FRACTURE THAT DOESN'T BREAK SKIN

CLOSED FRACTURE

FRACTURE WHERE SKIN SURFACE IS BROKEN

OPEN FRACTURE/COMPOUND FRACTURE

THIS TYPE OF FRACTURE IS SEEN THE MOST IN CHILD ABUSE

SPIRAL FRACTURE

THIS FRACTURE HAPPENS WHEN A MASSIVE OBJECTIVE CRUSH BONE

• FAT EMBOLISM IS MOST SEEN WITH THIS TYPE OF FRACTURE

CRUSH/COMPRESSION FRACTURE

WHAT ARE SOME COMMON CAUSES OF FRACTURES

• OSTEOPOROSIS
• BED REST
• STEROIDS - EX. PREDNISONE
• TRAUMA

SOME SIGNS AND SYMPTOMS FOR A FRACTURE

PRIORITY: INTERNAL BLEEDING

• HYPOTENSION
• TACHYCARDIA
• HEMATURIA
• PAIN SWELLING
• CREPITUS
• MUSCLE SPASMS

IN THIS TYPE OF FRACTURE, CEREBRAL SPINAL FLUID IS SEEN DRAINAGE FROM NOSE CAUSING RHINORRHEA

BASILAR SKULL FRACTURE

THIS FRACTURE HAPPENS WHEN IT IS LOCATED T-6 OR HIGHER CAUSING THIS TYPE SHOCK (TWO ANSWERS)

1. SPINE FRACTURE
2. NEUROGENIC SHOCK

IN THIS FRACTURE, PATIENT IS BLEEDING/DROOLING FROM THE MOUTH. WHAT IS THE PRIORITY NURSING ACTION?

• MANDIBULAR FRACTURE
• SUCTION OF THE MOUTH

WHAT ARE SOME SIGNS AND SYMPTOMS OF A HIP FRACTURE?

• SHORTENING OF THE LEG ON THE AFFECTED SIDE
• MUSCLE SPASM AROUND THE AFFECTED AREA
• ECCHYMOSIS OF THIGH AND HIP
• GROIN AND HIP PAIN WHEN BEARING WEIGHT

THE NURSE IS ASSESSING A CLIENT WITH AN OPEN LEG FRACTURE. THE NURSE SHOULD INQUIRE ABOUT THE LAST TIME THE CLIENT HAD WHICH DONE?

TETANUS BOOSTER

USED SHORT TERM BEFORE SURGERY (PRE-OP) TO REALIGN BONES IN THE HIP AND FEMUR FRACTURES (PULLS BACK INTO PLACE THE BONE THAT WAS DISPLACED.

BUCK'S TRACTION

SOME KEY POINTS TO REMEMBER FOR BUCKS TRACTION

• WEIGHTS = FREE HANGING; NEVER REMOVED UNLESS ORDERED BY PCP
• TRACTION ROPES ARE TIGHT (NOT LOOSE OR RESTING ON FLOOR/BED)
• TO REPOSITION PATIENT - HOLD WEIGHTS
• KEEP LIMB IN NEUTRAL POSITION
• ASSESS FOR SKIN BREAKDOWN
• NEURO CHECKS: PULSES, MOTOR, SENSATION AND CAP REFILL
• SUPINE POSITION (NO FOWLERS!)
• INFECTION: ELEVATED WBC; ASSESS SITE FOR DRAINAGE - "COCA); PERFORM PIN CARE FOR TRACTION WITH STERILE TECHNIQUE (PRE-OP: BUCK'S TRACTION)
• ABDUCTION IS NOT REQUIRED

PRIORITY AFTER HIP/FEMUR SURGERY

1. BLEEDING (PRIORITY): HGB: <7 - REPORT TO HCP! , MONITOR PULSES DISTAL TO INJURY; OBSERVE TO HYPOTENSION AND TACHYCARDIA
2. POSITIONING CARE: ABDUCT LEGS; NO CROSSING LEGS; NO LEANING FORWARD; NO SITTING AT 90 DEGREE ANGLE

