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    Fractures

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    Kim Gonzales
    Fractures occur when a force exceeds the bone's tensile or compressive strength, breaking its continuity. There are several types, including closed/simple fractures where the skin is intact, and open/compound fractures where the bone is exposed. Risk factors include age, diseases like Paget's, and high-energy impacts. Complications can include infection, fat embolism, nerve damage, delayed healing, and compartment syndrome with increased pressure. Diagnostic tests evaluate the location and extent of injury using x-rays, bone scans, and blood/urine tests of kidney and liver function, blood counts, and coagulation.

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    Fractures

    Uploaded by

    Kim Gonzales
    6K views39 pages
    Fractures occur when a force exceeds the bone's tensile or compressive strength, breaking its continuity. There are several types, including closed/simple fractures where the skin is intact, and open/compound fractures where the bone is exposed. Risk factors include age, diseases like Paget's, and high-energy impacts. Complications can include infection, fat embolism, nerve damage, delayed healing, and compartment syndrome with increased pressure. Diagnostic tests evaluate the location and extent of injury using x-rays, bone scans, and blood/urine tests of kidney and liver function, blood counts, and coagulation.

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    Fractures occur when a force exceeds the bone's tensile or compressive strength, breaking its continuity. There are several types, including closed/simple fractures where the skin is intact, and open/compound fractures where the bone is exposed. Risk factors include age, diseases like Paget's, and high-energy impacts. Complications can include infection, fat embolism, nerve damage, delayed healing, and compartment syndrome with increased pressure. Diagnostic tests evaluate the location and extent of injury using x-rays, bone scans, and blood/urine tests of kidney and liver function, blood counts, and coagulation.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    6K views39 pages

    Fractures

    Uploaded by

    Kim Gonzales
    Fractures occur when a force exceeds the bone's tensile or compressive strength, breaking its continuity. There are several types, including closed/simple fractures where the skin is intact, and open/compound fractures where the bone is exposed. Risk factors include age, diseases like Paget's, and high-energy impacts. Complications can include infection, fat embolism, nerve damage, delayed healing, and compartment syndrome with increased pressure. Diagnostic tests evaluate the location and extent of injury using x-rays, bone scans, and blood/urine tests of kidney and liver function, blood counts, and coagulation.

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    Fractures

    Fracture
    Break in the continuity
    of the bone.
    When force is applied that exceeds the
    tensile strength
    or compressive strength
    of the bone.
    Types of Fracture
    Closed (simple)
    The bone is broken, but the skin is not lacerated.
    Open (compound)
    If the skin is open. The bone may or may not be
    visible in the wound.
    COMPRESSION SIMPLE
    GREENSTICK COMPOUND
    OCCULT SPIRAL
    COMMINUTED TRANSVERSE
    OBLIQUE
    RISK FACTORS
    Risk factor

    Toddler
    Risk factor
    Risk factor
    Paget’s Disease
    Risk factor
    Risk factor
    Pathophysiolgy of
    Fracture
    Moderate to
    severe energy
    transmitted

    Bone impact
    exceed tensile Swelling
    strength Pain

    Fat embolus
    Deformity
    Break in the
    Loss of function
    continuity of the
    Myoglobinurea Impaired
    bone
    sensation
    Compartment Decrease
    syndrome Bleeding mobility
    Hematoma
    formation

    Stimulates
    Bone tissue dies
    inflammatory response

    Decalcify fracture
    bone ends

    Bone tissue
    revascularization
    Osteoblast

    Procallus

    Callus

    Remodeling

    New bones
    Clinical Manifestations
    • Local Swelling
    • Loss of function or abnormal movement of affected
    part
    • Deformities such as shortening, rotation
    • Crepitation
    • Pain/ local tenderness
    • Anesthesia and flaccidity (few minute to hrs)
    - This is due to a temporary loss of nerve function at
    the site associated vascular injury.
    Complication
    Osteomyelitis
    The open area is a rich
    culture medium for infection.
    It retards healing by
    destroying newly formed
    bone and interrupting it’s
    blood supply.
    S. aureus is the usual cause.
    Complications
    Embolism
     Fat & Pulmonary Embolism
    Fractures of long bones may
    release enough fat to travel
    through the veins, they attract
    platelets which become part
    of the microembolus and
    deplete circulating platelets
    Disseminated Intravascular Coagulation
    Precipitating mechanism
    Treat the
    underlying
    problem
    Tissue damage Endothelial damage

