Week 11 - Fractures & Trauma Assessment

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Questions and Answers

What characterizes an open fracture?

It results from mechanical overload of the bone.

The skin is broken and bone is exposed. (correct)

The bone is completely broken through.

The skin is intact with no exposure of the bone.

In which type of fracture does the bone not completely break, often seen in children?

Greenstick fracture (correct)

Complete fracture

Transverse fracture

Spiral fracture

What occurs during the fracture hematoma stage of bone healing?

The bone is realigned and immobilized.

Cartilage develops at the fracture site.

Blood vessels grow back and restore function.

A semisolid clot forms around the fracture ends. (correct)

Which of the following is a potential complication of a fracture?

Fat embolism syndrome Signup and view all the answers

What is a critical aspect of trauma nursing assessment following a fracture?

Evaluating potential neurovascular compromise. Signup and view all the answers

What type of fracture is characterized by the ends being separated from one another?

Displaced fracture Signup and view all the answers

Which symptom is most commonly associated with fractures due to the inflammatory response?

Edema Signup and view all the answers

What is a significant cause of mortality in pelvic fractures?

Hemorrhage Signup and view all the answers

Which of the following is a critical step in managing an unstable pelvic fracture?

Using pelvic binders or sheets Signup and view all the answers

What is a primary focus of post-operative care for hip fractures?

Monitoring vital signs and neurovascular status Signup and view all the answers

Which complication is most commonly associated with hip fractures in older adults?

Mortality due to falls Signup and view all the answers

Which condition is characterized by fat globules entering the bloodstream after a fracture?

Fat embolism syndrome Signup and view all the answers

During trauma nursing assessment, which sign is indicative of an impending compartment syndrome?

Diminished peripheral pulses Signup and view all the answers

In the management of fractures, what is the main purpose of applying skin traction?

Short-term alignment and reduction Signup and view all the answers

Which clinical manifestation is commonly associated with an increased risk of compartment syndrome?

Coolness and loss of color in the extremity Signup and view all the answers

What can be a result of prolonged ischemia in cases of compartment syndrome?

Limb no longer viable Signup and view all the answers

Which treatment is fundamental in managing rhabdomyolysis following a crush injury?

Fluid resuscitation Signup and view all the answers

What is the primary purpose of understanding the Mechanism of Injury (MOI) in trauma care?

To predict and prepare for certain injuries Signup and view all the answers

Which of the following is NOT considered a red flag for assessing mechanism of injury?

Sports-related injuries with direct impact Signup and view all the answers

In the primary survey for trauma assessment, which step comes immediately after assessing airway?

Breathing Signup and view all the answers

What is the main goal of collaborative management during fracture treatment?

Anatomical realignment of bone fragments Signup and view all the answers

What aspect of e-scooter injuries makes them particularly concerning compared to cyclist injuries?

Increased risk of long bone fractures and paralysis Signup and view all the answers

What does the secondary survey in trauma assessment primarily aim to gather?

Comprehensive patient history and vital signs Signup and view all the answers

What is the appropriate action regarding a closed fracture before obtaining imaging?

Apply ice to reduce swelling Signup and view all the answers

Which of the following diagnostic tests is NOT routinely included in a trauma panel?

Liver biopsy Signup and view all the answers

What complication is most commonly associated with a hip fracture in older adults?

Deep vein thrombosis Signup and view all the answers

What is considered a significant risk factor for injuries among e-scooter riders?

Injury frequency being higher in winter months Signup and view all the answers

Which of the following is NOT included in the trauma primary survey?

Assessment of posterior surfaces Signup and view all the answers

What is the primary focus in the post-operative care of a patient who underwent open reduction for a fracture?

Monitoring for signs of infection Signup and view all the answers

When assessing for pelvic fracture management, which of the following is a priority intervention?

Application of a pelvic binder Signup and view all the answers

What management intervention is recommended for an open fracture?

Administer tetanus/antibiotic prophylaxis Signup and view all the answers

What phase of bone healing involves stabilizing the fracture site through the ossification of callus?

Ossification Signup and view all the answers

Which of the following is a key consideration for a nurse assessing neurovascular status in a fractured limb?

Comparative analysis of limb color and cap refill Signup and view all the answers

Which of the following is a clinical manifestation of a fracture?

All of the above Signup and view all the answers

Which of the following is NOT a recommended management strategy for compartment syndrome?

Apply cold compresses Signup and view all the answers

How much blood can a patient lose with each pelvic fracture?

500 ml Signup and view all the answers

How much blood can a patient lose with a femur fracture?

1000-1500 ml Signup and view all the answers

You are assessing a patient a few hours after his cast was applied and he is complaining of severe pain at the fracture site that remains unrelieved even after analgesia is given. What do you suspect?

Compartment syndrome Signup and view all the answers

A client was brought to the emergency department after suffering a closed femur fracture and lacerations around the face due to a hit-and-run accident. The client is conscious and stable. Which of the following assessment findings, if observed after a few hours, should be reported to the physician immediately?

