N418 Exam 2 Musculoskeletal Injury: Fractures

What stage of fracture healing is described below?? (1. Fracture hematoma, 2. Granulation tissue (Inflammatory), 3. Callus formation - soft callus, 4. Ossification - hard callus (Reparative), 5. Consolidation, and 6. Remodeling (Remodeling)) - Active phagocytosis absorbs products of local necrosis - Hematoma converts into fibrous network of new blood vessels, fibroblasts, & osteoblasts - This granulation tissue is the basis for new bone substance (osteoid) - During days 3-14 after injury

2. granulation tissue (inflammatory)

Clinical manifestations of compartment syndrome includes one or more the the 6 P's. What are the 6 P's?? *** usually the area is very hard (like woodlike)

- P ain: out of proportion, not managed by opioids analgesics, or on passive stretch (early finding; one of the first) - P ressure: increasing in compartment (goes along with pain) - P aresthesia: numbness/tingling (early finding) - P allor: coolness, loss of normal color (can be late finding) - P aralysis: or loss of function (late finding) - P ulselessness: diminished or absent peripheral pulses (late finding)

What are the 6 stages of fracture healing? o it takes bone awhile to heal, it takes up to a year and sometimes longer for it to be fully healed. Typically you are looking at least 6-8 weeks of limited mobility if it's a lower extremity.

1. Fracture hematoma 2. Granulation tissue (Inflammatory) 3. Callus formation - soft callus 4. Ossification - hard callus (Reparative) 5. Consolidation 6. Remodeling (Remodeling)

What stage of fracture healing is described below?? (1. Fracture hematoma, 2. Granulation tissue (Inflammatory), 3. Callus formation - soft callus, 4. Ossification - hard callus (Reparative), 5. Consolidation, and 6. Remodeling (Remodeling)) - First 72 hours - Bleeding creates hematoma surroundings fractured ends and clot formation

1. fracture hematoma

What stage of fracture healing is described below?? (1. Fracture hematoma, 2. Granulation tissue (Inflammatory), 3. Callus formation - soft callus, 4. Ossification - hard callus (Reparative), 5. Consolidation, and 6. Remodeling (Remodeling)) o Minerals (calcium, phosphorus, & magnesium) and new bone matrix are deposited in the osteoid o Unorganized network of bone is formed and woven around fracture parts o Callus is made mostly of cartilage, osteoblasts, calcium, and phosphorus. o Appears by end of week 2 o Can be seen on x-ray (when they do follow up x-ray this is what they are looking for, to see if the callus is formed)

3. callus formation-- soft callus

What stage of fracture healing is described below?? (1. Fracture hematoma, 2. Granulation tissue (Inflammatory), 3. Callus formation - soft callus, 4. Ossification - hard callus (Reparative), 5. Consolidation, and 6. Remodeling (Remodeling)) o ________ of the callus o Occurs 3 weeks-6 months after fracture until healed o Gentle stress does not cause movement at fracture site o Fracture can still be seen on x-ray o Clinical Union o Limited mobility; cast removed

4. ossification-hard callus (reparative)

What stage of fracture healing is described below?? (1. Fracture hematoma, 2. Granulation tissue (Inflammatory), 3. Callus formation - soft callus, 4. Ossification - hard callus (Reparative), 5. Consolidation, and 6. Remodeling (Remodeling)) o Callus continues to develop o Decreased distance between bone fragments until closed o Radiologic Union (looks healed on x-ray) o Up to 1 year after fracture

5. consolidation

What stage of fracture healing is described below?? (1. Fracture hematoma, 2. Granulation tissue (Inflammatory), 3. Callus formation - soft callus, 4. Ossification - hard callus (Reparative), 5. Consolidation, and 6. Remodeling (Remodeling)) o Final Stage o Excess bone tissue is reabsorbed o Union complete o Gradual return to pre-injury strength and shape o Wolff's law (bone remodels in response to physical loading) o So this is where weight bearing starts to help to stress the bone and cause that remodeling o Patient will be non-weight bearing until there is a good callus formation and then add limited weight bearing and progress that

6. remodeling

_______ traction is a type of skin traction and is common for hip/femur fractures o Boot that wraps around the patients leg and you use Velcro to secure it with rope attached that hangs over the end of the bed with a weight on it. The weight gives a constant pulling action to try to keep the bone in alignment