MAJOR COMPLICATION W/ LONG BONE INJURIES (FEMUR), FEMUR, AND PELVIS FRACTURES, COMPRESSION FRACTURES

FAT GLOBULES ARE RELEASED INTO THE BLOODSTREAM THAT CAN LEAD TO BLOCKAGE

FAT EMBOLISMS

KEY SIGNS W/ FAT EMBOLISM SYNDROME

1. MENTAL STATUS CHANGES - CONFUSION, RESTLESSNESS, AND ALTERED MENTAL STATUS
2. DYSPNEA
3. CHEST PAIN
4. LOW PULSE OX
5. PETECHIAE OVER NECK AND CHEST

THE MOST FAVORABLE INDICATION OF RESOLUTION OF FAT EMBOLISMS

CLEAR MENTATION

MOST IMPORTANT INTERVENTION FOR FAT EMBOLISM

MINIMIZE MOVEMENT OF FRACTURE

NO PROPHYLATIC MEDS/BONE THINNERS OR COMPRESSION DEVICES

SIGNS AND SYMPTOMS OF OSTEOMYELITIS

TEMP

YELLOW DRAINING FROM SITE

TREATMENT FOR OSTEOMYELITIS

LONG TERM USE OF ANTIBIOTICS FOR WEEKS TO MONTHS

WOUND DEBRIDEMENT

AMPUTATION

POSSIBLE COMPLICATIONS OF CASTS

HOT SPOTS - INFECTION

COMPARTMENT SYNDROME - DECREASED PERFUSION

• COMES FIRST IN PRIORITIZATION BETWEEN THE 2

SIGNS OF COMPARTMENT SYNDROME

• SEVERE PAIN (EARLIEST SIGN OF SUDDEN COMPARTMENT SYNDROME) - UNRELIEVE W/ MORPHINE ; NOT RESOLVING W/ MEDS ; EXTREME PAIN W/ PASSIVE MOVEMENT

• PARESTHESIA - TINGLING/BURNING/ NUMBNESS ; PROBLEMS MOVING FINGER/TOES
• DISCOLORATION
• LATE SIGN: LACK OF PULSE - MEDICAL EMERGENCY

INTERVENTIONS FOR COMPARTMENT SYNDROME

• NOTIFY PCP
• ASSESS FINGER/TOES W/ NEURO CHECKS : 'PMSC'
• ELEVATE LIMB TO THE LEVEL OF THE HEART
• FASCIOTOMY

THINGS TO REMEMBER FOR CAST CARE

• C - CLEAN AND DRY : COVER CAST W/ A PLASTIC BAG FOR BATHING AND ALLOW CAST TO DRY FOR 24-48 HOURS
• A - ABOVE (ELEVATE) THE HEART FOR 1ST 48 HOURS ON A PILLOW
• S - SCRATCH AN ITCH : USE HAIR DRYER ON LOW/COOL SETTING
• T - TAKE IT EASY : NO BEARING WEIGHT AND NO FINGER INDENTATIONS (USE PALM OF HANDS) OR PRESSURE AND NO HARD SURFACES; NEVER CUT IT OFF UNLESS ORDERED TO DO SO

REVIEW CANE AND CRUTCHES SECTION OF FRACTURES VIDEO STARTING AT 27:30

REVIEW

PRESSURE ON AN ANATOMIC COMPARTMENT IS INCREASED BEYOND NORMAL

COMPARTMENT SYNDROME

WHAT TYPE OF ASSESSMENT CAN REVEAL SYMPTOMS OF COMPARTMENT SYNDROME OR FRACTURES IN GENERAL?

NEUROVASCULAR ASSESSMENT

WHAT DOES A NEUROVASCULAR ASSESSMENT CONSIST OF?

• COLOR OF EXTREMITY: PALLAR CAN INDICATE VASCULAR INSUFFICIENCY
• TEMP
• CAP REFILL
• PERIPHERAL PULSES
• EDEMA
• SENSATION
• PAIN
• 5 P'S - PAIN, PARALYSIS, PARENTHESIAS, PALLOR, AND PULSELESSNESS

WHAT CAN DEVELOP 24-48 HOURS POST SURGERY FOR A HIP FRACTURE

ATELECTASIS OR PNEUMONIA

OLDER PATIENTS ARE ALSO AT RISK FOR DELIRIUM AND PULMONARY EMBOLISM, ESPECIALLY IN OLDER ADULT PATIENTS WHO HAVE PREEXISTING RESPIRATORY CONDITIONS

