4 Fractures 2010

747 views

Published on

pathophysiology

Published in: Health & Medicine
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
747
On SlideShare
0
From Embeds
0
Number of Embeds
34
Actions
Shares
0
Downloads
21
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

4 Fractures 2010

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

×