Chapter 42 Management of Patients With Musculoskeletal Trauma

Fractures of the Wrist The patient presents with a deformed wrist, pain, swelling, weakness, and limited finger ROM, and possibly reports of ______ in the affected hand. Tingling sensation may indicate injury to the median nerve Treatment usually consists of _______ and _______ with a sugar-tong splint until swelling resides.

"tingling" closed reduction immobilization

______ fractures are a type of intra-articular fracture. The typical mechanism of injury is that an external force drives the femoral shaft into the hip joint, fracturing the acetabulum. This may be caused by high-speed motor vehicle crashes or fallen from heights

Acetabular

Inward turning on sole of foot and front of foot Supination with internal rotation Pronation with external rotatio

Ankle fracture

Foot is twisted, causing stretching or tearing of ligaments.

Ankle sprain

Sudden forced motion, stretching muscles beyond normal capacity

Ankle strain

_______ occurs when the bone loses its blood supply and dies. It may occur after a fracture with disruption of the blood supply to the distal area. The patient develops pain with movement that progresses to pain at rest. It is also seen with prolonged high-dose corticosteroid therapy, radiation therapy, sickle cell disease, rheumatoid arthritis, and other diseases

Avascular Necrosis (AVN)

Medical Management Hip fracture ______ extension traction, a type of temporary skin traction, was traditionally applied because it was believed to reduce muscle spasm, to immobilize the extremity, and to relieve pain. Surgical treatment consists of (1) open or closed reduction of the fracture and internal fixation, (2) replacement of the femoral head with a prosthesis (hemiarthroplasty), or (3) closed reduction with percutaneous stabilization for an intracapsular fracture.

Buck's

Fall on shoulder or outstretched arm Direct blow to the clavicle

Clavicle fracture

______ syndrome is characterized by the elevation of pressure within an anatomic compartment that is above normal perfusion pressure. ________ syndrome arises from an increase in compartment volume, a decrease in compartment size, or aspects of both.

Compartment syndrome Compartment syndrome

The nurse avoids using the affected extremity for blood pressure measurements and venipuncture in the patient with _______.

Complex Regional Pain Syndrome (CRPS)

_______ is a rare condition characterized by chronic pain in a limb, typically after an injury. Dysfunctional peripheral and central nervous system responses that mount an excessive response to the precipitating event are thought to be the cause of the pain.

Complex Regional Pain Syndrome (CRPS)

Delayed Complications of fractures ______ occurs when healing does not occur within the expected time frame for the location and type of fracture. ______ may be associated with distraction (pulling apart) of bone fragments, systemic or local infection, poor nutrition, or comorbidity. The healing time is prolonged, but the fracture eventually heals.

Delayed union Delayed union

Falling on a hand with a flexed elbow Elbow overextended

Dislocated elbow

Anterior: Some combination of hyperextension, external rotation, and abduction Anterior blow to shoulder Posterior: Fall on flexed and adducted arm Direct axial load to humerus

Dislocated shoulder

Other Early Complications of Fractures _______ is a systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia. Its causes are diverse and can include massive tissue trauma. Early manifestations of ______ include unexpected bleeding after surgery and bleeding from the mucous membranes, venipuncture sites, and gastrointestinal and urinary tracts.

Disseminated intravascular coagulation (DIC) Disseminated intravascular coagulation (DIC)

There are three major types of hip fracture. ______ fractures are fractures of the trochanteric region and of the subtrochanteric region. _______ fractures are fractures of the neck of the femur. Fractures of the neck of the femur may damage the vascular system that supplies blood to the head and the neck of the femur, and the bone may become ischemic. For this reason, AVN is common in patients with femoral neck fractures ________ fractures are fractures to the regions surrounding prosthetics joints

Extracapsular Intracapsular Periprosthetic

Fracture Healing and Complications ________ describes the clinical manifestations that occur when fat emboli enter circulation following orthopedic trauma, especially long bone fractures. At the time of fracture, fat globules may diffuse from the marrow into the vascular compartment. The fat globules may occlude the small blood vessels that supply the lungs, brain, kidneys, and other organs.

