Fracture Classification and Types

Disruption or break in the continuity of bone.

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<p>The extremity shortens, and the leg externally rotates (abduction).</p> Signup and view all the answers

<p>Traction is the application of a pulling force to an injured or diseased body part or extremity. It is used to prevent or reduce pain and muscle spasm, immobilize a joint or part of the body, reduce a fracture or dislocation, and treat a pathologic joint condition.</p> Signup and view all the answers

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<p>Fat embolism syndrome is a serious complication of fractures, particularly long-bone fractures. Fat globules enter the circulatory system and collect in areas with abundant blood vessels, such as the lungs and brain. This can lead to respiratory distress, chest pain, alterations in mental status, and possibly death. Manifestations include chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, hypoxemia, and petechiae on the neck, anterior chest wall, axilla, inside of cheek, and conjunctiva. Interventions include fluid resuscitation to prevent shock and respiratory support, such as oxygen therapy or ventilation.</p> Signup and view all the answers

<p>Avascular necrosis is the death of bone tissue due to an interruption of blood flow. This commonly occurs in the hip after hip fractures.</p> Signup and view all the answers

<p>Compartment syndrome is a condition where swelling within a muscle compartment causes increased pressure, leading to nerve compression and impaired blood flow. It is a medical emergency that requires immediate surgical intervention.</p> Signup and view all the answers

<p>Compartment syndrome occurs when swelling within a muscle compartment causes increased pressure, resulting in nerve compression and impaired blood flow. This can be caused by decreased compartment size (restrictive dressings, splints, casts, traction, or premature closure of fascia) or increased compartment contents (swelling, bleeding, inflammation, IV infiltration). Manifestations include severe pain (unrelieved by opioids and out of proportion to the level of injury), pressure, paresthesia/weakness, pallor (+ coolness, loss of normal color), paralysis (or loss of function), and pulselessness (dec or absent peripheral pulses, inc CRT).</p> Signup and view all the answers

<p>Infection is a common concern after a fracture, particularly with open fractures. Osteomyelitis, an infection of the bone, can result. Manifestations include pain, local signs (swelling, tenderness, warmth at the infection site), and systemic signs (fever, chills, night sweats, restlessness). Interventions include aggressive surgical debridement of open fractures and antibiotics. If healing is unsuccessful, amputation may be necessary.</p> Signup and view all the answers

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<p>Thermal burns are caused by flame, flash, scald, or contact with hot objects. The severity of the injury depends on the temperature of the burning agent and the duration of contact time.</p> Signup and view all the answers

<p>Cold burns are due to frostbite which is true tissue freezing that results in ice crystal formation within the tissues/cells. Cold stress leads to peripheral vasoconstriction, decreased blood flow, and vascular stasis. Superficial frostbite involves the skin and subcutaneous tissue: the skin appears waxy, pale, yellow to blue/mottled, feels crunchy/frozen, and the patient may report tingling, numbness, or burning sensation. Deep frostbite extends to muscle, bone, and tendon: the skin is white, hard, insensitive to touch, and has the appearance of a deep thermal injury with mottling progressing to gangrene.</p> Signup and view all the answers

<p>Chemical burns result from contact with acids, alkalis, and organic compounds. In addition to skin damage, the eyes can be injured if splashed. Acid examples include hydrochloric, oxalic, and hydrofluoric acids. Alkali examples include cement, oven and drain cleaners, and heavy industrial cleaners. Organic compound examples include phenols (chemical disinfectants) and petroleum products (creosote and gasoline).</p> Signup and view all the answers

<p>Smoke and inhalation injury occurs when breathing noxious chemicals or hot air damages the respiratory tract. The three types are:</p> <ol> <li> <p>Upper airway injury: Injury to the mouth, oropharynx, and/or larynx, resulting in redness, blistering, edema, difficulty breathing/swallowing.</p> </li> <li> <p>Lower airway injury: Injury to the trachea, bronchioles, and alveoli, leading to altered mental status, dyspnea, facial burns or singed nose/facial hair, hoarseness, wheezing, and black sputum.</p> </li> <li> <p>Metabolic asphyxiation: Oxygen delivery to or consumption by tissues is impaired (for example: carboxyhemoglobin formation in CO poisoning).</p> </li> </ol> Signup and view all the answers

<p>Electrical burns are caused by intense heat generated from an electrical current, resulting in direct damage to nerves and vessels, causing anoxia and death of tissue. The density of the tissue affected offers varying resistance (for example: bone and fat offer the most, blood vessels and nerves offer the least). Currents that pass through vital organs are more life-threatening. Muscle contractions can be strong enough to fracture long bones and vertebrae, so consider cervical spine injury (immobilize, monitor respiratory status). Electrical burns put patients at risk for dysrhythmias and cardiac arrest, both immediate and delayed. They are also at risk for severe metabolic acidosis, which may be caused by decreased renal and hepatic function, cell hypoxia, and myoglobinuria. Myoglobinuria is the release of myoglobin into circulation due to massive muscle and blood vessel injury which can block renal tubules, leading to acute tubular necrosis and acute kidney injury.</p> Signup and view all the answers

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<p>Superficial (first degree): Appearance: Erythema, blanching on pressure, pain and mild swelling, no vesicles or blisters (but may see peeling/blistering after 24 hours); Possible causes: Quick heat flash, sunburn; Structures involved: Superficial epidermal damage; tactile/pain sensation intact.</p> Signup and view all the answers

