4 Fractures 2010
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4 Fractures 2010

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4 Fractures 2010 4 Fractures 2010 Presentation Transcript

  • Fractures
  • Objectives
    • Describe the sequence of fracture healing
    • Differentiate between open and closed reduction, cast immobilization, and traction
    • Describe neurovascular assessment of injured extremity
    • Explain common complications associated with fracture injury and healing
  • Description
    • A disruption or break in the continuity of the structure of bone
    • Traumatic injuries account for the majority of fractures
  • Description
    • Described and classified according to:
      • Type
      • Communication or noncommunication with external environment
      • Anatomic location
  • Classification by Fracture Types
  • Classification by Fracture Communication
  • Classification by Fracture Location
  • Description
    • Described and classified according to:
      • Appearance, position, and alignment of the fragments
      • Classic names
      • Stable or unstable
  • Description
    • Closed (simple)
    • Open (compound)
  • Description
    • Stable fractures
      • Occur when a piece of the periosteum is intact across the fracture
      • External or internal fixation has rendered the fragments stationary
  • Description
    • Stable fractures
      • Transverse
      • Spiral
      • Greenstick
  • Description
    • Unstable fractures
      • Comminuted
      • Oblique
  • Clinical Manifestations
    • Patient history indicates a mechanism of injury associated with:
      • Immediate localized pain
      •  Function
      • Inability to bear weight or use affected part
    • Guarding
    • May not be accompanied by obvious bone deformity
  • Fracture Healing
    • Reparative process of self-healing ( union ) occurs in the following stages:
      • Fracture hematoma
      • Granulation tissue
      • Callus formation
      • Consolidation
      • Ossification
      • Remodeling
  • Bone Healing
    • 1. Fracture haematoma
    • bleeding & oedema create haematoma which surrounds the ends of the fragments
    • Occurs within 72 hrs
    • 2. Granulation tissue
    • active phagocytosis absorbs products of local necrosis
    • Granulation tissue (new blood vessels, fibroblasts & osteoblasts) produces the basis for new bone substance
    • Occurs 3-14 days post injury
  • Bone Healing (cont.)
    • 3. Callus formation
    • As minerals are deposited, an unorganised network of bone is formed that is woven about the fracture parts
    • Callus is composed of cartilage, osteoblasts, calcium & phosphorus
    • Begins to appear by end of 2 nd week
  • Bone Healing (cont.)
    • 4. Ossification
    • Ossification (development of bone) of the callus
    • Sufficient to prevent movement at fracture site
    • Occurs from 3 weeks to 6 months
  • Bone Healing (cont.)
    • 5. Consolidation
    • As callus develops, the distance between bone fragments diminishes & eventually closes
    • 6. Remodelling
    • Excess bone tissue is reabsorbed & union is completed
  • Bone Healing
  • Collaborative Care
    • Overall goals of treatment :
    • Anatomic realignment of bone fragments (reduction)
    • Immobilization to maintain alignment
    • Restoration of normal function
  • Fracture Reduction
    • Closed reduction
    • Nonsurgical, manual realignment
    • Open reduction
    • Correction of bone alignment through a surgical incision
  • Fracture Immobilization
    • Casts
    • Temporary circumferential immobilization device
    • Common treatment following closed reduction
  • Fracture Immobilization
    • External fixation
    • Metallic device composed of pins that are inserted into the bone and attached to external rods
  • Fracture Immobilization
    • Internal fixation
    • Pins, plates, intermedullary rods, and screw
    • Surgically inserted at the time of realignment
  • Traction
    • Application of a pulling force to an injured part of the body while counter-traction pulls in the opposite direction
  • Fracture Reduction - Traction
    • Skin traction (short-term)
    • Skeletal traction (longer periods)
  • Purpose of Traction
    • Prevent or reduce muscle spasm
    • Immobilization
    • Reduction
    • Treat a pathologic condition
  • Neurovascular Assessment
    • Colour
    • Temperature
    • Capillary refill
    • Peripheral pulses
    • Oedema
    • Sensation
    • Motor function
    • Pain
  • Complications of Fractures Infection
    • Open fractures and soft tissue injuries have  incidence
    • Osteomyelitis can become chronic
  • Complications of Fractures Infection
      • Open fractures require aggressive surgical debridement
      • Post-op IV antibiotics for 3 to 7 days
  • Complications of Fractures Compartment Syndrome
    • Condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space
  • Complications of Fractures Compartment Syndrome
    • Two basic etiologies create compartment syndrome:
      • Decreased compartment size
        • Restrictive dressings
        • Splints
        • Casts
  • Complications of Fractures Compartment Syndrome
    • Two basic etiologies create compartment syndrome:
      • Increased compartment content
        • Bleeding
        • Oedema
  • Complications of Fractures Compartment Syndrome
    • Clinical Manifestations
      • Six P s:
        • Paresthesia
        • Pain
        • Pressure
        • Pallor
        • Paralysis
        • Pulselessness
  • Complications of Fractures Venous Thrombosis
    • Veins of the lower extremities and pelvis are highly susceptible to thrombus formation after fracture, especially hip fracture
  • Complications of Fractures Venous Thrombosis
    • Precipitating factors:
      • Venous stasis caused by incorrectly applied casts or traction
      • Local pressure on a vein
      • Immobility
  • Complications of Fractures Fat Embolism Syndrome (FES)
    • Characterized by the presence of fat globules in tissues and organs after a traumatic skeletal injury
  • Complications of Fractures Fat Embolism Syndrome (FES)
    • Fractures that most often cause FES:
      • Long bones
      • Ribs
      • Tibia
      • Pelvis
  • Complications of Fractures Fat Embolism Syndrome (FES)
    • Tissues most often affected:
      • Lungs
      • Brain
      • Heart
      • Kidneys
      • Skin
  • Complications of Fractures Fat Embolism Syndrome (FES)
    • Clinical Manifestations
      • Usually occur 24 to 48 hours after injury
      • Interstitial pneumonitis
        • Produce symptoms of ARDS
  • Complications of Fractures Fat Embolism Syndrome (FES)
    • Clinical Manifestations
      • Symptoms of ARDS:
        • Chest pain
        • Tachypnea
        • Cyanosis
        •  PaO 2
  • Complications of Fractures Fat Embolism Syndrome (FES)
    • Clinical Manifestations
      • Symptoms of ARDS:
        • Dyspnea
        • Apprehension
        • Tachycardia
  • Complications of Fractures Fat Embolism Syndrome (FES)
    • Clinical Manifestations
      • Rapid and acute course
      • Feeling of impending disaster
      • Patient may become comatose in a short time