Fat embolism syndrome (FES)

Medical Management for fracture Reduction _______ reduction refers to restoration of the fracture fragments to anatomic alignment and positioning. Either ______ reduction or ______ reduction may be used to reduce a fracture. The specific method selected depends on the nature of the fracture; however, the underlying principles are the same. Usually, the physician reduces a fracture as soon as possible to prevent loss of elasticity from the tissues through infiltration by edema or hemorrhage. In most cases, _______ reduction becomes more difficult as the injury begins to heal

Fracture reduction closed reduction or open reduction Fracture reduction

Fractures of the Pelvis _______ and _______ are two of the most serious consequences that may occur. Bleeding arises mainly from the laceration of veins and arteries by bone fragments and possibly from a torn iliac artery. The peripheral pulses, especially the dorsalis pedis pulses of both lower extremities, are palpated; absence of a pulse may indicate a tear in the iliac artery or one of its branches.

Hemorrhage and shock

_______ refers to benign bone growth in an atypical location, such as in the soft tissue. _______ that is categorized as traumatic myositis ossificans usually develops in response to soft tissue trauma. It is characterized by pain and joint stiffness that causes decreased ROM. If significant ROM dysfunction persists, surgery may be indicated to remove the bone growth and restore function

Heterotopic ossification Heterotopic ossification

The nurse encourages active motion of the fingers and shoulder. The patient is instructed to perform the following 4 exercises to reduce swelling and prevent stiffness:

Hold the hand at the level of the heart. Move the fingers from full extension to flexion. Hold and release. Repeat at least 10 times every hour when awake. Use the hand in functional activities. Actively exercise the shoulder and elbow, including complete range-of-motion exercises of both joints.

Fractures of the _____ presents with the affected arm hanging limp at the side or supported by the uninjured hand. Neurovascular assessment of the extremity is essential to evaluate the full extent of injury and the possible involvement of the nerves and blood vessels of the arm.

Humeral Neck

Fracture Healing and Complications _______ shock resulting from hemorrhage is more frequently noted in trauma patients with pelvic fractures and in patients with a displaced or open femoral fracture in which the femoral artery is torn by bone fragments. Treatment for shock consists of stabilizing the fracture to prevent further hemorrhage, restoring blood volume and circulation, relieving the patient's pain, providing proper immobilization, and protecting the patient from further injury and other complications

Hypovolemic

Medical Management Femoral Shaft _______ fixation usually is carried out immediately. Intramedullary locking nail devices are typically used. _______ fixation permits early mobilization, which is associated with improved outcomes and recovery Traction may be used until surgery can be performed. ______ traction is a temporary intervention, however, until such time as the patient is stable and may tolerate surgical intervention

Internal Internal Skeletal

Twisting injury that produces incomplete tear of ligaments and capsule around the joint

Knee sprain

Sudden forced motion causing muscle to be stretched beyond normal capacity

Knee strain

Sharp, sudden pivot Direct blow to knee Forced internal rotation Wear from repetitive squatting or climbing Torsional weight-bearing force

Meniscal tears of knee

Occurs with repeated loading of bone; often in an unconditioned extremity

Metatarsal stress fracture

Delayed Complications of fractures _______ occurs most commonly in tibial fractures, whereas ________ occurs most commonly in fractures of the hand (or fingers) Factors contributing to delayed union, nonunion, and malunion are those associated with impaired bone healing

Nonunion malunion

Delayed Complications of fractures _______ results from failure of the ends of a fractured bone to unite _______ is the healing of a fractured bone in a malaligned position In both of these instances, the patient complains of persistent discomfort and abnormal movement at the fracture site.

Nonunion malunion

Fractures of the Humeral Shaft Well-padded splints are used to initially immobilize the upper arm and to support the arm in 90 degrees of flexion at the elbow. A sling or collar and cuff support the forearm. The weight of the hanging arm and splints put traction on the fracture site. Fractures of the shaft of the humerus require ______ shoulder exercises are performed as prescribed to provide active movement of the shoulder, thereby preventing a "frozen shoulder."

Pendulum

______ fractures are fractures of the proximal radius. ______ fractures are common and are usually produced by a fall on an outstretched hand with the elbow extended. If blood has collected in the elbow joint, it is aspirated to relieve pain and to allow early active elbow and forearm ROM exercises

Radial head Radial head

Maintaining and Restoring Function _______ and ______ are maintained as prescribed to promote bone and soft tissue healing. Edema is controlled by elevating the injured extremity and applying ice as prescribed. _______ is monitored routinely, and the primary provider is notified immediately if signs of neurovascular compromise develop.