Buck's traction

What intervention for fractures is described below: o Prevents heel breakdown o Prevents plantar flexion (maintains foot in neutral position)

Prafo boot

T or F. it takes bone awhile to heal, it takes up to a year and sometimes longer for it to be fully healed. Typically you are looking at least 6-8 weeks of limited mobility if it's a lower extremity. **fracture healing

T

What fracture healing complication is described below (delayed union, nonunion, malunion, angulation, pseudoarthrosis, refracture, myositis ossificans): - abnormal position in relation to midline of structure (type of malunion)

angulation

What interprofessional management/ care of fractures is described below? - Typically for closed reduction when they cast, they put a soft cast on bc there is swelling in the first 24- 48 hrs. so if it's in th ER they put the soft cast and send them home to follow up with orthopedic surgeon to get a hard cast later

cast care

What interprofessional management/ care of fractures is described below? DO NOT: 1. get cast wet 2. remove any padding 3. insert any objects inside cast 4. bear weight on new cast for 48 hour (not all casts are made for weight bearing; check with HCP when unsure) 5. cover cast with plastic for prolonged periods.

cast care

What interprofessional management/ care of fractures is described below? DO: 1. apply ice directly over fracture for first 24 hour (avoid getting cast wet by keeping ice in plastic bag and protecting cast with cloth). 2. check with HCP before getting fiberglass cast wet 3. dry cast thoroughly after exposure to water (blot dry with towel; use hair dryer on low setting until cast is thoroughly dry) 4. elevate extremity above level of heart for first 48 hours 5. Move joints above and below cast regularly 6. use hair dryer on cool setting for itching

cast care

What interprofessional management/ care of fractures is described below? DO: 7. Report signs of possible problems to HCP: --increasing pain despite elevation, ice, and analgesia --swelling associated with pain and discoloration of toes or fingers --pain during movement --burning or tingling under the cast --sores or foul odor under the cast 8. keep appointment to have fracture and cast checked

cast care

What interprofessional management/ care of fractures is described below? - Temporary circumferential immobilization device - Common following closed reduction - Able to perform most ADL's while providing stability - Made of synthetic or natural materials - Usually incorporates the joints above and below fracture - Upper Extremity Injuries: sugar-tong splint, posterior splint, short and long-arm cast, sling may be used - Vertebral Injuries: body jacket brace, - Lower Extremity Injuries: long leg cast, short leg cast, cylinder cast, hip spica cast, *****splint/immobilizer******

casts

A ______ fracture is simple; skin is NOT broken, you cannot see the bone. - Ask yourself: Is the skin broken or not?

closed fracture

A _______ fracture is a fracture with more than two fragments. The smaller fragments appear to be floating. **displaced fracture

comminuted fracture

What main complication of fractures is described below? - Causes neurovascular impairment - Most common in leg, but can occur in any muscle group - Usually associated with trauma fractures especially long bones, extensive soft tissue damage, and crushing injuries - Can occur initially as response to injury or delayed several days - Ischemia can occur within 4-8 hours after onset (very important to understand and recognize early to treat)

compartment syndrome

What main complication of fractures is described below? - Fascia (hard fibrous tissue that encapsulates some of the muscle) has limited ability to stretch o So if you start getting fluid, bleeding, edema within those muscle compartments and the fascia is not stretching it can cause compression of the vessels and nerves - Causes: Decreased compartment size from restrictive dressings (too tight)/immobilization devices (too early, swelling), excessive traction, early closure of fascia OR increased compartment contents r/t bleeding, inflammation, edema, IV infiltration

compartment syndrome

What main complication of fractures is described below? - Increased pressure within muscle compartment (causes compression of the nerves, veins, and arteries so it decreases blood supply and it can result in limb ischemia and tissue necrosis) - Fascia (hard fibrous tissue that encapsulates some of the muscle) has limited ability to stretch o So if you start getting fluid, bleeding, edema within those muscle compartments and the fascia is not stretching it can cause compression of the vessels and nerves - Causes: Decreased compartment size from restrictive dressings (too tight)/immobilization devices (too early, swelling), excessive traction, early closure of fascia OR increased compartment contents r/t bleeding, inflammation, edema, IV infiltration - Causes neurovascular impairment - Most common in leg, but can occur in any muscle group - Usually associated with trauma fractures especially long bones, extensive soft tissue damage, and crushing injuries - Can occur initially as response to injury or delayed several days - Ischemia can occur within 4-8 hours after onset (very important to understand and recognize early to treat)

