Fracture Healing
What is delayed union in fracture healing?
Healing progresses more slowly than expected but eventually occurs
What is the difference between closed reduction and open reduction?
Closed reduction is nonsurgical, and manual realignment (traction, casts, splints, brace). Open reduction is surgical incision (internal fixation - wires, screws, pins, etc)
What is a complication nurses should assess for in body jacket brace and hip spica casts?
Superior mesenteric artery syndrome/cast syndrome
The fracture of what bones increase the risk of developing a fat embolism?
High risk with long bone (femur, tibia, etc), rib, and pelvis fractures
What is the priority when a facial fracture is present or suspected?
Priority: Patent airway and adequate ventilation. Treat patient as if spinal injury present as well
What is nonunion in fracture healing?
Fracture does not heal despite treatment (no evidence of callus formation on xray)
A patient in buck's traction is experiencing painful muscle spasms. What should the nurse assess for first?
Weights off ground/in correct position
What is a long arm cast used for and what should we assess frequently?
Stable forearm or elbow fractures and unstable wrist fractures, often used with sling. Assess the axilla and change absorbent dressings as needed
What should we NOT do if compartment syndrome is present or suspected?
Do not elevate extremity or apply cold therapy if compartment syndrome is present or suspected
If a pt with a mandibular fracture is vomiting, what do we do FIRST? When would we cut the wires? (in gerneral)
Turn pt on side and suction first. Respiratory distress (including aspiration) and cardiac arrest.
What is angulation in fracture healing?
Type of malunion where bone is healed in abnormal position related to midline of structure (heals at angle)
How long is skin traction used for and what is the concern/assessment priority?
Short-term (48-72 hrs) before skeletal traction or surgery. Assess for skin breakdown.
Name 3 things we would teach a patient with a cast
Elevate above heart level for first 48 hours, regularly move joints above and below cast, use hair dryer on cool setting for itching, report foul smells or burning or tingling; don't get the cast wet, don't stick anything in the cast, don't cover with plastic for prolonged periods
What are the 6 P's of compartment syndrome?
Pain (analgesics don’t help), increasing pressure in compartment, paresthesia, pallor (temp and color), paralysis (loss of motor function), pulselessness
What are some nursing considerations for a stable vertebral fracture?
Keep the spine in good alignment until union achieved, and neuro assessment of distal extremities. Early mobilization and bracing (Halo vest, cervical collar). Logrolling
What is myositis ossificans in fracture healing?
Calcium deposited in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury
How long is skeletal traction used for and what is the concern/assessment priority?
Long-term. Assess for signs of infection and complications of prolonged mobility.
What are sugar tong splints used for?
Acute wrist injuries or injuries with risk of significant swelling
How can we prevent venous thromboemboli? (3)
Prophylactic anticoagulant drugs, intermittent pneumatic compression devices (SCD), ROM on the unaffected
What movements should we tell pts post-hip arthroplasty (posterior approach) NOT to do (3) and what are some devices the pt can use?
NO flexion > 90 degrees, NO hip adduction (don’t cross legs), NO internal rotation. Elevated toilet seat, abductor pillow (prevents hip adduction), don’t put on shoes/pants without assistive device
Name 3 factors that can affect fracture healing
Displacement, blood supply, local tissue injury, immobilization, internal fixation devices, infection, poor nutrition, systemic disease, lifestyle factors
Encourage mobility, check and clean pin insertion sites daily, the s/sxs of infection, do not remove device
Name symptoms of superior mesenteric artery syndrome/cast syndrome and how is it treated?
Abdominal pain and pressure, nausea, vomiting. Assess for decreased bladder and bowel function. Gastric decompression via NG tube.
What organ is affected by rhabdomyolysis and what should the nurse assess if it is suspected?
Look for dark reddish-brown urine. Assess urine output.
What are 3 complications of pelvic fractures and what should we assess for to monitor for these complications?
Bonus: Colles' fracture presentation
Intraabdominal injuries (laceration of organs), acute pelvic compartment syndrome, paralytic ileus, FES. Also sepsis and VTE. Assess bowel and urinary elimination and for abdominal distension.