fractures depndds on these factors:
- age
- type of fx
- type of bone injury
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what factors may increase healing time of bones?
- older age
- larger bones
- complex fractures
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what can cause delayed healing of fracture
- callus dislodged
- edema impairs blood flow
- infeciton
- poor nutrition
- chronic disease
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what may cause NON-UNION in fracture healing
- excessive bone loss
- necrosis
- chronic disease
- disease process that affects bone
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what assessment should be made with bone fractures
- edema/swelling
- pain
- deformity
- lossof funciton
- crepitus
- muscle spasms
- bleeding thru open wound
- ecchymosis (later)
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what dx tests are done to verify bone fracture
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what are the primary goals for bone fracture
*hint: 4 goals
- realignment of bone fragments
- maintainence of realignment
- prevention of complications
- resoration of function
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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
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how is acute compartment syndrome treated
fasciotomy - to relieve pressure
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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
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s/s of fat embolism
- altered mental status
- increased pulse, resp, temp
- cp
- dyspnea
- crackles
- decrase sa02
- petechiae (50-60%)
- retinal hemorrhage
- mild thrombocytopenia
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treatment for fat emolism
- bedrest
- gentle handling
- o2
- hydration IV fluids
- possible steriod tx
- fracture immoblizaiton
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what is the earliest manifestation of fat embolism syndrome
altered mental status
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how is a fracture managed (emergent situation)
#1 thing to watch for
SHOCK!!! assess and manage shock!!
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what do we want to do with the extremity that is suspected to be fracture?
- immobilize!
- apply traction
- elevate
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if the skin is broken with a fracture, what do we do''?!??
- stop bleeding!!! prevent shock!
- neurovascular assessments
- ABX & TETANUS
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what is the most common fixation device (open or closed reduction) of fractures
the cast... duh!
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what is the #1 complication of a TIGHT CAST?
compartment syndrome
*important to assess the 6 ps
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what are some complications that come with having a cast
- compartment syndrome
- infection
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the application ofr pulling force to a part of the body to provide
reduction
alignment
rest
TRACTION
*also used to decrease muscle spams and prevent/correct deforimity and tissue damage
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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
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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
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with traction use, what might it indicate if pt reports severe pain from muscle spasms?
- wts may be too heavy
- pt may need realignment
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what is one of the most common ways of reducing and immobilizing a fracture
open reduction w/ internal fixation (ORIF)
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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
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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
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external fixation w/ closed reduction, where do the pins and screws attach to?
external frame
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under what circumstances might an external fixation w/ closed reduction be used"?
when pts have soft tissue injruy (open fracture)
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