9. Description
Stable fractures
Occur when a piece of the periosteum is
intact across the fracture
External or internal fixation has rendered
the fragments stationary
12. Fracture Healing
Reparative process of self-healing (union)
occurs in the following stages:
1. Fracture hematoma (d/t bleeding, edema)
2. Granulation tissue → osteoid (3 – 14 days
post injury)
3. Callus formation (minerals deposited in
osteoid)
13. Fracture Healing
Reparative process of self-healing (union)
occurs in the following stages:
4. Ossification (3 wks – 6 mos)
5. Consolidation (distance between fragments
decreases → closes).
6. Remodeling (union completed; remodels to
original shape, strength)
15. Collaborative Care
Overall goals of treatment:
Anatomic realignment of bone fragments
(reduction)
Immobilization to maintain alignment
(fixation)
Restoration of normal function
16. Collaborative Care
Fracture Reduction
Closed reduction
Nonsurgical, manual realignment
Open reduction
Correction of bone alignment through a
surgical incision
17. Collaborative Care
Fracture Reduction
Traction (with simultaneous counter-traction)
Application of pulling force to attain
realignment
Skin traction (short-term: 48-72 hrs)
Skeletal traction (longer periods)
See Table 61-7
24. Nursing Management
Nursing Assessment for Fractures
Brief history of the accident
Mechanism of injury
Special emphasis focused on the region distal to
the site of injury
25. Nursing Management
Nursing Assessment
Neurovascular assessment
Color and temperature
cyanotic and cool/cold: arterial insufficiency
Blue and warm: venous insufficiency
Capillary refill (want < 3 sec)
Peripheral pulses (↓ indicates vascular insufficiency)
29. Nursing Management
Nursing Implementation
General post-op care
Assess dressings/casts for bleeding/drainage
Prevent complications of immobility
Measures to prevent constipation
Frequent position changes/ ambulate as permitted
ROM exercised of unaffected joints
Deep breathing
Isometric exercises
Trapeze bar if permitted
30. Nursing Management
Nursing Implementation
Traction
Ensure:
No frayed ropes, loose knots
Ropes in pulley grooves
Pulley clamps fastened securely
Weights must hang freely
Appropriate body alignment
Inspect skin
Around slings
Around pins
31. Nursing Management
Nursing Implementation: Cast care
Casts can cause neurovascular
complications if
Too tight
Edematous
Frequent neurovascular checks
Ice and elevation during early phase
See Table 61-10
33. Complications of Fractures
Infection
Collaborative Care
Open fractures require aggressive surgical
debridement
Post-op IV antibiotics for 3 to 7 days
(prophylactic)
34. 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
Causes capillary perfusion to be reduced below a
level necessary for tissue viability
39. Complications of Fractures
Compartment Syndrome
Clinical Manifestations
Absence of peripheral pulse = ominous late
sign
Myoglobinuria
Dark reddish-brown urine
40. Complications of Fractures
Compartment Syndrome
Collaborative Care
Prompt, accurate diagnosis is critical
Early recognition is the key
Do not apply ice or elevate above heart level
41. Complications of Fractures
Compartment Syndrome
Collaborative Care
Remove/loosen the bandage and bivalve the
cast
Reduce traction weight
Surgical decompression (fasciotomy)
42. Complications of Fractures
Venous Thrombosis
Veins of the lower extremities and pelvis are
highly susceptible to thrombus formation after
fracture, especially hip fracture
43. Complications of Fractures
Venous Thrombosis
Precipitating factors:
Venous stasis caused by incorrectly applied
casts or traction
Local pressure on a vein
Immobility
Prevent with anticoagulant medications
44. Complications of Fractures
Fat Embolism Syndrome (FES)
Characterized by the presence of fat globules in
tissues and organs after a traumatic skeletal
injury
45. Complications of Fractures
Fat Embolism Syndrome (FES)
Fractures that most often cause FES:
Long bones
Ribs
Tibia
Pelvis
47. Complications of Fractures
Fat Embolism Syndrome (FES)
Clinical Manifestations
Usually occur 24-48 hours after injury
Interstitial pneumonitis
Produce symptoms of ARDS
48. Complications of Fractures
Fat Embolism Syndrome (FES)
Clinical Manifestations
Symptoms of ARDS:
Chest pain
Tachypnea
Cyanosis
PaO2
49. Complications of Fractures
Fat Embolism Syndrome (FES)
Clinical Manifestations
Symptoms of ARDS:
Dyspnea
Apprehension
Tachycardia
50. 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
51. Complications of Fractures
Fat Embolism Syndrome (FES)
Collaborative Care
Treatment directed at prevention
Careful immobilization of a long bone fracture
Most important preventative factor
52. Complications of Fractures
Fat Embolism Syndrome (FES)
Collaborative Care (treatment)
Symptom management
Fluid resuscitation
Oxygen
Reposition as little as possible
53. Fracture of the Hip
Fracture of proximal third of femur
Common in the elderly
More frequent in women than men.
Up to 35% of clients will die within the
first year
54. Fracture of the Hip
Intracapsular fractures:
Occur within hip joint capsule
Extrascapular fractures
Intertrochanteric: between greater and
lesser trochanter
Subtrochanteric: below lesser trochanter
55. Clinical Manifestations
External rotation of affected leg
Muscle spasm
Shortening of the affected extremity
Severe pain and tenderness in region of
fracture
56. Collaborative Care
Surgical repair is preferred
Allows for early mobilization and decreases
the risk of major complications.
Buck’s traction may be utilized
preoperatively to decrease painful muscle
spasms.
58. Post-Operative Care
General post-op care (V/S, DB & C, etc.)
Neurovascular checks
Prevent external rotation (sandbags,
pillows)
59. Preventing Dislocation of Femur
Head Prosthesis
Do Not
Flex hip greater than 90 degrees.
Place hip in adduction
Allow hip to internally rotate
Cross legs
Put on shoes/socks without adaptive device (8
weeks)
Sit in chair without arms to aid in rising to a
standing position
60. Preventing Dislocation of Femur
Head Prosthesis
Do
Use elevated toilet seat
Use chair in shower/tub
Use pillow between legs when on “good” side
or supine (for 8 weeks post-op)
Keep hip in neutral position when sitting,
walking and lying.
Notify surgeon if severe pain, deformity, or
loss of function
Inform dentist of presence of prosthesis