compartment syndrome

What main complication of fractures is described below? One or more of six P's - P ain: out of proportion, not managed by opioids analgesics, or on passive stretch (early finding; one of the first) - P ressure: increasing in compartment (goes along with pain) - P aresthesia: numbness/tingling (early finding) - P allor: coolness, loss of normal color (can be late finding) - P aralysis: or loss of function (late finding) - P ulselessness: diminished or absent peripheral pulses (late finding) *** usually the area is very hard (like woodlike)

compartment syndrome

the following is interprofessional care of _____ ______: - Assess urine output o Can develop rhabdomyolysis secondary to ______ _____ which can cause renal failure so we need to monitor urine output o If they start having dark brownish red colored and scant amounts of urine this should raise a red flag

compartment syndrome

the following is interprofessional care of _____ ______: - Possible surgical decompression (fasciotomy), amputation o Fasciotomy- surgeon makes a cut through the skin and through the fascia to open it up and provide more room for swelling and edema. They leave it open for a few days until the swelling resolves and then they take them back to surgery and close it up § Will be doing wet to dry dressings for this bc you want to keep the internal structures moist but the skin around it dry to prevent breakdown o If we don't get to it in time or we can't resolve it they may end up with an amputation if they have tissue necrosis § This is why it's very important to recognize _____ _____ and intervene as soon as possible

compartment syndrome

the following is interprofessional care of _____ ______: - Prompt, accurate diagnosis and treatment to avoid permanent damage to muscles and nerves - Notify HCP immediately to relieve pressure - Typically with swelling we want to raise the arm, with _____ ______ you don't want to raise the arm it can decrease perfusion bc perfusion is working against gravity and compression now. You also don't want to lower the arm bc it can make edema worse. keep arm level

compartment syndrome

A ______ fracture is when the break goes completely through the bone. - Ask yourself: Is the bone completely broken or not?

complete fracture

The following are _____ of fractures: - Majority have none or not life-threatening, but death can result - Open fractures can cause severe blood loss, damage vital organs, and are medical emergencies - Direct ________: bone infection (open fractures), bone union problems, avascular necrosis - Indirect _______: (associated with blood vessel and nerve damage) compartment syndrome, VTE, fat embolism syndrome (FES), rhabdomyolysis, hypovolemic shock

complications

What complication of fractures is described below: - - abnormal condition of joint characterized by flexion and fixation (cant straighten) o Prevent: Active-passive ROM

contracture

What fracture healing complication is described below (delayed union, nonunion, malunion, angulation, pseudoarthrosis, refracture, myositis ossificans): progresses more slowly than expected

delayed union

the following are ______ tests for fractures: - History & Physical Exam - X-ray (most common) - CT Scan/MRI (occasionally for more detail if difficult to diagnose, in a difficult spot, or very small)

diagnostic tests

The following are ____ complications of fractures: bone infection (open fractures), bone union problems, avascular necrosis

direct

A _____ fracture includes separated ends and out of position; often Comminuted (> 2 fragments) or Oblique

displaced fracture

What intervention for fractures is described below? - Muscle Relaxers from muscle spasms causing pain and discomfort and also spasms can prevent the bone from staying in alignment or it can move the bone - Analgesics- pain - Immunizations- especially with open or compound fractures you want to make sure they are up to date on their tetanus and diphtheria bc they may need booster - Antibiotics- surgery or open fracture

drug therapy

What intervention for fractures is described below? - Facilitates bone healing process o Increases the calcium uptake of bone o Activates intracellular calcium stores o Increases the production of bone growth factors - Used with delayed union or nonunion - Non-invasive, semi-invasion, and invasive methods

electrical bone growth stimulation

What interprofessional management/ care of fractures is described below? - Metal pins inserted into bone then attached to external rods - Stabilizes fracture while healing - Traction can be applied (skeletal fraction), compresses fragments, immobilizes fragments - For complex fractures with extensive soft tissue damage, congenital bony defects, nonunion or malunion and limb lengthening, limb salvage - Assessment > pin loosening, infection o High risk for osteomyelitis and soft tissue infections bc its an external device going into the bone o Assess regularly for redness, erythema, drainage, edema, and pin loosening