MEDICAL MANAGEMENT OF FRACTURES THAT PROMOTE BONE AND SOFT TISSUE HEALING

REDUCTION

IMMOBILIZATION

THE RESTORATION OF BONE FRAGMENTS TO ANATOMICAL ALIGNMENT AND ROTATION (FOR INJURIES THAT ARE NOT AS SEVERE)

• CLOSED OR OPEN MAY BE USED

REDUCTION

AFTER A FRACTURE HAS BEEN REDUCED, IT IS NECESSARY TO DO THIS TO THE BONE FRAGMENTS

• EX. BANDAGES, CASTS, SPLINTS, CONTINUOUS TRACTION, AND EXTERNAL FIXATORS, METAL IMPLANTS

IMMOBILIZATION

WHAT SHOULD PATIENT W/ EDEMA DO TO THEIR INJURED AREA?

ELEVATE EXTREMITY AND APPLY ICE TO THE INJURED AREA

CONTROLS MUSCLE SPASMS AND IMMOBILIZES AN EXTREMITY BEFORE SURGERY

SKIN TRACTION

USED TO TREAT FRACTURES OF THE FEMUR, TIBIA, AND CERVICAL SPINE

SKELETAL TRACTION

MEDICAL MANAGEMENT OF COMPARTMENT SYNDROME

• CONSERVATIVE MEASURES FIRST! ELEVATION OF LIMB AT HEART LEVEL AND REMOVAL OF ANY CONSTRICTIVE DRESSINGS *CASTS
• IF S/S AREN'T RELIEVED IN 1 HOUR, FASCIOTOMY IS PERFORMED TO RELIEVE PRESSURE IN THE COMPARTMENT THROUGH EXCISION OF THE FASCIA

NURSING MANAGEMENT FOR ACUTE FRACTURES

• MONITORING FOR S/S OF INFECTION
• USING STERILE TECHNIQUE FOR DRESSING CHANGE
• ADMINISTERING ANTIBIOTICS ON TIME TO MAINTAIN SERUM LEVELS, AND MONITORING FOR SIDE EFFECTS
• MAIN SKIN INTEGRITY AND PROPER BODY ALIGNMENT
• MONITOR FOR PAIN/DISCOMFORT
• ADMINISTER PAIN MEDS AS PRESCRIBED

NURSING MANAGMENT FOR CASTS:

• DURING DRYING TIME, PICK UP CAST W/ PALMS OF HAND TO PREVENT DENTING THE CAST. AS DENTS CAN CAUSE PRESSURE ON UNDERLYING TISSUES AND CAUSE SKIN BREAKDOWN
• NEUROVASCULAR CHECKS

TYPICAL PRESENTATION OF A HIP FRACTURE

SHORTENED LIMB AND EXTERNALLY ROTATED

SOFT TISSUE INJURY

CONTUSION

SPRAIN

INJURY TO LIGAMENTS AND TENDONS AROUND A BONE

CHILDREN (NOTES)

NOT COMMON FOR CHILDREN <2 YEARS OLD

• USUALLY CAUSED BY SOMEONE ELSE OR ACCIDENTAL TRAUMA

1. SEVERE CLOSED DISPLACED FRACTURE
2. SEVERE OPEN DISPLACED FRACTURE

REQUIRES OPEN REDUCTION INTERNAL FIXATION

REQUIRES OPEN REDUCTION EXTERNAL FIXATOR

NOTES

IF A PATIENT HAS SEVERE SWELLING A SPLINT MAY BE USED BEFORE A CAST TO PREVENT COMPARTMENT SYNDROME

CLOSED REDUCTION - MAY BE CAST, SPLINT OR OTHER DEVICE - CAN BE DONE IN SURGERY

ORIF - REQUIRES SURGERY - SEVERE FRACTURES

INTERVENTIONS FOR PRESSURE INJURIES IN SPLINTS/CASTS

WINDOW OR BIVALVE CAST

INTERVENTIONS FOR DISUSE SYNDROME (NOT USING MUSCLES)

ISOMETRIC EXERCISES

WHAT DOES OCCUPATIONAL THERAPY DO?

ADL'S INCLUDING EATING

WHAT DOES PHYSICAL THERAPY DO?

EVERYTHING OT DOESN'T DO

MOST COMMON CONCERNS FOR PELVIS FRACTURES

SHOCK AND HEMORRHAGE BECAUSE IT'S EXTREMELY VASCULAR