Change in the level of consciousness Signup and view all the answers

During the primary survey of a trauma assessment, which of the following is the highest priority?

Ensuring a patent airway Signup and view all the answers

A client with a femur fracture is being assessed by the nurse. The nurse is concerned about a fat embolism and knows to monitor for which of the following signs and symptoms of a fat embolism? (Select all that apply)

Tachypnea Signup and view all the answers

A client is admitted following a motor vehicle collision (MVC) where the left thigh was crushed beneath the vehicle. The nurse must prioritize assessing for which of the following complications?

Acute renal failure Signup and view all the answers

A plaster splint is applied with an elastic bandage to the leg of a client hospitalized with a fractured tibia in preparation for open reduction and internal fixation of the fracture. The client complains of increasing pain in the affected leg and foot that is not relieved by loosening of the elastic bandage. Which is the best action for the nurse to implement?

Perform neurovascular assessment of the foot Signup and view all the answers

List the 6 Ps characteristics of impending compartment syndrome

paresthesia, pain, pressure, pallor, paralysis, pulselessness Signup and view all the answers

What are some red flags of compartment syndrome? (Select all that apply)

Throbbing pain out of proportion to initial injury Signup and view all the answers

What type of fracture involves the bone breaking completely through?

Complete fracture Signup and view all the answers

What causes compartment syndrome? (Select all that apply)

Decreased compartment size (resulting from restrictive dressing, splints, casts, etc.) Signup and view all the answers

Which clinical manifestations are typically associated with hip fractures? (SATA)

External rotation Signup and view all the answers

What are the purposes of traction? (Select all that apply)

Prevent/reduce muscle spasm Signup and view all the answers

Which factor does NOT influence bone healing?

None of the above Signup and view all the answers

What factors are CRUCIAL for bone healing? (Select all that apply)

Adequate circulation to the fracture site Signup and view all the answers

What is a common cause of rhabdomyolysis in the context of fractures?

Crush injuries Signup and view all the answers

What stage of bone healing involves excess bone reabsorbing and the restoring of the bone's original strength and shape?

Remodeling Signup and view all the answers

Which clinical manifestation is an early sign of fat embolism syndrome?

Hypoxemia Signup and view all the answers

Which type of fracture is most commonly associated with osteoporosis in older adults?

Femoral neck fracture Signup and view all the answers

What should you avoid doing with a new cast?

Bear weight on the cast for the first 48 hours Signup and view all the answers

Study Notes

Week 11 - Fractures: Mechanism of Injury & Red Flags

Mechanism of Injury (MOI): describes how energy is transferred from the environment to the body, providing insight into potential injuries. Knowing the MOI helps predict and prepare for injuries.
MOI Red Flags (MVCs): high-speed collisions or rollover accidents, impacts at high velocities (e.g., head-on, rear-end, side impact), ejection from vehicle (unrestrained driver), and significant intrusion into the vehicle.
E-Scooters: injuries more common in those under 18 and more frequent in winter months. Increased risk of long bone fractures and paralysis compared to cyclists.
Trauma Assessment: includes a primary and secondary survey for life-threatening conditions and injury priorities.

Primary Survey

Airway (with simultaneous C-spine protection)
Breathing
Circulation
Disability (neuro status)
Expose/environmental controls (remove clothing for a full body assessment; keep pt warm)

Secondary Survey

Trauma Panel & Diagnostics (e.g., CBC, Lytes & BUN, Creatinine, Amylase, Lipase, PT, PTT)

Fractures

Disruption/break in continuity of bone, often from mechanical overload exceeding bone's ability to absorb stress. Some fractures secondary to disease (e.g., cancer, osteoporosis).
Open Fractures: skin broken, bone/soft tissues exposed (risk of infection).
Closed Fractures: skin intact.
Complete Fracture: bone completely breaks through.
Incomplete Fracture: bone does not completely break (e.g., greenstick fracture).
Displaced Fracture: two ends separated from each other (e.g., when ends are far apart).
Nondisplaced Fracture: bone ends aligned and periosteum intact.

Fractures: Pathophysiology

Muscle spasm and pulling of fragments
Disruption of periosteum and blood vessels in cortex and marrow of fractured bone.
Bleeding from soft tissues and bone ends.
Intense inflammatory response at fracture site from surrounding bone tissue death.

Fractures: Clinical Manifestations

Immediate localized pain, tenderness, muscle spasm
Deformity (unnatural position)
Edema (inflammatory response)
Ecchymosis (bruising)
Decreased/loss of function

Fractures: Bone Healing - Stages

Bleeding creates hematoma & clot within 72 hours.
Phagocytosis absorbs necrosis and converts hematoma to granulation tissue leading to new bone formation within 3-14 days.
Minerals and new bone matrix form an unorganized network of bone (callus) around the fracture by the end of the second week
Callus ossifies, stabilizing the fracture site from 3 weeks to 6 months.
Excess bone is reabsorbed; bone remodeled in response to stress with weight bearing gradually introduced.

