Patho
Etiology
Clinical Man.
Comp.
At-risk Pop.
100
True or False?
An incomplete fracture is when the bone is broken to form two or more separate pieces.
False
100
Name two types of traumas that could result in a fracture.
A fall, motor vehicle accident, sports injury, blunt force trauma
100
A patient presents to the emergency room with their right wrist double the size of their left. What is this clinical manifestation called?
Swelling/Edema
100
A 27-year-old male presents to the emergency room in extreme pain, holding a bag of ice on their left clavicle. An x-ray reveals he suffered a complete closed fracture of his left clavicle. Upon surgery, the surgeon inserted a metal plate to hold the bones in place. What is the patient at most risk for?
Infection (VanMeter & Hubert, 2022)
100
Out of the following, who is at most risk for fractures?
a) A baby sleeping in a crib
b) Your favourite childhood school teacher leading a yoga session
c) A 80 year old grandmother with a history of osteoporosis
c) A 80 year old grandmother with a history of osteoporosis
Why?
200
List the following fractures from longest healing time to shortest healing time.
- Pott’s fracture
- Pathologic
- Comminuted
1) Pathologic Fracture
2) Comminuted Fracture
3) Pott's Fracture
200
Name the disorder that weakens bones, making them more likely to break
Osteoporosis
200
A patient presents to the clinic and refuses to move their right arm. What clinical manifestation is this called?
Guarding or protecting against movement
200
The fractured bone has healed within the appropriate time line, but is not is proper alignment resulting in a deformity or dysfunction. What is this complication called?
Malunion
200
Provide one reason why a 75 year old male with decreased vision, balance problems, a UTI, and other comorbidities is at greater risk for falls resulting in a fracture?
Tendency to fall, postural imbalances
Decreased vision affects where they are walking (hazards)
Inadequacy of fat or muscle tissue to act an an absorber
Gait and balance problems cause instability
Orthostatic hypotension
300
List at least two types of cells that are active during the remodeling stage of bone healing?
Chondroblasts, fibroblasts, osteoblasts and/or osteoclasts
300
Which of the following is not a common cause of fractures?
a) Osteoporosis
b) Diabetes mellitus
c) Overuse / repetitive activity
d) Hypertension
d) Hypertension
300
You witness your mother slip on the ice outside. You run to her aid and notice she is unable to get up. You suspect a hip fracture. What clinical manifestation is NOT suspected?
a) Impaired capillary refill time
b) Shortening of affected extremity
c) Internal rotation of affected extremity
d) Severe pain
C) Internal rotation of affected extremity
300
You’re a nurse on a surgical unit. Your patient is recovering from a comminuted fracture surgery and has a cast on his left ankle. Upon assessment, you notice your patient’s toes are cold, numb, and no pedal pulse on affected leg. You suspect the cast on his left leg is too tight. What is this complication called?
Ischemia related to compartment syndrome (VanMeter, 2022)
300
What is the most common cause for fractures in a middle aged women (40-65)?
a) Motor vehicle accidents
b) Falls as a result of running to the bathroom due to incontinence
c) Hiking on rocky and steep trails
Motor Vehicle accidents (AAOS, 2021)
400
Place the following stages of bone healing in order from beginning to end:
bony callus, procallus (fibrocartilage), hematoma, remodeling, granulation tissue
1. Hematoma
1. Granulation Tissue
3. Procallus (Fibrocartilage)
4. Bony Callus
5. Remodeling
400
As a community nurse providing a patient teaching about fractures, what patient risk factors should you be concerned with? (Select all that apply)
a) An ETOH intake of more than 2 glasses a day
b) Excessive acid reflux
c) Malnutrition
d) Previous fracture at 5 years old
A and C
Why?
400
Patient presents to the clinic and is unable to rotate their left hand from pronation to supination. What is this clinical manifestation called?
Decreased function
400
Your patient on the unit suffered a hip fracture 24 hours ago. While waiting for an x-ray, you notice they have sudden dyspnea, respiratory distress & hypoxia. They also have a petechial rash over their chest. What complication could they be experiencing?
Fat Embolism
400
Explain why a woman post menopause is more at risk for fractures compared to menstruating 25-year-old?
Cessation of the menstrual cycle causes declining estrogen levels. Low estrogen affects calcium absorption, decreasing bone density (VanMeter & Hubert, 2022).
**bonus 100* What is the BMD range for osteoporosis in postmenopausal women?
500
Your patient is healing from a simple closed fractured femur and is in the procallus stage of bone healing. Are they able to bear weight? Yes or no
Bonus 1000: Rationale
No, because the two bone ends are being splinted together through the work of phagocytes, fibroblasts, chondroblasts begin to form cartilage. Osteoblasts are not generating new bone at this stage, thus the structure is not strong enough to bear weight.
500
You are on a competitive track and field team and finals are approaching. Prior to your 800m race, you decide you are going to push yourself in training for the next two weeks by performing two a day training sessions. Based on this scenario, what type of fracture are you most at risk for?
Stress fracture
500
You have fallen from a tree and see your humerus break through your skin (compound fracture). Pain is the first immediate symptom you feel.
True or False?
False
Why?
Delayed pain occurs when nerve function at the site is lost temporarily.
500
A patient healing from a complete fracture in their left femur is experiencing muscle spasms in their left quadricep. List three complications that could arise from muscle spasms?
1. Move bone fragment out of position
2. Causes deformity
3. Rotation of the bone
4. Soft tissue damage (i.e. open compound fracture)
5. Bleeding and inflammation
500
A toddler (2 years old) fell off a picnic table holding a metal tin of crayons and was unable to break her fall. Explain why a fracture may not show in toddlers on an x-ray within the first 24 hours?
Toddlers heal much faster than adults due to their constant remodeling process.Their epiphyseal plate is continuing to grow and expand allowing osteoblasts to remodel and build stronger and longer bones.This creates a greater ratio of cancellous (spongy bone) compared to the osteon of compact bone, that reduces with age. As a result of toddlers having more cancellous (spongy bone) structure, it is harder to detect fractures on x-rays within the first 24 hours.