external fixation

The following are fracture healing _______: o Many _________ contribute to healing/nonhealing: o Displacement and site § Displaced is more complicated and can take longer to heal § Fractures near joints like wrists or ankles sometimes can take a little longer to heal o Immobilization and inadequate reduction § To keep in alignment and touching so healing can occur § Use splints or casts § Reduction is when you have a displaced fracture that they put back in alignment. If not put back it may not heal right and may take longer to heal

factors

The following are fracture healing _______: o Many _________ contribute to healing/nonhealing: o Poor nutrition § Have to have adequate nutrition to heal, if nutrition is not good they may have delayed healing o Systemic disease, blood supply, infection § Can delay healing o Age § Can take longer in older patients o Smoking § Can delay healing

factors

The following are fracture healing _______: o Many _________ contribute to healing/nonhealing: o Use of internal fixation devices § Pins, screws, plates to put the bone back in alignment § Typically speeds up healing unless you have some type of problem with the device such as infection o Excessive movement of fragment § Don't want to move that area (this is why we immobilize) until you have good union. Then once there is union you can start putting a little stress on it

factors

What complication of fractures is described below: Diagnosis of Exclusion Major signs: --confusion, agitiation --petechial rash (axillae, conductive, palate); rash in about 20-50%

fat embolism syndrome (FES)

What complication of fractures is described below: o Fat emboli in lungs cause hemorrhagic interstitial pneumonitis (s/s of ARDS) o Triad - hypoxemia, changes in mental status, petechial rash (20-50%) o If they don't have the petechial rash it does not rule it out bc only 20-50% experience it o No specific lab tests to diagnose, diagnosis of exclusion

fat embolism syndrome (FES)

What complication of fractures is described below: o Systematic fat globules from fracture distributed into tissues, lungs, & other organs after traumatic skeletal injury o Contributes to mortality rates of fractures o Most common in long bones, ribs, tibia, and pelvis o 24-48 hrs. after injury, rapid and acute o Fat emboli in lungs cause hemorrhagic interstitial pneumonitis (s/s of ARDS) o Triad - hypoxemia, changes in mental status, petechial rash (20-50%) o If they don't have the petechial rash it does not rule it out bc only 20-50% experience it o No specific lab tests to diagnose, diagnosis of exclusion

fat embolism syndrome (FES)

the following is interprofessional care for what complication of fractures? - Prevention is key: Immobilization and handling of long bone fractures - Management related to supportive measures for signs and symptoms - Pulmonary edema/ARDS can cause increased mortality, most survive without complications

fat embolism syndrome (FES)

What complication of fractures is described below: o Planter-flexed position of the foot occurs because it has been allowed to assume an unsupported position from prolonged bedrest (Achilles tendon shrinks) § Prevent: Support foot in neutral position- prafo boot or high-top tennis shoes § Can usually be worked out with physical therapy o Peroneal nerve palsy (pressure from short leg cast) or spina nerve compression § Not as easily treated as plantar

footdrop

Classification of a _____ is either OPEN or CLOSED. - Closed= Simple o Skin is not broken, you can't see the bone - Open= Compound o Break in the skin - Ask yourself: Is the skin broken or not?

fracture

Classification of a ______ is either complete or incomplete. - Complete: break goes completely through the bone - Incomplete: partly across but bone remains intact (and probably is going to remain in alignment - Ask yourself: Is the bone completely broken or not?

fracture

Classification of a ______ is either displaced or non displaced alignment. - Nondisplaced: Remains in alignment or position; usually Transverse, Spiral, or Greenstick - Displaced: Separated ends and out of position; often Comminuted (> 2 fragments) or Oblique

fracture

Classification of a _______ includes the direction of _____ line: - Linear - Oblique - Transverse - Longitudinal Spiral

fracture

The most common cause of a ______ is: - Traumatic injuries account for the majority of _______s. o Pathological _______s may not be secondary to a traumatic injury but vast majority of ______s are caused by some type of physical trauma

fracture

definition of a ______: a disruption or break in the continuity of the bone

fracture

the following are clinical manifestations of a ______: - Pain and tenderness (usually one of the main complaints) - Functional Loss (may not be able to use hand, guarded) - Deformity (displaced fracture may be obvious) - Edema and swelling - Ecchymosis, contusion - Crepitation (bone fragments rubbing together that you kind of feel or hear) - Muscle spasms (really contribute to the discomfort, pain, and tenderness) o That's why muscle relaxants are very helpful for _______s