Reduction and immobilization edema Neurovascular status (circulation, motion, and sensation)

Open fractures are graded according to the following criteria: _______ is a clean wound less than 1 cm long. ________ is a larger wound without extensive soft tissue damage or avulsions. _______ is highly contaminated and has extensive soft tissue damage. It may be accompanied by traumatic amputation and is the most severe.

Type I Type II Type III (A, B, C)

Other Early Complications of Fractures _______, including DVT and PE, are associated with reduced skeletal muscle contractions and bed rest. Patients with fractures of the lower extremities and pelvis are at high risk for ______.

VTE VTE

Fractures of the Elbow (distal humerus) The most serious complication of a supracondylar fracture of the humerus is ______, which results from antecubital swelling or damage to the brachial artery and leads to a shortening (contracture) of the forearm muscles. ______ more commonly occurs in children than adults and will result in a "clawlike" appearance to the hand and wrist.

Volkmann contracture Volkmann contracture

Falling on an outstretched arm

Wrist sprain or fracture

Nursing Management Hip Fracture The most comfortable and safest way to turn the patient is to turn to the uninjured side. The standard method involves placing a pillow between the patient's legs to keep the affected leg in an ______ position. Proper alignment and supported ______ are maintained while turning The patient is encouraged to exercise as much as possible by means of the overbed _______. This device helps strengthen the arms and shoulders in preparation for protected ambulation

abducted abducted trapeze

Clinical Manifestations of Fractures The clinical signs and symptoms of a fracture include ______, _______, _______, ______, _______, and _________

acute pain, loss of function, deformity, shortening of the extremity, crepitus, and localized edema and ecchymosis

Subtle personality changes, restlessness, irritability, or confusion in a patient who has sustained a fracture are indications for immediate _________.

arterial blood gas studies

Nursing Management for Compartment syndrome Compartment syndrome is managed by maintaining the extremity _______; Compartment syndrome is managed by ______ and _______ or ______, if one or the other is present.

at the heart level opening and bivalving the cast opening the splint

________ tissue, frequently from the iliac crest, harvested from the patient for their own use _______ tissue harvested from a donor

autograft allograft

Medical Management Bone grafting Grafted bone undergoes a reconstructive process that results in a gradual replacement of the graft with new bone. During surgery, the bone fragments are débrided and aligned, infection (if present) is removed, and a bone graft is placed in the bony defect. The bone graft may be an ______, ________, or _______

autograft an allograft or a bone graft substitute

Complex Regional Pain Syndrome Clinical manifestations of CRPS include severe burning pain, local edema, hyperesthesia, stiffness, discoloration, vasomotor skin changes, and trophic changes that may include glossy, shiny skin, and changes in hair and nail growth The nurse avoids using the affected extremity for ______ and _______ in the patient with CRPS.

blood pressure measurements and venipuncture

Fractures of the Hand The most common type of metacarpal fracture in adults is referred to as _______ fracture, which occurs when a closed fist bangs against a hard surface, fracturing the neck of the fifth finger. For a nondisplaced fracture of the phalanx (finger bone), the finger is splinted for 3 to 4 weeks to relieve pain and to protect the finger from further trauma. Splinting sometimes consists of _______ a fractured finger to an adjoining nonfractured finger

boxer's "buddy taping"

Stable Pelvic Fractures Stable fractures of the pelvis include fracture of a single pubic or ischial ramus, fracture of ipsilateral pubic and ischial rami, fracture of the pelvic wing of the ilium, and fracture of the sacrum or coccyx. Most fractures of the pelvis heal rapidly because the pelvic bones are mostly ______, which has a rich blood supply.

cancellous bone

Fracture of the ______ (collar bone) is a common injury that can result from a fall or a direct blow to the shoulder. Therefore, when the ______ is fractured, the patient assumes a protective position, slumping the shoulders and immobilizing the arm to prevent shoulder movements.

clavicle clavicle

Medical Management for fracture Reduction In most instances, _____ reduction is accomplished by bringing the bone fragments into anatomic alignment through manipulation and manual traction. The extremity is held in the aligned position while a cast, splint, or other device is applied. Traction (skin or skeletal) may be used until the patient is physiologically stable to undergo surgical fixation.

closed

Medical Management Tibia and Fibula Most closed, nondisplaced fractures that do not involve the ankle joint are treated with ______ reduction and immobilization in a non-weight-bearing short-leg cast or brace. The leg is ______ to control edema. Weight-bearing status varies and depends on the type of fracture. Activity decreases edema and increases circulation.

