Understanding Bone Fractures

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Questions and Answers

What is the typical healing time for a midshaft femur fracture in an adult?

10 weeks

3 weeks

20 weeks (correct)

1 week

Which of the following is NOT a method of fracture reduction?

Splinting

Physical therapy (correct)

Manual traction

External fixation

What is a primary goal of immobilization after a fracture reduction?

Promote movement

Encourage weight bearing

Maintain realignment (correct)

Reduce pain medication

What complication is associated with open reduction?

Infection Signup and view all the answers

In which situation is open reduction especially facilitated?

Complex fractures Signup and view all the answers

What is the primary purpose of callus formation in bone healing?

To prevent movement at the fracture site Signup and view all the answers

During which stage of bone healing does ossification begin?

Stage 4: Ossification Signup and view all the answers

What is meant by 'radiologic union' in the context of bone healing?

The complete bony union evident on an x-ray Signup and view all the answers

What can contribute to delayed union in fracture healing?

Smoking Signup and view all the answers

What happens during the remodeling stage of bone healing?

Excess bone tissue is resorbed Signup and view all the answers

Which of the following factors is NOT a cause of delay in bone healing?

Inadequate exposure to sunlight Signup and view all the answers

What is a potential outcome of a fracture that heals but is not properly aligned?

Malunited fracture Signup and view all the answers

How does physical loading stress influence bone remodeling?

It leads to new bone deposition at sites under stress Signup and view all the answers

What is the primary purpose of traction in orthopedic treatment?

To apply a pulling force for realignment of the fractured extremity Signup and view all the answers

Which of the following is NOT a use of traction?

Increasing mobility in all joints of the body Signup and view all the answers

What type of traction uses adhesive tape and may include boots or splints applied directly to the skin?

Skin traction Signup and view all the answers

What is the recommended weight used in skin traction for a patient?

5 to 10 lbs (2.3 to 4.5 kg) Signup and view all the answers

When managing skin traction, what is a key nursing responsibility?

Ensure the ropes of the traction device are unobstructed Signup and view all the answers

What is the primary cause of most fractures?

Trauma Signup and view all the answers

Which type of fracture occurs without a complete break across the bone?

Incomplete fracture Signup and view all the answers

A displaced fracture is characterized by which of the following?

The broken bone ends are separated Signup and view all the answers

Which of the following is NOT classified as a traumatic fracture?

Fracture due to osteoporosis Signup and view all the answers

What does a comminuted fracture involve?

Multiple fragments of bone resulting from the break Signup and view all the answers

Which statement correctly describes a nondisplaced fracture?

The bone retains normal alignment Signup and view all the answers

Bone diseases, such as osteoporosis, primarily contribute to which type of fracture?

Pathologic fracture Signup and view all the answers

What kind of force is NOT typically a cause of fractures?

Excessive hydration Signup and view all the answers

What is the primary purpose of skeletal traction?

To align injured bones and joints Signup and view all the answers

Which of the following is NOT a piece of equipment used in skeletal traction?

Ultrasound machine Signup and view all the answers

What should be monitored to avoid complications during skeletal traction?

The positioning and alignment of the patient Signup and view all the answers

What is a common range of weight used in skeletal traction?

5 to 45 lbs Signup and view all the answers

What type of traction involves the insertion of pins into the skull?

Halo traction Signup and view all the answers

Which site is commonly associated with skeletal traction?

Calcaneus bone Signup and view all the answers

What is the risk of using excessive weight in skeletal traction?

Delayed union or nonunion Signup and view all the answers

What provides countertraction in skeletal traction?

The patient’s body weight Signup and view all the answers

Study Notes

Fracture Definition

A disruption or break in the continuity of a bone.
Two main types:
- Traumatic: caused by an accident.
- Pathologic: caused by disease, like osteoporosis.

Causes of Fractures

Trauma: most common cause.
- Examples:
  - Sports injuries.
  - Vigorous exercise.
  - Motor vehicle crashes.
  - Falls (especially in older adults).
  - Direct blows to the bone.
  - Indirect force from muscle contractions or pulling on the bone.
Malnutrition: can weaken bones.
Bone diseases: like osteoporosis increase fracture risk in older adults.

Fracture Classification

According to the extent of the break:
- Complete: break goes across the entire width of the bone, dividing it into two sections.
- Incomplete: break only goes through part of the bone.
Based on bone alignment:
- Displaced: bone fragments are separated and out of their normal positions.
- Nondisplaced: bone fragments stay in alignment.

Bone Healing Stages

Stage 1: Hematoma formation:
- Blood clots at the fracture site.
- Inflammation occurs.
Stage 2: Soft callus formation:
- Fibrocartilage fills in the gap between bone fragments.
- Appears by the end of the second week.
Stage 3: Hard callus formation:
- New bone tissue is deposited.
- X-ray shows callus formation.
- Begins nonbony union.
Stage 4: Ossification:
- Callus is gradually resorbed.
- Occurs 3 weeks to 6 months after injury.
- Fracture is still evident on x-ray.
- Allows for limited mobility.
Stage 5: Consolidation:
- Distance between bone fragments decreases and closes.
- Ossification continues.
- Complete bony union visible on x-ray.
- Can take up to 1 year.
Stage 6: Remodeling:
- Excess bone tissue is resorbed.
- Bone returns to pre-injury strength and shape.
- Responds to physical loading stress (Wolff’s law).