fracture

the following is interprofessional care/management of _______s: - Goals - (1) anatomic realignment of bone fragments with reduction (2) immobilization to maintain alignment (3) restoration of normal or near-normal function of the injured part - ________ Reduction o If bone is not displaced then this is probably not necessary - _________ Immobilization - Open _______s - Electrical Bone Growth Stimulation - Drug Therapy - Nutritional Therapy

fracture

What interprofessional management/ care of fractures is described below? - Casts, braces, splints, immobilizers - External fixation Internal fixation

fracture immobilization

What interprofessional management/ care of fractures is described below? o Non-surgical, manual realignment of bone fragments o Traction and Countertraction applied o Restores position, length, and alignment o Local or general anesthesia (more commonly these days we use conscious sedation) Immobilization follows with traction, casts, splints or braces

fracture reduction: closed reduction

What interprofessional management/ care of fractures is described below? - Depends on type and location of fracture, age, concurrent disease o If it's near a joint, or it's a compound, or comminuted fracture they are more likely to need open reduction o Patient who are older who may have fragile bones or osteoporosis

fracture reduction: open reduction

What interprofessional management/ care of fractures is described below? - Risks include infection, anesthesia-associated, effect of pre-existing disease - Benefit: facilitates early ambulation o Early Ambulation >> Decreased Risk of Complications R/T Prolonged Immobility

fracture reduction: open reduction

What interprofessional management/ care of fractures is described below? - Surgical correction of bone alignment through incision - Internal fixation: ORIF o Pins, screws, things they use to put the bone in alignment and keep it in alignment - External fixation o Devices that are both internal and then come out through the skin. They are put in temporarily until the bone heals up good enough - Depends on type and location of fracture, age, concurrent disease o If it's near a joint, or it's a compound, or comminuted fracture they are more likely to need open reduction o Patient who are older who may have fragile bones or osteoporosis - Risks include infection, anesthesia-associated, effect of pre-existing disease - Benefit: facilitates early ambulation o Early Ambulation >> Decreased Risk of Complications R/T Prolonged Immobility

fracture reduction: open reduction

What interprofessional management/ care of fractures is described below? - Use of pulling force to attain alignment with countertraction - _______ pulls in one direction and Countertraction pulls in opposite direction - Mostly used to immobilize, prevent/reduce pain & spasms, reduce a fracture/dislocation, treat pathologic joint conditions - Skin ______ - Skeletal _________

fracture reduction: traction

A ______ fracture is an incomplete fracture with one side splintered and the other side bent o Called a _______ because it's like a fresh stick or green stick from a tree, when you go to break it doesn't break completely in half it kind of splinters and some of the stick remains intact. Whereas an old stick would snap completely in half - We see these more often in pediatrics and younger adults. Less likely to see in an older adult bc as we get older our bones become less malleable and they are more likely to snap. **nondisplaced fracture **CLASSIFICATION: DIRECTION OF FRACTURE LINE

greenstick fracture

What complication of fractures is described below: severe blood loss from open fractures or puncture of vital organs

hypovolemic shock

An ______ fracture is when partly across but bone remains intact (and probably is going to remain in alignment - Ask yourself: Is the bone completely broken or not?

incomplete fracture

The following are ____ complications of fractures: (associated with blood vessel and nerve damage) compartment syndrome, VTE, fat embolism syndrome (FES), rhabdomyolysis, hypovolemic shock

indirect

What interprofessional management/ care of fractures is described below? - ORIF - Pins, plates, rods, screws, nails are surgically inserted - Realigns and maintains position of bony fragments - Stainless steel, Vitallium, Titanium - X-rays to regularly evaluate proper alignment and healing

internal fixation

A _______ fracture is a fracture involving the bone in the line of its axis **CLASSIFICATION: DIRECTION OF FRACTURE LINE

linear fracture

What fracture healing complication is described below (delayed union, nonunion, malunion, angulation, pseudoarthrosis, refracture, myositis ossificans): - heals in timeframe but in unsatisfactory position; can produce deformity or dysfunction (especially if it's a fracture of a joint or movable part)

malunion

What complication of fractures is described below: - disuse and prolonged immobilization o Prevent: Isometric muscle- strengthening exercises as able

muscle atrophy

What 3 drugs are used for drug therapy for fractures?