closed elevated

A _______ fracture is one that does not cause a break in the skin. An _______ fracture is one in which the skin or mucous membrane wound extends to the fractured bone.

closed (simple fracture) open (compound, or complex, fracture)

If the fragments in a fracture are not displaced, the fracture is treated by _______ Displaced fractures are managed by _______, using a compression plate with screws, intramedullary nails, or rods

closed reduction ORIF

Fractures of the Clavicle The treatment goal is to align the shoulder in its normal position by means of ______ and ________. Surgical intervention is not typical but may be indicated if the fracture is located in the distal third of the clavicle or is severely displaced

closed reduction immobilization

Stable Pelvic Fractures Stable pelvic fractures are treated with a few days of bed rest and symptom management until discomfort is controlled. The patient with a fractured sacrum is at risk for paralytic ileus; therefore, bowel sounds should be monitored. The patient with a fracture of the _______ experiences pain when sitting and when defecating. Sitz baths may be prescribed to relieve pain, and stool softeners may be given to ease defecation.

coccyx

Clinical Manifestations of Fractures When the extremity is gently palpated, a crumbling sensation, called _______, can be felt or may be heard. It is caused by the rubbing of the bone fragments against each other. Localized ______ and _______ occur after a fracture as a result of trauma and bleeding into the tissues. These signs may not develop for several hours after the injury or may develop within an hour, depending on the severity of the fracture.

crepitus edema and ecchymosis

Fractures of the ______ result from motor vehicle crashes, falls on the elbow, or a direct blow. These fractures may result in injury to the median, radial, or ulnar nerves

distal humerus (elbow)

Fractures of the _______ are common and are usually the result of a fall on an open, dorsiflexed hand.

distal radius (Wrist)

Nursing Management Patients With Closed Fractures The patient with a closed fracture has no opening in the skin at the fracture site. The fractured bones may be nondisplaced or slightly displaced, but the skin is intact. The nurse educates the patient regarding the proper methods to control ______ and ______ Fracture healing and restoration of strength and mobility may take an average of 6 to 8 weeks, depending on the quality of the patient's bone tissue

edema and pain

Fractures of the Clavicle Fracture of the distal third of the clavicle, without displacement and ligament disruption, is treated with a sling and restricted motion of the arm. The nurse cautions the patient not to ______ above shoulder level until the fracture has healed (about 3 to 6 weeks) but encourages the patient to exercise the elbow, wrist, and fingers as soon as possible.

elevate the arm

Clinical Manifestations Hip Fracture With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated. The patient reports pain in the hip and groin or in the medial side of the knee. With most fractures of the femoral neck, the patient cannot move the leg without a significant increase in pain. The patient is most comfortable with the leg slightly flexed in ______ rotation.

external

Medical Management for Compartment syndrome Prompt management of acute compartment syndrome is essential. The surgeon needs to be notified immediately if neurovascular compromise is suspected. Delay in treatment may result in permanent nerve and muscle damage, necrosis, infection, rhabdomyolysis with acute kidney injury, and amputation If conservative measures do not restore tissue perfusion and relieve pain, a ______ is indicated to relieve the constrictive muscle fascia. After ______, the wound is not sutured but is left open to allow the muscle tissues to expand; it is covered with moist, sterile saline dressings or with artificial skin.

fasciotomy fasciotomy

A ______ is a complete or incomplete disruption in the continuity of bone structure and is defined according to its type and extent. _______ occur when the bone is subjected to stress greater than it can absorb

fracture fracture

Unstable Pelvic Fractures Therefore, these patients are at risk for _____ Immediate treatment in the ED for a patient with an unstable pelvic fracture includes stabilizing the pelvic bones and compressing bleeding vessels with a _______, which is an external binding and stabilizing device.

hemorrhagic shock pelvic girdle

Femoral Shaft Assessment and Diagnostic Findings Assessment includes checking the neurovascular status of the extremity, especially circulatory perfusion of the lower leg and foot, and comparing with the unaffected leg. A Doppler ultrasound may be indicated to assess blood flow. X-rays are used to confirm the diagnosis and determine the extent of injury. Dislocation of the _______ and _______ may accompany these fractures.

