Exam 16 - Fractures, Complications of Fractures, and Interventions

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Questions and Answers

What type of fracture occurs when the bone breaks through the skin?

Displaced fracture

Incomplete fracture

Closed fracture

Open fracture (correct)

Which type of fracture is characterized by a complete break that extends fully through the bone?

Complete fracture (correct)

Comminuted fracture

Impacted fracture

Greenstick fracture

What is the mechanism that most commonly leads to a pathological fracture?

Direct impact

Weakened bone structure (correct)

Rapid muscle contraction

Twisting force

Which of the following fractures is more likely to occur in children due to the flexibility of their bones?

Greenstick fracture Signup and view all the answers

What is an example of a fracture caused by a twisting force?

Spiral fracture Signup and view all the answers

Which type of fracture involves one bone fragment being wedged into another bone fragment?

Impacted fracture Signup and view all the answers

Which assessment finding might indicate a thromboembolus in a patient with pelvic and hip fractures?

Numbness and cyanosis in the affected area Signup and view all the answers

What lab test is crucial for the assessment of bleeding when anticoagulant therapy is initiated?

Prothrombin Time (PT) Signup and view all the answers

Which of the following indicates the need for a patient with a thromboembolus to remain on bed rest?

Risk of dislodging the thrombus Signup and view all the answers

Which symptom is most characteristic of gas gangrene?

Gas bubbles under the skin Signup and view all the answers

What is the primary purpose of using external fixation devices in bone fractures?

To hold bone fragments in normal position Signup and view all the answers

Which of the following is NOT considered a symptom of a fracture?

Increased joint flexibility Signup and view all the answers

What is the primary purpose of splinting in immediate fracture management?

To prevent edema of the affected part Signup and view all the answers

What is the role of osteoclasts in the process of bone repair?

Destroying dead bone Signup and view all the answers

Which of the following is a NOT a part of the Seven Ps of orthopedic assessment?

Patience Signup and view all the answers

What does the term 'crepitus' refer to in the context of fractures?

Grating sound of bone ends moving over one another Signup and view all the answers

What is the primary reason adequate blood supply is crucial in the healing process after a fracture?

It leads to healing without concern for avascular necrosis. Signup and view all the answers

What is a common post-operative nursing intervention that must be done regularly, especially for extremities?

Completing a circulation check at least q 4 hrs. Signup and view all the answers

In the management of unstable vertebral fractures, what is a common treatment method?

Fracture reduction and stabilization with a halo brace. Signup and view all the answers

What is the primary concern during medical management of shock in a pelvic fracture patient?

Restoration of blood volume Signup and view all the answers

Which characteristic does NOT typically indicate the presence of compartment syndrome?

Tachypnea Signup and view all the answers

Which of the following actions is inappropriate for a patient recovering from surgical fixation of a hip fracture?

Elevating the affected limb while sitting. Signup and view all the answers

During assessment of a pelvic fracture patient, which sign indicates a possible fat embolism syndrome?

Mental disturbances or disorientation Signup and view all the answers

What is a critical observation in patients with vertebral fractures to assess for potential complications?

Neurological responses and signs of hemorrhage. Signup and view all the answers

What is a significant risk if decompression in compartment syndrome is delayed?

Permanent disability of the extremity Signup and view all the answers

What type of fracture treatment may involve the placement of wires around bones?

Surgical internal fixation. Signup and view all the answers

Which statement correctly describes the assessment of pelvic fractures?

Hematuria is a common sign indicating potential pelvic injury. Signup and view all the answers

What complication can occur due to irreversible ischemic damage caused by compartment syndrome?

Volkmann's contracture Signup and view all the answers

Which assessment finding would likely indicate internal hemorrhage in a pelvic fracture patient?

Increased abdominal girth Signup and view all the answers

When assessing a patient for renal trauma, which diagnostic tool is the most appropriate?

CT scan Signup and view all the answers

What is NOT an objective data point when assessing a patient in shock?