Bone Healing: Factors Influencing Healing

Displacement and site of the fracture
Blood supply to the area
Immobilization and internal fixation devices (e.g., screws, pins)
Inadequate reduction and immobilization
Excessive movement of fracture fragments
Infection, poor nutrition, and systemic disease

Fractures: Assessment & Management

Initial nursing assessment includes subjective (symptoms, hx, meds, previous sx) and objective (signs; system based assessments, e.g., integumentary, CV, neuro, MSK).
Initial Nursing Management: treat life-threatening injuries first, then control external bleeding.

Neurovascular Assessment (as part of initial and ongoing assessments; every 3 hours first 4 hours after casting, then q.3-4 hrs)

Peripheral vascular assessment: color, temp, cap refill, peripheral pulses, edema
Peripheral neurological assessment: sensation, motor function, and pain (e.g., wiggle fingers, toes).
Compare bilaterally

Collaborative Management (Goals for Fracture Treatment)

Anatomical realignment of bone fragments
Immobilization to maintain realignment
Restoration of normal or near-normal function of injured parts

Management: Open Reduction

Correction of bone alignment via surgery
Often used for comminuted fractures with severe neurovascular injury
Includes internal fixation (pins, rods, etc).

Management: Closed Reduction

Nonsurgical, manual realignment of fracture to anatomical position
Tractional forces to bone fragments to restore position, length and alignment.

Management: Traction

Application of pulling force to injured or diseased part of body/extremity (countertraction pulls in opposite direction).
Maintains constant pulling force to prevent/reduce muscle spasm, reduce a fracture and immobilize a joint/part of the body.
Main traction types: skin traction and skeletal traction.

Complications of Fractures

Direct: problems with bone infection, bone union, avascular necrosis.
Indirect: compartment syndrome, rhabdomyolysis (breakdown of skeletal muscle), venous thromboembolism, fat embolism syndrome, and hypovolemic shock..

Cast Care for Patients (Do's and Don'ts)

Do's: Ice directly after fracture; Elevate above heart level for 24 hrs; Move joints above and below cast.
Don'ts: Get plaster cast wet; Insert objects inside the cast; Bear weight on new cast for 48 hrs immediately (unless otherwise specified by HCP); Don't cover cast with plastic for prolonged periods; Avoid high impact activities.

Management: Casts - Temporary circumferential immobilization device

Allows the patient to perform many normal ADLs
Application incorporated joints above and below fracture.

Management: Pharmacological Therapy

Pain management is a key part; analgesic NSAID's are commonly used to reduce inflammation; muscle relaxants can also be used.
Open fractures: tetanus prophylaxis and antibiotics.

Management for Compartment Syndrome

Quick identification
Elevation may exacerbate the condition (do not elevate above heart level).
Application of cold compresses may result in vasoconstriction and rebound vasodilation that may exacerbate compartment syndrome.
Surgical decompression (fasciotomy) may be necessary if elevation, cold compresses, or splint adjustments aren't effective.

Rhabdomyolysis

Breakdown of skeletal muscle fibers with leakage of muscle contents into the circulation.
Common cause: crush injuries
Clinical features: Nonspecific, elevated CK (Creatine Kinase), dark reddish-brown urine (myoglobinuria).

Venous Thromboembolism

Precipitating factors: incorrect cast application, local pressure on a vein, and immobility.
Management: preventative anticoagulants as ordered by HCP (e.g., LMW heparin).

Fat Embolism Syndrome

Presence of fat globules from fracture distributed to tissues and organs after traumatic skeletal injury.
Causes: long bone, rib, tibia, pelvic fractures, total joint replacement, spinal fusion, liposuction, crush injury.
Theories relate to how fat is released from the marrow into the circulatory system followed by tissue damage and oxygen deprivation.
Clinical manifestations include: Hypoxia, dyspnea, tachypnea and changes in LOC. Petechial rash may be noted (as well as dark urine), and signs of acute respiratory distress syndrome(ARDS).

Pelvic Fractures

Mechanism of injury (MOI) typically major trauma e.g., motor vehicle collisions, falls.
Classified as stable or unstable based on the disruption of the ring.
Clinical findings may include bruising around the flank, groin, or perineum (bleeding); pelvic binder (or other device) may be used.
Management: Immediate hemorrhage control and supportive care.

Hip Fractures

Leading cause of morbidity among older adults.
Occur due to falls and associated low bone density.
Clinical presentation will vary depending on the location of the fracture.
Management: initially focuses on immobilization, neurovascular assessment, and pain management, followed by surgical interventions (as needed).

Trauma Tips

Assess for pain management needs, including pain medication, and succinct documentation.
Other considerations include: transfer to trauma center if indicated, and family support & travel directions.

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Description

This quiz covers the mechanics of injury related to fractures and red flags associated with high-impact situations like MVCs and e-scooter accidents. It emphasizes the importance of a thorough primary and secondary trauma assessment to ensure patient safety and effective treatment. Test your knowledge on the mechanisms, red flags, and assessment techniques vital for healthcare professionals.