muscle relaxers analgesics antibiotics *also immunizations

What fracture healing complication is described below (delayed union, nonunion, malunion, angulation, pseudoarthrosis, refracture, myositis ossificans): - calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury

myositis ossificans

A ______ fracture remains in alignment or position; usually Transverse, Spiral, or Greenstick.

non displaced fracture

What fracture healing complication is described below (delayed union, nonunion, malunion, angulation, pseudoarthrosis, refracture, myositis ossificans): - fails to heal despite treatment, X-ray has no evidence of callus formation

nonunion

the following is _____ management of fractures: - Assessment: Neurovascular (special attention to site and distal portion and compare both extremities throughout) o Neurovascular Assessment- color, temperature, capillary refill, pulses, edema, sensation, motor function, pain § Peripheral vascular assessment § Peripheral neurologic assessment

nursing

the following is _____ management of fractures: - Implementation: o Foot drop-high top sneakers, neutral position, prafo boots o Pain- narcotics, comfort care o Muscles spasms- carisoprodol (soma®), methocarbamol (robaxin®, cyclobenzaprine (flexeril®) o Patient Teaching: cast care/pin care, ambulation (prevent complications associated with immobility), assistive devices, counseling and referrals, nutritional support

nursing

the following is _____ management of fractures: - Implementation: o Promotion of Health/Prevention of fractures and complications o Acute Care, Pre-Op, Post-Op (General Principles of Post-Op Care), Traction o Muscle atrophy-isometric muscle contraction o Contracture- position change, active/passive ROM, progressive stretching

nursing

the following is _____ management of fractures: - Planning: Goals: promote healing without complications, satisfactory pain relief, achieve optimal rehabilitation potential

nursing

the following is _____ management of fractures: - _______ Diagnoses: o Impaired physical mobility o Risk for peripheral neurovascular dysfunction Acute pain

nursing

What intervention for fractures is described below? - Well-balanced diet- good nutrition so they can heal and grow new tissue - Adequate fluid intake (2000-3000ml/day); 2500 ml for prevention of renal calculi o Especially if immobile, can cause reabsorption of calcium from the bone increasing risks of renal calculi - High fiber diet o Risk for constipation bc immobile, analgesics, opioids

nutritional therapy

An ____ fracture is when the line of the fracture extends across and down the bone. (kind of slanted across the bone o Can be difficult to differentiate from a spiral but the oblique is in the same direction all across the bone whereas the spiral is more of a twisting type of motion **displaced fracture

oblique fracture

An _____ fracture is compound; there IS a break in the skin. - Ask yourself: Is the skin broken or not?

open fracture

With an _____ fracture, interprofessional management/ care includes: o Surgical debridement and irrigation o Prophylactic antibiotics (pre-op, irrigation, post-op) o Tetanus and diphtheria immunization o Immobilization

open fracture

The 6 P's in Compartment syndrome are pain, paresthesia, pallor, polar, paralysis, and pulses. Which of these is described below: early or late signs: early assessment paramaters: assess area involving using 0 to 10 rating scale with 0 being no pain and 10 being worst pain imaginable client teaching/symptoms to report: increasing pain not relieved with elevation or pain meds

pain

The 6 P's in Compartment syndrome are pain, paresthesia, pallor, polar, paralysis, and pulses. Which of these is described below: early or late signs: early assessment paramaters: assess capillary refill; brisk is less than 3 seconds client teaching/symptoms to report: increased capillary refill time more than 3 seconds; blue fingers or toes

pallor

The 6 P's in Compartment syndrome are pain, paresthesia, pallor, polar, paralysis, and pulses. Which of these is described below: early or late signs: late assessment paramaters: assess mobility: moves fingers or toes, able to plantar dorsiflex the ankle area not involved or restricted by cast client teaching/symptoms to report: unable to move fingers or toes

paralysis

The 6 P's in Compartment syndrome are pain, paresthesia, pallor, polar, paralysis, and pulses. Which of these is described below: early or late signs: early assessment paramaters: assess for numbness/tingling, pins or needles; sedation should be absent client teaching/symptoms to report: numbers or tingling, pins or needles sensation

paresthesia

A _______ fracture is a spontaneous fracture at the site of a diseased bone. o Maybe somebody that have osteoporosis or bone cancer, the bone is not healthy. Sometimes it breaks even without any type of traumatic injury

pathologic fracture

The 6 P's in Compartment syndrome are pain, paresthesia, pallor, polar, paralysis, and pulses. Which of these is described below: early or late signs: late assessment paramaters: assess skin temperature by touch: warm or cool client teaching/symptoms to report: cool/cold fingers or toes