Patient reports feeling cold Signup and view all the answers

Which medical management strategy is utilized to relieve pressure in compartment syndrome?

Fasciotomy Signup and view all the answers

Study Notes

Fracture Definitions and Classifications

Fracture: A traumatic injury to a bone where its continuity breaks.
Causes: Forceful blows (twisting, crushing), direct force, torsion, violent muscle contractions.
Pathological Fracture: Fracture without trauma, from weakened bones, e.g., osteoporosis, cancer, tumors, Cushing's syndrome, malnutrition, long-term steroid use.
Open (Compound) Fracture: Bone breaks through the skin, high infection risk.
Closed (Simple) Fracture: Bone remains contained, no skin break.
Displaced Fracture: Bone ends separated at fracture line.
Incomplete Fracture: Bone breaks through only one cortex.
Classification by Appearance:
- Complete: Fracture line through bone, periosteum disrupted on both sides
- Comminuted: Bone splintered into 3+ fragments, multiple fracture lines
- Transverse: Break directly across the bone at a right angle
- Oblique: Break diagonally across the bone at approximately a 45° angle
- Spiral: Break that coils around the bone (torsion fracture)
- Impacted (Telescope): One bone fragment forcibly wedged into another
- Greenstick: Incomplete fracture where one side breaks and bends, common in children due to their soft, flexible bones
- Colles': Fracture of distal radius near wrist joint, often from falling
- Pott's: Fracture of distal fibula and medial malleolus with foot displacement
Signs and symptoms vary based on bone location, muscle attachments, fracture type, and related injuries.

Fracture Signs and Symptoms

Pain: Consistent symptom, increases with movement and pressure
Loss of function: Injured part may not move voluntarily
Deformity: Limb bends unusually or shape changes
Crepitus: Grating sound of bone ends, do not attempt to assess this
False motion: Abnormal movement at fracture site
Edema: Swelling, mostly over the fracture site
Muscle spasms: Involuntary contractions, potentially shortening the limb
Loss of sensation/paralysis: Distal to injury
Bruising/hematoma: From periosteum disruption, vessel injury, soft tissue damage

Bone Repair Process

Fracture tears periosteum and blood vessels
Inflammation and swelling due to bleeding and edema
Blood clots in the area
Fibrin meshwork forms between bone ends
Osteoblasts cross the meshwork, build collagen and calcium deposits
Callus forms (bony deposits) as osteoblasts create bone and osteoclasts remove dead bone
Osteoblasts and osteoclasts remodel callus into trabecular bone along stress lines

Fracture Assessment

Seven Ps: Pain, pallor, paresthesia (numbness), paralysis, polar temperature, puffiness (edema/hematoma), pulselessness
Subjective data: Pain, loss of sensation or movement, injury cause
Objective data: Warmth, edema, bruising, deformity, loss of function, signs of shock, circulatory, motor & sensory impairment

Fracture Diagnosis

Radiographic examination
Fluoroscopy

Fracture Medical Management

Immediate Management: Splinting, body alignment preservation, elevation, cold packs (initial 24 hrs), analgesics, monitoring color, sensation, temp, shock signs
Secondary Management:
- Simple fractures: Closed reduction (manual manipulation), traction, ORIF (surgical alignment), immobilization (cast, splint, internal fixation devices)
- Open (compound) fractures: Surgical debridement, tetanus toxoid, wound culture/antibiotics, observe for infection/complications, wound closure, fracture reduction, immobilization, complication treatment

Nursing Interventions/Patient Education

Diet, fluids, exercise unaffected joints, muscle-setting exercises, skin care, elimination, prevent immobility complications
Patient teaching: Comfort in bed, safe transfers, weight-bearing restrictions, activity limits, ambulatory device use, edema control, pain/discomfort management, exercise, pin care (asepsis), muscle toning