hip and knee

Fractures of the Humeral Shaft Fractures of the ______ are most frequently caused by (1) direct trauma that results in a transverse, oblique, or comminuted fracture or (2) an indirect twisting force that results in a spiral fracture. The nerves and brachial blood vessels may be injured with these fractures, so neurovascular assessment is essential to monitor the status of the nerve or blood vessels. Damage to either requires immediate attention.

humerus shaft

Clinical Manifestations Fat embolism syndrome (FES) The classic triad of clinical manifestations of FES include _______, _______, and _______

hypoxemia, neurologic compromise, petechial rash

Fractures of the Elbow (distal humerus) The goal of therapy is prompt reduction and stabilization of the distal humeral fracture, followed by controlled active motion after swelling has subsided and healing has begun. If the fracture is not displaced, the arm is ______ in a posterior long-arm splint for 2 to 3 weeks. At that point, ROM exercises can begin with the use of a hinged brace

immobilized

After the fracture has been reduced, the bone fragments must be ______ and maintained in proper position and alignment until union occurs. _______ may be accomplished by external or internal fixation. Methods of external fixation include bandages, casts, splints, continuous traction, and external fixators.

immobilized Immobilization

Fracture of the Ribs Because rib fractures cause pain with respiratory effort, the patient tends to decrease respiratory excursions and refrains from coughing. As a result, tracheobronchial secretions are not mobilized, aeration of the lung is diminished, and a predisposition to atelectasis and pneumonia results. To help the patient cough and take deep breaths and use an ______, the nurse may splint the chest with their hands, or may educate the patient on using a pillow to temporarily splint the affected site.

incentive spirometer

Nursing Management Patients With Open Fractures In an open fracture, there is a risk for osteomyelitis, tetanus, and gas gangrene. The objectives of management are to prevent ______ of the wound, soft tissue, and bone, and to promote healing of bone and soft tissue. Intravenous (IV) antibiotics are given upon the patient's arrival in the hospital along with ______ if needed _______ and ______ are initiated in the operating room as soon as possible. The wound is cultured, and bone grafting may be performed to fill in areas of bone defects. The fracture is carefully reduced and stabilized by external fixation, and the wound is usually left open

infection intramuscular (IM) tetanus toxoid Wound irrigation and débridement

Other Early Complications of Fractures All open fractures are considered contaminated and are treated as soon as possible with copious irrigation, débridement, and IV antibiotics. Surgical ______ fixation of fractures carries a risk of infection.

internal

With ______ fixation, the surgeon determines the amount of movement and weight-bearing stress the extremity can sustain and prescribes the level of activity

internal

An _______ fracture extends into the joint surface of a bone. Because each end of a long bone is cartilaginous, if the fracture is nondisplaced, x-rays will not always reveal the fracture because cartilage is nonradiopaque. MRI or arthroscopy will identify the fracture and confirm the diagnosis. The joint is stabilized and immobilized with a splint or cast, and no weight bearing is allowed until the fracture has healed. Intra-articular fractures often lead to posttraumatic arthritis

intra-articular

Medical Management Femoral Shaft Open femoral fractures require immediate and extensive irrigation and débridement in the operating suite A common complication after fracture of the femoral shaft is restriction of ______ motion. Active and passive _______ exercises begin as soon as possible

knee knee

Fractures types are classified by ______ and ______ Fractures are also described according to the ______ or the _______

location and type. degree of break character of any fractured bone fragments

Fractures of the Clavicle Most of these fractures occur in the _______ of the clavicle and take 3 to 6 weeks to heal. A ________, may be used to pull the shoulders back, reducing and immobilizing the fracture.

middle third clavicular strap (figure-eight bandage)

Medical Management for fracture Reduction Some fractures require ______ reduction. Through a surgical approach, the fracture fragments are anatomically aligned. Internal fixation devices may be used to hold the bone fragments in position until solid bone healing occurs. Internal fixation devices ensure firm approximation and fixation of the bony fragments

open

Nursing Management Bone grafting Nursing care for the patient with a bone graft includes ______ management and monitoring the patient for possible complications. The nurse needs to reinforce educational information concerning the objectives of the bone graft, immobilization, non-weight-bearing exercises, wound care, monitoring for signs of infection, and the importance of follow-up care with the orthopedic surgeon