polar

What fracture healing complication is described below (delayed union, nonunion, malunion, angulation, pseudoarthrosis, refracture, myositis ossificans): - nonunion at fracture site in which a false joint is formed with abnormal movement at site

pseudoarthrosis

The 6 P's in Compartment syndrome are pain, paresthesia, pallor, polar, paralysis, and pulses. Which of these is described below: early or late signs: late assessment paramaters: assess pulses distal to injury; pulse is palpable and strong client teaching/symptoms to report: weak palpable pulses, unable to palpate pulses, pulse detected only by Doppler

pulses

What fracture healing complication is described below (delayed union, nonunion, malunion, angulation, pseudoarthrosis, refracture, myositis ossificans): - - new fracture at original site

refracture

What complication of fractures is described below: - muscle damage causes release of myoglobin which precipitates and causes obstruction in renal tubules, results in acute kidney injury (AKI) and acute tubular necrosis o Can be cause by excessive tissue injury and compartment syndrome if there is a significant amount of tissue involved o Assess urine for amount and color, muscle weakness and pain § If experiencing an acute kidney injury or acute tubular necrosis you will have decreased urine output and the urine will be dark reddish brown o Labs: Elevated Creatine kinase (CK) levels, elevated myoglobinuria , electrolyte imbalances, and increased BUN & Creatinine

rhabdomyolysis

What complication of fractures is described below: o Assess urine for amount and color, muscle weakness and pain § If experiencing an acute kidney injury or acute tubular necrosis you will have decreased urine output and the urine will be dark reddish brown o Labs: Elevated Creatine kinase (CK) levels, elevated myoglobinuria , electrolyte imbalances, and increased BUN & Creatinine

rhabdomyolysis

_______ traction includes: - Longer terms to align bones and joints - Weights 5-45 pounds - Surgical insertion of pins, wires into bone with weights to align and immobilize - Too much weight can cause delayed union or nonunion and not enough weight would not help to maintain alignment - Complications > infection, effects of prolonged mobility

skeletal

What interprofessional management/ care of fractures is described below? - Longer terms to align bones and joints - Weights 5-45 pounds - Surgical insertion of pins, wires into bone with weights to align and immobilize - Too much weight can cause delayed union or nonunion and not enough weight would not help to maintain alignment - Complications > infection, effects of prolonged mobility

skeletal traction

____ traction includes: - Short-term (48-72 hrs.) until skeletal traction or surgery - Decreases muscle spasms - Usually limited to 5-10 pounds - Tape, boots, splints - Buck's Traction is common for hip/femur fractures o Boot that wraps around the patients leg and you use Velcro to secure it with rope attached that hangs over the end of the bed with a weight on it. The weight gives a constant pulling action to try to keep the bone in alignment - Skin assessment critical

skin

What interprofessional management/ care of fractures is described below? - Short-term (48-72 hrs.) until skeletal traction or surgery - Decreases muscle spasms - Usually limited to 5-10 pounds - Tape, boots, splints - Buck's Traction is common for hip/femur fractures o Boot that wraps around the patients leg and you use Velcro to secure it with rope attached that hangs over the end of the bed with a weight on it. The weight gives a constant pulling action to try to keep the bone in alignment - Skin assessment critical

skin traction

A ______ fracture is when the line of fracture extends in a spiral direction along the bone shaft. (like the bone was taken and twisted) **nondisplaced fracture **CLASSIFICATION: DIRECTION OF FRACTURE LINE

spiral fracture

A _____ fracture occurs in normal or abnormal bone that is subject to repeated stress, such as from jogging or running.

stress fracture

A ______ fracture is when the line of the fracture extends across the bone shaft at a right angle to the longitudinal axis. **nondisplaced fracture **CLASSIFICATION: DIRECTION OF FRACTURE LINE

transverse fracture

What complication of fractures is described below: o High risk of _______ in the orthopedic surgical population, after fractures and replacement surgeries, especially hip (lower extremities and pelvis very susceptible) o Prophylactic anticoagulants (most common we use is enoxaparin at a prophylactic dose of 40 mg/day unless they have renal insufficiency then it would be 30 mg/day) o Anti-embolism hose, sequential compression devices (SCD) o Range of motion exercises o Mobilize if possible

venous thromboembolism (VTE)