Hip Fractures

Prevalence: Most common hospital-treated fracture, mostly from falls, common in older adults (decreased flexibility, strength, bone density)
High mortality rate after 75.
Types:
- Intracapsular: Femur broken inside joint (head/neck), risk of avascular necrosis; often requires prosthesis
- Extracapsular: Outside the joint, more common, intertrochanteric/subtrochanteric, adequate blood supply = healing without avascular necrosis risk
Symptoms: Severe pain/tenderness, leg shortening/edema, external leg/foot rotation
Diagnosis: X-ray, CBC
Treatment: Temporary immobilization/traction until surgery; surgical repair (nails, screws, arthroplasty, bone graft, intermedullary rod)
Post-operative care: Vital signs monitoring, wound assessment, body alignment, DVT prevention (stockings, exercises, anticoagulants), pulmonary toilet, turning, complication monitoring (pneumonia, DVT, PE, fat embolism, urinary retention/constipation, skin breakdown, infection)
Patient education: Hip precautions, weight-bearing, ambulation aids, exercise, DVT prevention, pain management

Vertebral Fractures

Locations: Vertebral body, lamina, articulating processes, with/without displacement
Pressure on spinal nerves from displacement
Severed spinal cord = paralysis
Symptoms: Pain, partial/complete mobility & sensory loss below injury level
Assessment: Neurological (pupils, hand grip, extremity movement, orientation, vitals, painful stimuli), fecal/urinary retention, hemorrhage signs
Diagnosis: X-rays, myelography, CT scans, spinal tap
Medical Management: Stable: Pain meds, muscle relaxants, anticoagulants, upright posture; Unstable: Fracture reduction, postural positioning, traction (halo, pelvic), surgical intervention (Harrington rod)
Nursing care: Stability maintenance, log rolling, elevated HOB, traction continuity assessment, skin integrity/distal pulses
Patient teaching: Mattress firmness, sitting posture, lifting, back exercises

Pelvic Fractures

Etiology/Cause*: Significant trauma (high falls, car accidents, crushing injuries)
Symptoms: Inability to bear weight, tenderness/edema, hematuria (blood in urine), hemorrhage (life-threatening)
Assessment*:
Subjective*: Pelvic pain, backache, anxiety, restlessness, and disorientation (signs of shock)
Objective*: Muscle spasm, bruising over pelvic area, inability to raise legs, external foot rotation, vitals (hypotension, tachycardia, tachypnea, oliguria, diaphoresis), observe for fat embolism, bowel sounds, urine color/output, girth
Diagnosis*: Abdominal X-rays, CT scans, IV pyelogram, labs (CBC, urine, stool)
Medical Management*:
Bedrest,* pelvic sling, skeletal traction, spica/body cast
Nursing*: Shock monitoring, abdominal girth measurement, I&O (foley catheter), nursing interventions for mobility/skin/fluids/pain, patient teaching

Compartment Syndrome

Definition*: Arterial vessel compression reduces blood supply to an extremity’s compartment.
Causes*: Tissue pressure increases within fascia-enclosed spaces affecting arteries, veins, muscles, nerves.
Time-critical*: 6 hours = irreversible ischemic damage; 24-48 hours = permanent disability.
Complications*: Volkmann’s contracture (elbow, wrist, fingers flexed), infection (delayed decompression).
Symptoms*: Intense pain (increased with movement), numbness/tingling, inability to flex digits, coolness, pale/bluish skin, slow capillary refill, absent pulse
Diagnosis*: Clinical assessment combined with measurement of tissue pressure directly within the compartment.
Medical Management*: Fasciotomy (incision into fascia) to relieve pressure, open wound.
Nursing*: Analgesics, elevation, cold packs, remove constricting material.

