NSG 211: Fractures

Clinical Manifestations of Hip FX

- External Rotation - Muscle Spasm - Shortening - Severe Pain - Increased pain with movement

What is Fat Embolism Syndrome and the triad symptoms?

- Fat globules enter circulation - Occurs with FX of long bones (humerus/femur) or pelvis - Hypoxemia, neurological compromise, petechial rash

Immediate Care for FXs (2) What to do with open FXs?

- Immobilized - Assess neurovascular status - Open FX: Cover with sterile dressing to prevent infection.

Who does hip fxs happen to?

- Old Age - Women - Falls

Type of FXs Plastic or Bowing Buckle Greenstick Complete/Transverse/Oblique Pathologic Spiral Compression

- Plastic or bowing: Bone is bending without breaking - Buckle: One side of the bone buckles or FXs - Greenstick: Incomplete FX (seen in kids) - Complete: Transverse/Oblique/Spiral breaking all the way across - Pathologic: Osteoporosis - Spiral: Twisting (Seen in abuse) - Compression: Weight and Compression (seen in vertebrae)

Which three FXs warrant investigation of a pediatric client?

- Spiral Femur FX - Rib FX - Humerus FX

Symptoms of prosthesis dislocation after hip replacement

- sudden severe pain - lump in buttocks - limb shortening - external rotation

Ice is used to reduce swelling for the first ____ hours.

8

During compartment syndrome, this is a medical emergency and the nurse needs to keep the extremity __________ of the heart.

AT LEVEL

Ways to prevent dislocation after hip surgery

Avoid 90 degree flexion (sitting in chair) Avoid crossing legs/ankles Abductor Pillow in and out of bed Elevated toilet seats

Open (Compound) vs Closed (Simple) Fractures

Closed fracture-one that doesn't open the skin Open fracture (compound) is one in which the skin or mucous membrane wound extends to the fractured bone.

Complete vs Incomplete Fractures

Complete fracture-the bone is separated completely by a break into two parts. Incomplete fracture-the bone fracture doesn't extend through the full width of the bone.

Bones grow mostly in the _____________ area.

Epiphyseal Area

Three types of hip fractures

Extracapsular-fractures of trochanteric region Intracapsular-fractures of the neck of the femur Periprosthetic-fractures to the regions surrounding the prosthetics joints

Total hip replacement involves _______ and _________.

Femur and Acetabulum

What is the physis?

Growth plate of a bone

Malunion Non-union

Nonunion-failure of the bone to come together (happens frequently with tibial fractures) Malunion- the healing of a bone in a malaligned position (fractures in the hands and/or fingers)

Difference between open and closed reduction

Open reduction require surgery use of pins, rods, plates, and screws. Closed reduction uses the manipulation of manual traction of realignment (set the bone back in place)

What is number one clinical manifestation for a broken bone? BROKEN

PAIN Bruising with pain Reduced movement Odd appearance Kracking sound Edema/Erythema Neurovascular Impairment

The 5Ps of Compartment Syndrome

Pain Pallor Pulselessness Paresthesia Paralysis

Salter-Harris Fracture SALTER

S: Slip separated or straight across A: Above FX (physis) L: Lower FX (below physis) T: Through E: Everything R: Rammed/Crushed

5 Types of FX involving physis

Type I Fracture is through the physis, widening it Type II Fracture is partially through the physis, extending into the metaphysis Type III Fracture is partially through the physis, extending into the epiphysis Type IV Fracture is through the metaphysis, physis, and epiphysis Type V Crushing injury to the physis

Open Fractures Type I Type II Type III

Type I: Clean wound, <1 Type II: Larger w/o extensive tissue damage Type III: Highly contaminated, extensive soft tissue damage. Most severe

Crutch walking on stairs

Up stairs Move unaffected leg up first Downstairs Moves the affected leg down.

What is primary reason surgery is done for hip FXs?

Want to restore blood flow to the bone ASAP

What is osteogenesis imperfecta?

brittle bone disease

What is a fasciotomy?

surgical procedure where the fascia is cut to relieve tension or pressure commonly to treat the resulting loss of circulation to an area of tissue or muscle