<p>Full-thickness burns involve all skin elements and local nerve endings, resulting in a dry, waxy, white, leathery, or hard appearance. Thrombosed vessels may be visible and the area is insensitive to pain due to nerve destruction. Muscle, tendons, and bones may also be involved.</p> Signup and view all the answers

<p>Eschar is leathery, devitalized burn tissue. It can interfere with breathing if found on the chest or back, causing circumferential burns.</p> Signup and view all the answers

<p>Burns in specific locations pose unique risks. Burns to the face, neck, back, and chest can lead to respiratory obstruction from edema or eschar. Burns to the hands, feet, joints, and eyes can make self-care difficult and may impact function. Burns to the ears and nose are prone to infection due to thin skin, exposure of underlying cartilage, and poor blood supply. Burns to the perineum and buttocks are at high risk for infection due to potential exposure to urine and feces. Circumferential burns around extremities can restrict movement, compromise blood circulation distal of the burns, and potentially lead to nerve damage and compartment syndrome.</p> Signup and view all the answers

<p>The rule of nines divides the body surface area into sections, each representing 9% or multiples of 9%, to estimate the percentage of body surface area burned. The entire head is 9%, each arm is 9%, each leg is 18%, the abdomen/perineum + lower back/buttocks is 18%, and the chest + upper back is 18%.</p> Signup and view all the answers

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<p>The emergent phase of burn management is the period of resolving immediate life-threatening problems following a burn injury. It typically lasts up to 72 hours from the time of the burn. The primary concerns during this phase are hypovolemic shock and edema formation. It ends when fluid mobilization and diuresis begin.</p> Signup and view all the answers

<p>The emergent phase of burn management is characterized by significant fluid and electrolyte shifts. These shifts are a major contributor to hypovolemic shock, as fluid moves out of blood vessels into the interstitial space, causing third spacing. Insensible fluid loss due to evaporation also worsens fluid loss. Potassium shifts leading to hyperkalemia occur as injured cells and hemolyzed red blood cells release potassium. Sodium shifts result in hyponatremia as sodium moves into the interstitial space. Meanwhile, inflammation and healing occur. Necrosis, a hallmark of burns, sets in, initiating an inflammatory response involving neutrophils, monocytes, and fibroblasts. Healing begins within six hours but is often hindered by impaired immune function, increasing the risk of infection. Manifestations during the emergent phase include hypovolemic shock, characterized by decreased blood pressure, increased heart rate, low urine output, and tachypnea. Hematocrit levels rise due to fluid loss. Paralytic ileus may occur with absent or decreased bowel sounds. Shivering, often due to heat loss, anxiety, and pain, may be present. Edema is a common consequence of fluid shifts and third spacing.</p> Signup and view all the answers

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<p>12,600 mL over the next 24 hours</p> Signup and view all the answers

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<p>The acute phase of burn management starts with the mobilization of extracellular fluid and diuresis. It lasts until partial-thickness wounds are healed or full-thickness burns are covered by skin grafts. This phase can extend for weeks or months.</p> Signup and view all the answers

<p>The acute phase sees a decrease in edema as diuresis occurs and bowel sounds return. The patient may become more aware of their situation, requiring emotional support and information. Healing begins during this phase, with necrotic tissue sloughing off. Partial-thickness burns must be kept free from infection and desiccation for healing. Full-thickness burns require surgical removal of eschar and placement of skin grafts for healing. Manifestations during the acute phase include eschar formation. As eschar is removed, red or pink scar tissue appears. Healing is typically spontaneous and occurs within 10-21 days. Electrolyte imbalances may occur, with hyponatremia resulting in headache, irritability, confusion, vomiting, seizures, and coma. Hypernatremia, often due to hypertonic fluid resuscitation or tube feedings, can cause changes in mental status. Hyperkalemia, which may accompany renal failure or massive muscle injury, presents with dysrhythmias, confusion, tetany, muscle cramps, paresthesia, and weakness. Hypokalemia, related to vomiting, diarrhea, prolonged GI suction, or IV therapy, results in dysrhythmias, muscle weakness, paresthesia, decreased GI motility, and decreased reflexes.</p> Signup and view all the answers

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<p>Pain management is a key component of burn care, addressing both background pain (constant) and treatment-induced pain (dressing changes, ambulation, rehab activities). Medications such as opioids, anxiolytics, and other analgesics are used, along with non-pharmacological strategies.</p> Signup and view all the answers

<p>The rehabilitation phase of burn management begins when the patient's wounds are nearly healed, and they are engaging in some self-care. This phase may start as early as two weeks or as long as 7-8 months. Key goals include working towards resuming a functional role in society and rehabilitating from post-burn surgeries (functional and/or cosmetic).</p> Signup and view all the answers

<p>In the rehabilitation phase, wounds heal spontaneously or via skin grafting. Newly healed skin appears flat and pink. Within 4-6 weeks, the area becomes raised and hyperemic (extra blood flow). Contractures can form if adequate ROM is not maintained. Mature healing takes around 12 months. Newly healed areas may be hypersensitive or hyposensitive, especially to cold, heat, and touch. Direct sunlight should be avoided for at least one year on the affected area.</p> Signup and view all the answers

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