Management of Fractures


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Management of Fractures

  1. 1. Management of FRACTURE By: Ms.S Peter
  3. 3. RICE Rest Ice Compression Elevation Nursing responsibilities.??
  4. 4. Diagnostic Studies for Fracture • X-ray examinations: - location and extent of fractures/trauma, may reveal pre-existing and yet undiagnosed fracture(s). • Bone scans, tomograms, computed tomography (CT)/magnetic resonance imaging (MRI) scans: Visualizes fractures, bleeding, and soft-tissue damage; differentiates between stress/trauma fractures and bone neoplasms. • Arteriograms: May be done when occult vascular damage is suspected. • Complete blood count (CBC): Hematocrit (Hct) (signifying hemorrhage at the fracture site or at distant organs in multiple trauma). Increased white blood cell (WBC) count is a normal stress response after trauma. • Urine creatinine (Cr) clearance: Muscle trauma increases load of Cr for renal clearance. • Coagulation profile: Alterations may occur because of blood loss, multiple transfusions, or liver injury. NURSING RESPONSIBILITIES ??????
  5. 5. Hold Exercise Reduce Principle Of Treatment of #
  6. 6. Outline ClosedFracture Reduce Closed Reduction Mechanical Traction Open Reduction Hold Sustained Traction Cast Splintage Functional Bracing Internal Fixation External Fixation Exercise
  7. 7. Operative Open reduction Mechanical Traction Non-operative Closed reduction Reduction
  8. 8. Closed reduction Suitable for – Minimally displaced fractures – Most fractures in children – Fractures that are likely to be stable after reduction • Most effective when the periosteum and muscles on one side of fracture remain intact • Under anesthesia and muscle relaxation, a threefold maneuver applied: • Preparing pat/family….. Pre-post care
  9. 9. Non Operative • Sustained traction • Cast Splintage • Functional Bracing Operative • Internal Fixation • External Fixation Hold
  10. 10. HOLD To prevent displacement To promote soft-tissue healing To alleviate pain by some restriction of movement To allow free movement of the unaffected parts
  11. 11. Traction • Traction is applied to limb distal to the fracture • To exert continuous pull along the long axis of the bone Indications • spiral fractures of long bone shafts: – Shaft of femur – Tibia – Lower humerus • Methods – Traction by gravity – Balanced traction – Fixed traction
  12. 12. Mechanical Traction • Some fractures (eg . fracture of femoral shaft) are difficult to reduce by manipulation because of powerful muscle pull • However, they can be reduced by sustained muscle mechanical traction; also serves to hold the fracture until it starts to unite
  13. 13. Traction by Gravity Thomas Splint
  14. 14. Cast Splintage • POP • Fiber Glass • 3-D Cortex casts (Polimer) • Velcro bandage
  16. 16. Indication 1. Fracture that cannot be reduced except by operation 2. Fracture that are inherently unstable and prone to displacement after reduction 3.Fracture that unite poorly and slowly • fracture of the femoral neck 4.Pathological fracture • Bone disease may prevent healing 5.Multiple fracture • Where early fixation reduced the risk of general complication 6.Fracture in patient who present severe nursing difficulty
  17. 17. Depending on site and type of # the fixation is used ---- • Plate & screws – long bones • Locking plate – Comminuted osteoporotic # • Intramedullary nail- Long bone -- # near the middle of shaft • Compression screw plate - # neck of femur, femur head • Trans fixation of screws – small detached fragments – • Krischner wire – bony fragments of # of small bones in hand /foot • Tension band wiring – patella or olecranon ,,,,metaphyseal
  18. 18. • Metals used ---- non corrosive --- • Chromium, nickel, molybdenum , alloy of chromium, molybdenum and nickel , Titanium
  19. 19. Advantages Precise reduction • ORIF-open reduction and internal fixation Immediate stability • Hold the fracture securely Early movement • no ‘fracture disease‘ • like edema, stiffness, etc
  20. 20. Complications Infection Non-union Implant failure Re-fracture
  21. 21. Infection Risk of infection depends on: 1)The patient  devitalized tissue, dirty wound, unfit patient 2)The surgeon  thorough training, surgical dexterity and adequate assistant are all essential 3)The facilities  aseptic routine • The infection should be rapidly controlled by intravenous antibiotic • If infection cannot be controlled, the implant should be replaced with some form of external fixation
  22. 22. NON-UNION Factors associated with the occurrence of delayed union and nonunion • the severity of the fracture, • the location of the fracture, • the nature of the blood supply to the bone, • the extent of soft tissue damage and its interposition, • bone loss, • air contact • contamination, whether a tumor is involved
  23. 23. Systemic factors for delayed or nonunion • smoking, • alcoholism, • age, • chronic illness (e.g. diabetes mellitus), • malnutrition, • use of medications (e.g. NSAIDs and steroids Nonunion may increase due to the treatment itself involving : • inadequate reduction, • poor stabilization, • distraction, • damage to the blood supply, or • postoperative infection.
  24. 24. EXTERNAL FIXATION • Fracture with soft tissue involvement • Severe comminuted and unstable # • Fracture of pelvis • # with nerve and vascular involvement • Infected # • United #
  25. 25. Advantages technically quick and easy to perform no soft tissue stripping; ease of removing hardware; risk of infection at the site of the fracture is minimal
  26. 26. Management of Open Fractures A break in skin and underlying soft tissues leading directly to communicating with the fracture
  27. 27. Treatment- Outline Irrigation Debridement: Skin, Fat, Muscle, Bone Wound closure Analgesic + Antibiotic + Antitetanus (AAA): IV, IM Fracture stabilization
  28. 28. Open # : Fracture Stabilization • A window is made in the plaster over the wound for dressing Immobilization in a plaster •Eg. open fracture of tibiaSkeletal traction •Can be easily applied •Readily reduced and adjusted •Wound can be assessed for dressing •Excellent stability External fixator • Rarely usedInternal fixator
  29. 29. Aftercare The limb is elevated & it's circulation carefully monitored Antibiotic cover If the wound has been left open, it is inspected after 2-3 days & covered appropriately Physiotherapy and rehabilitation
  31. 31. General Complications • Shock • Diffuse coagulopathy • Respiratory dysfunction • Crush syndrome • Venous thrombosis & Pulmonary embolism • Fat embolism • Tetanus Nurse’s responsibilities ?????
  32. 32. Closed Fracture First Aid --- Immediate– initial • Airway, Breathing and Circulation • Splint the fracture • Look for other associated injuries • Check distal circulation – is distal circulation satisfactory? • Check neurology – are the nerve intact? • AMPLE history- Allergies, Medications, Past medical history, Last meal, Events • Radiographs – 2 views, 2sides, 2 joints, 2 times.
  33. 33. First aid • immobilization • Control hemorrhage • Control pain– morphine -- • Care of wounds
  34. 34. General Resuscitation Manipulation (improve position of fragments) Splintage (hold fragments together until unite) Exercise & weight-bearing