Outcomes of Healing

Delayed Union: Healing takes longer than expected.
Non Union: Fracture doesn't heal at all.
Malunited Fracture: Bone heals but not completely straight.

Causes of Delayed Bone Healing:

Displacement and site of fracture.
Excessive movement of fracture fragments.
Poor blood supply.
Local tissue injury.
Inadequate immobilization.
Internal fixation devices (e.g., screws, pins).
Infection.
Poor nutrition.
Systemic diseases (e.g., diabetes).
Age: Longer healing time in adults, shorter in infants.
Smoking: Increases healing time.

Diagnostic Studies

History and physical examination.
Plain X-ray.
CT scan.
MRI.

Fracture Management Goals

Anatomic realignment of bone fragments through reduction.
Immobilization to maintain realignment.
Restoration of normal or near-normal function of the injured part.

Fracture Management Principles

Fracture Reduction: Realigning broken bone fragments.
- Manual traction: Applying pulling force to bone fragments.
- Closed reduction: Nonsurgical manual realignment.
- Open reduction: Surgical correction of bone alignment.
- Skeletal traction: Traction applied directly to the bone.
- External fixation: Pins and rods outside the body.
- Internal fixation: Devices (screws, plates) placed within the body.
Fracture Immobilization: Fixing the broken bone in place
- Casting or splinting: Applying a cast or splint for immobilization.
- Skeletal traction: Used for longer-term immobilization.

Closed Reduction

Nonsurgical realignment of bone fragments.
Traction and countertraction is manually applied.
May be followed by: Casting, splints, or orthoses (braces) to maintain alignment and immobilize the injured part.

Open Reduction

Surgical correction of broken bone alignment.
Includes internal fixation: Wires, screws, pins, plates, rods, or nails.
Advantages: Allows for earlier ambulation.
Risks: Infection, complications from anesthesia, preexisting medical conditions.

Traction

A pulling force applied to an injured extremity.
Counter-traction pulls in the opposite direction.

Uses of Traction

Prevent or reduce pain and muscle spasms.
Immobilize a joint or part of the body.
Maintain skeletal length and alignment.
Reduce a fracture or dislocation.
Treat a pathologic joint condition (e.g., tumor, infection).

Types of Traction

Skin Traction:
- Tape, boots, or splints applied directly to the skin.
- Used for short periods or intermittently.
- Example: Buck traction.
Skeletal Traction:
- Traction force applied directly to the bone.
- Long-term pull for bone and alignment.
- Uses pins, wires, and weights.

Skin Traction

Traction force is applied through adhesive tapes, boots, or splints attached to the skin.
Used to decrease muscle spasms in the injured extremity.
Typically for : hip, knee, or femur fracture.
Traction weights: 5 to 10 lb (2.3 to 4.5 kg).

Nursing Management of Skin Traction

Regularly assess the skin for pressure points and skin breakdown.
Ensure:
- Ropes are unobstructed and moving smoothly over pulleys.
- Weights are hanging freely and not touching the floor.

Skeletal Traction

Traction force is applied directly to the bone using pins or wires.
Used to align injured bones and joints, treat joint contractures, and congenital hip dysplasia.
Provides a prolonged pull, keeping injured bones and joints aligned.
Weight ranges from 5 to 45 lb (2.3 to 20.4 kg).

Types of Skeletal Traction

Balanced suspension skeletal traction: The most common type.
Halo traction:
- Used for patients who need prolonged immobilization or surgery.
- Pins are inserted into the skull, and a pulling force is applied using a halo device.
- Immobilizes and realigns fractures of the cervical spine or upper thoracic spine.

Nursing Management of Skeletal Traction

Maintain constant traction forces by:
- Correct positioning and alignment of the patient.
- Keeping weights off the floor and moving freely through pulleys.
Countertraction is supplied by the patient’s body weight or weights pulling in the opposite direction.

Common Sites for Skeletal Traction

Olecranon
Metacarpal
Upper end of femur
Lower end of femur
Upper end of tibia
Lower end of tibia
Calcaneus bone

Nursing Management of Patient with Fracture

Regularly assess the patient's physical and psychological status.
Monitor for complications:
- Compartment syndrome.
- Infection.
- Delayed union.
- Nonunion.
- Malunion.
Provide patient education:
- Proper use of assistive devices.
- Importance of maintaining immobilization.
- Signs and symptoms of complications.
- Follow-up care instructions.
Encourage patient participation in rehabilitation:
- Exercise to maintain muscle strength and joint mobility.
- Gradual return to activity as tolerated.
- Follow-up with healthcare professionals to monitor progress.

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Description

This quiz covers the definition, causes, and classification of bone fractures. It explores both traumatic and pathologic fractures, as well as how malnutrition and bone diseases contribute to fracture risk. Test your knowledge on the various types and classifications of fractures.