pain

Assessment and Diagnostic Findings of Compartment syndrome A patient may not exhibit all, or even more than just one of the "five Ps"; therefore, ______ assessment is most crucial in early recognition of acute compartment syndrome. Palpation of the muscle, if possible, reveals it to be swollen and hard with the skin taut and shiny. The orthopedic surgeon may measure tissue pressure by inserting a tissue pressure-monitoring device, such as a handheld direct injection device, into the muscle compartment. Nerve and muscle tissues deteriorate as compartment pressure increases. Prolonged pressure of more than _____ can result in permanent dysfunction

pain 30 mmHg

Assessment and Diagnostic Findings of Compartment syndrome The patient with acute compartment syndrome reports deep, throbbing, unrelenting pain, which is unrelieved by medications, seems disproportional to the injury, and intensifies with passive ROM. Frequent assessment of neurovascular function after a fracture is essential and focuses on the "five Ps": ______, _______, _______, ______, ______

pain, pallor, pulselessness, paresthesias, paralysis

Fractures of the Humeral Neck Limitation of motion and stiffness of the shoulder occur with disuse. Therefore, _______ exercises begin as soon as tolerated by the patient. In ______ exercises, the physical therapist instructs the patient to lean forward and allow the affected arm to hang in abduction and rotate.

pendulum pendulum

Tibia and Fibula Assessment and Diagnostic Findings The _______ nerve is assessed; if damaged, the patient cannot dorsiflex the great toe and has diminished sensation in the first web space. The ______ artery is assessed for damage by evaluating pulses, skin temperature, and color and by testing the capillary refill response. The affected leg and ankle are compared with the unaffected leg and ankle.

peroneal tibial

Fractures of the Radial and Ulnar Shafts Frequently, displacement occurs when both bones are broken. The forearm's unique functions of ______ and ______ must be preserved with proper anatomic alignment

pronation and supination

Fractures of the Humeral Neck Many impacted fractures of the surgical neck of the humerus are not displaced and do not require _______. The arm is supported and immobilized by a sling and swathe that secure the supported arm to the trunk.

reduction

Medical Management Hip fracture The goal of surgical treatment for hip fractures is to obtain a ________ Adequate reduction is important for fracture healing—the better the reduction, the better the healing.

satisfactory fixation so that the patient can be mobilized quickly and avoid secondary medical complications.

Emergency Management of a fracture Immediately after injury, if a fracture is suspected, the body part must be immobilized before the patient is moved. Adequate ______ is essential. Immobilization of the long bones of the lower extremities may be accomplished by bandaging the legs together, with the unaffected extremity serving as a splint for the injured one. In an upper extremity injury, the arm may be bandaged to the chest, or an injured forearm may be placed in a sling. The _______ status distal to the injury should be assessed both before and after _______ to determine the adequacy of peripheral tissue perfusion and nerve function.

splinting neurovascular splinting

Emergency Management of a fracture With an open fracture, the wound is covered with a ______ to prevent contamination of deeper tissues. No attempt is made to reduce the fracture, even if one of the bone fragments is protruding through the wound. ______ are applied for immobilization

sterile dressing splints

Fractures of the _____ and _______ often occur in association with each other and tend to result from a direct blow, falls with the foot in a flexed position, or a violent twisting motion. Most of these fractures tend to be more distal than proximal; distal fractures may extend into the ankle joint

tibia and fibula

Nursing Management Patients With Open Fractures With open fractures, primary wound closure is usually delayed, particularly with higher-grade fractures. Heavily contaminated wounds are left unsutured and treated with _______ to facilitate wound drainage. Wound irrigation and débridement may be repeated, removing infected and devitalized tissue and increasing vascularity in the region

vacuum-assisted closures (VAC)

Fracture Healing and Complications With a comminuted fracture, fragments must be properly aligned to attain the best healing possible. It is essential for the fractured bone to have blood supply to the area to facilitate the healing process. In general, fractures of flat bones heal rapidly. A complex, comminuted fracture may heal slowly. Fractures at the ends of long bones, where the bone is more ______ and ______, heal more quickly than do fractures in areas where the bone is dense and less vascular.

vascular and cancellous

Thoracolumbar Spine Fractures of the thoracolumbar spine may involve (1) the ______ (2) the ______ and _______ processes, and (3) the ______ processes or ______ processes. The T12 to L2 area of the spine, called the thoracolumbar junction, is most vulnerable to fracture.

vertebral body, laminae and articulating spinous or transverse