    Increased tissue Intrinsic pathway of


    thromboplastin coagulation

    Extrinsic pathway
    of coagulation
    Heparin to prevent
    microclotting
    (controversial)
    Intravascular coagulation (production of
    microthrombi)
    Cryoprecipitate factor
    VIII
    Occlusion of small blood Production of thrombi
    vessels Fresh frozen plasma
    Activation of fibrinolytic
    Tissue necrosis system Platelets
    Consumption of clotting
    Digestion of fibrin clots factors

    Decreased clotting Thrombocytopenia


    Inhibition of platelet
    factors
    function

    Blood Bleeding

    Key: = treatment
    Complications
    incorrect

    Delayed union Failure


    Complications
    Nerve Damage
    - Bone fragments may
    rupture and compress
    nerves that may also
    be damaged by
    dislocation or direct
    trauma
    Complications

    Dislocation
    Subluxation temporary displacement of
    if the contact bone one or more bones in a joint
    between the opposing bone in which the opposing bone
    surface is partially lost. surface loss contact entirely.
    Complication
    Myoglobinuria
    (Rrabdomyolysis)

    Severe muscle trauma.


    An excess myoglobin
    (intracellular muscle protein)
    in the urine.
    Muscles damage, with
    disruption of sarcolemma,
    releases myoglobin which
    would lead to renal failure
    Complication
    COMPARTMENT SYNDROME
    - Pressure build within the
    compartment due to bleeding.
    - swelling reaches the point at which
    the fascia permits no outward
    enlargement
    - increasing pressure is directed
    inward and compresses
    components in the compartments.
    Nursing Diagnosis
    1. Acute pain r/t stimulation of free nerve endings 2
    to soft tissue injury.
    2. Risks for peripheral neurovascular dysfunction r/t
    reduction/interruption of blood flow.
    3. Impaired Gas Exchange r/t altered blood flow/fat
    emboli.
    4. Impaired physical mobility r/t skeletal instability 2
    to physical trauma.
    Nursing Diagnosis
    5. Impaired Tissue integrity r/t insertion of traction
    pins wires and screw/ physical immobilization
    6. Situational low Self –Esteem r/t loss of body
    parts/ change in functional abilities.
    7. Ineffective peripheral tissue perfusion r/t
    reduced arterial venous blood flow; tissue edema;
    hematoma formation.
    Diagnostic Tests
    RADIOLOGIC EXAM
    Radiologic exam- to determine location extent of
    fracture/trauma; may reveal preexisting undiagnosed
    fracture.
    Bone scan, tomograms, CT, MRI scan
    - Visualized fractures, bleeding and soft tissue damage.
    May be prepared for diagnostic tool because of superior
    ability to image some types of injuries.
    Arteriogram
    - May be done when occult vascular damage is suspected.
    URINE ANALYSIS
    Urine creatinine clearance

    - Muscle trauma increases load of Cr for renal clearance.


    - Creatinine level and urea nitrogen level should be analyzed when renal function is
    elevated.
    - NORMAL VALUE
    - .6-1.3 mg/dL
    URINE ANALYSIS
    Blood Urea Nitrogen
    - Urea normally freely filtered through renal
    glomeruli, small amount reabsorbed in the
    tubule and the remainder excreted in the
    urine.

    -NORMAL VALUE
    8-25 mg/dl
    BLOOD ANALYSIS
    Hemoglobin
    - main component of erythrocyte & serve
    as the vehicle for transportation of O2 and CO2.
    - NORMAL VALUES
    Male: 14-16.5 g/dL Female: 12-15 g/dL
    Hematocrit
    - Determinations are important in identifying anemia.
    - Fasting is not required.
    - NORMAL VALUES
    - Male: 42%-52% Female: 35%-47%
    BLOOD ANALYSIS
    WBC
    - Immune defense system of the body.
    - Cell count assess each leukocytes distribution.
    - increase WBC, normal response to trauma.

    NORMAL VALUE
    4,500 – 11, 000 cells/L
    Coagulation profile
    activated Partial Thromboplastin Time (aPTT)
    - Test screens
    deficiencies & inhibitors of all factors
    except factor VII & XIII.
    - Screen for coagulation disorders.
    - NORMAL VALUE
    20-36 seconds
    Coagulation profile
    Prothrombin Time (PT)
    - Measures the amount of time it takes for clot
    formation
    - within 2 sec (+ or - ) of the control is considered
    normal.
    NORMAL VALUES
    - Male: 9.6 -11.8 seconds Female: 9.5 -11.3 seconds

    -
    PT > 30 seconds at risk for HEMORRHAGE
    The end….

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