Shock

Causes*: Blood loss from fractured bones or vessels.
Symptoms*: Level of consciousness changes, restlessness/anxiety, weakness/lethargy, hypotension, tachycardia, tachypnea, hyperthermia, pale/cool/moist skin, oliguria.
Medical Management*: Restore blood volume (IV fluids, blood products), oxygen.
Nursing Interventions*: Fluid/IV site monitoring, frequent vital signs, urinary output, bed rest, NPO, avoid sedatives that mask neurologic changes, shock trousers if needed

Fat Embolism

Causes*: Platelets combine with fat, travel through lungs, obstruct vessels. Rare but life-threatening (pulmonary failure), associated with multiple fractures, crush injuries, long bones/pelvic fractures.
Symptoms*: Mental disturbances, irritability, restless, disoriented, stupor, coma, chest pain, muscle weakness, spasticity, rigidity, tachypnea, dyspnea, hypoxemia, crackles, wheezes, petechiae
Diagnosis*: Occurs within 24-48 hours, blood gases (hypoxemia), CBC (decreased H/H, fat, platelets), urine (fat), ESR (increased)
Nursing care*: Carefully monitor ABGs, fluids, oxygen, incentive spirometry, any steroid/digoxin therapy as ordered

Gas Gangrene

Cause*: Severe skeletal muscle infection caused by Clostridium bacteria, associated with compound fractures & lacerations, potentially fatal if untreated.
Symptoms*: Sudden/severe pain, toxic delirium, gas bubbles/crepitus visible in the skin, skin necrosis, watery discharge with foul odor
Medical Management*: Debridement (surgical removal), antibiotics (penicillin, cephalosporins), possibly amputation
Nursing*: Wound care with strict medical asepsis, infection control, isolation measures

Thromboembolism

Causes*: Blood clot (thrombus) travels and blocks a blood vessel. High risk with pelvic/hip fractures.
Symptoms*: Affected area cold, numb, cyanotic, sudden sharp pain, dyspnea, lung embolus cough, fever, hemoptysis.
Assessment*: Check for warmth, edema, color changes in the extremities, signs of pulmonary involvement, and bleeding if anticoagulants are being used.
Diagnostic Tests*: Labs (PT, PTT, INR, D-dimer, CBC), Doppler ultrasonography or duplex scanning, CT scan
Medical Management*: Anticoagulants, thromboectomy.
Nursing care*: Bed rest, leg elevation, active exercise, compression stockings, pulmonary assessment, anticoagulant monitoring

Delayed Fracture Healing

Definition*: Fracture takes longer than usual to heal.
Types*: Non-union (bone ends fail to unite within 6-9 months).
Treatment*: Electrical stimulation to stimulate bone production

External Fixation Devices

Used to hold bone fragments in place
Materials: Casts, skeletal/skin traction, braces, pins
Skeletal Pin External Fixation*:
Immobilizes fractures using pins inserted through bone, metal frame
Used for comminuted, open fractures, infected nonunions, or unstable joints
Requires general anesthesia
Frequent assessment of pins for infection

Casts

Immobilize bone during healing
Materials: Plaster, fiberglass, plastic
Types*: Short arm, long leg, spica (body), bivalve
Initial Assessment*: Baseline measurements and neurovascular assessment (pulses, color, temperature, capillary refill, sensation, motion) before and after cast application/removal, skin integrity
Nursing interventions*: Explain the procedure, precaution/care of cast, skin care, turning, toileting, weight-bearing restrictions, and cast removal procedure

Traction

Applies tension to an extremity/bone using weights and pulleys for alignment & stabilization
Types:
- Skeletal: Directly on bone using pins, tongs, wires
- Skin: On skin using weights on bandages
Common types: Bucks, Russell's
Nursing Care: Frequent neurovascular checks (pulses, movement, skin), weight/pulley/rope checks, ensure alignment, meticulous skin care, pain management.

Frames and Splints

Frames used for turning, positioning, and maintaining alignment
Types: Balkan, Bradford, Stryker, RotoRest, MicroAIR, etc.
Splints and braces: Immobilization and ambulation assistance
Crutch/cane/walker use safety: Proper measurements, rubber tips, adequate upper extremity strength

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Description

This quiz covers various types of fractures, their definitions, and classifications. It addresses causes, symptoms, and specific categories such as open, closed, and displaced fractures. Test your knowledge on important medical terminology related to fractures.