[xx] Bone Fractures

1. Bone Fractures: it is a break or crack in a bone.

2. Causes:

• Trauma (fall, car accident etc.)
• Twisting (sports injury, abuse stc.)
• Diseases (bone cancer or osteoporosis)

3. Children tend to heal faster than adults from bone fractures b/c the periosteum ( the dense fibrous membrane covering the bones) is stronger, more flexible, and thicker than an adults.

 

4. It can take anywhere from 3 to 12 weeks to heal from a bone fracture, depending on the person's age and health status. 

 

5. Complications of a bone fracture include:

• Infection (osteomyelitis)
• Compartment syndrome
• Fat embolism

6. Signs and Symptoms of a Bone Fracture [BROKEN]

• Brusing over the site (discolored with swelling) and pain
• Reduced movement of extremity or muscle
• Odd appearance (looks abnormal)
• Krackking sounds due to bone fragments rubbing together (crepitus)
• Edema and erythema at the site
• Neurovascular impairment.... 6P's (ischemia: pain, pallor, paralysis, paresthesia, pulselessness (late sign), poikilothermia)

7. Types of Bones Fractures

Did it break through the skin? Open / Closed

• Open Fracture (compound): a fractured bone that breaks through the skin
• Closed Fracture (simple): a fractured bone that does NOT penetrate through the skin (skin remains intact)

Is the bone completely broken or part of it? Complete / incomplete

• Complete Fracture: the fracture completely separates the bone in two.
• Incomplete Fracture: the fracture does NOT break the bone all the way through.

What is the pattern or details of the fracture? Straight across / up and down at an angle, crushed in fragments

• Greenstick: one side of the bone is bent while the other is broken... incomplete type of fracture (most common in pediatric patients because their bones are more flexible than an adults)
• Comminuted: the bone is broken into many fragments (3 or more)
• Transverse: the fracture is straight across the bone shaft
• Oblique: the fracture is slanted across the bone shaft
• Spiral: the fracture twists around the bone shaft(from a twisting injury)

Nursing intervertion

• Immobilize Fx: use splint to immobilize above + below Fx
  • why? goal is to put bone back in place so it can heal properly, re
• Stop bleeding! apply pressure w/ clean cloth
• Open/compound Fx: cover w/ sterile dressing... increased risk infection
• Apply ice: to reduce sweling
• Keep NPO until evaluated by MD.
• need X-ray
• Pain management w/ meds
• Document + monitor closely the relief -> compartment syndrome!!!(Conducting frequent Neurovescular assessment)

 

Various treatments for a Bone Fracture

bone reduction: putting the fratured bone back in its original state.

Closed reduction: done manually.... nonsurgical with general anesthesia

• Cast (plaster or fiberglass) placed to keep broken bone in place to allow it to heal

      -> Things to remember about casts:

• Monitor for compartment syndrome: 6P's

• Monitor for infection: hotspots in the cast, severe pain, fever
• Keep the cast and extremity elevated above the heart level (decreases swelling)
• Apply ice packs to the cast for the first 2 days to decrease swelling
• Even drying for new cast by turning every 2 hours
• Use palms of hand to handle (not fingertips) with a new wet plaster cast.
  • WHY? Prevents dent formation in the cast by handling with the palms of hand, which can cause skin breakdown overtime.
• Maintain skin integrity: petal the cast.... use soft tape called moleskin around the edge to preven skin breakdown
• Keep cast dry and never stick anything inside to scratch an itch

Open reduction: done surgically to put fractured bone back in its original state and a fixation device used:

• Internal: attached to the bone inside the skin (pins, rods, plates, screws or external)
• External: fixture attached to the outside of the skin that helps with bone healing (Can be adjusted... metal braces, screws.)

Traction: aligns the bone with a constant steady pulling action.

• Make sure the weights are hanging freely and not on floor
• Never remove weights with a MD order
• Pin care and monitor for infection (odorous draining, redness, pain)
• Neurovascular status: 6 P's
• Overhead trapeze bar to mover around in bed.