Exemplar 13.2: Fractures

Greenstick

Comminuted

Avulsion

Compression

Spiral

Impacted

"There are 3 stages to bone healing: inflammatory, reparative, and remodeling."

"The inflammatory stage is when the damage happens and a clot called a hematoma occurs around the break."

"These white blood cells called macrophages and neutrophils enter the wound get rid of debris and bacteria during the reparative phase."

" During the remodeling stage, these bone cells called fibroblasts, osteoblasts, and chondroblasts secrete this strong substance called cartilage to form a soft callus and connect the bones."

"Blood vessels reform in the area during the reparative phase."

"During the reparative stage, the soft callus is replaced by woven bone that forms a hard callus."

"The reparative phase will last 2-4 weeks for simple fractures.

"In the remodeling phase, the woven bone is replaced by this hard bone called lamellar bone."

"Your bone will return back to its original strength in a few months."

"Parents, make sure your children wear safety equipment in any applicable situation. These include seat belts, helmets, and knee and elbow pads."

"If you work in a factory or factory-like situation, you should make sure you wear hard hats."

"You should make sure you consume an adequate amount of calcium."

"You should maintain a healthy weight, but how much you exercise doesn't matter."

"If you smoke and drink too much, you should quit smoking and cut down on your alcohol consumption. You do not, however, have to completely cease drinking."

"If you have a toddler around the house, you should use protective gates at stairs."

"If you have an older parent that is living alone that you are worried about, you should not move things around in their home."

"Older adults, specifically older adult women, should get regular screenings for osteoporosis."

"If the patient's skin is red, warm, and swollen, and the patient reports leg pain and cramping, we will call her physician immediately."

"The doctor may call the radiography department to perform a Doppler ultrasound."

"The patient should not be on bed rest, even if DVT is confirmed."

"If I don't find DVT, I can prevent it by utilizing compression stockings or boots, ambulating the patient as much as tolerated, and suggesting prophylactic anticoagulants to her doctor."

"If a DVT dislodges, it can travel to the brain and cause a stroke, travel to the lungs and cause a pulmonary embolism, or travel to the heart and cause a myocardial infarction."

"Decreased blood flow, old age, obesity, inactivity/bed rest, smoking, and cancer are all the risk factors for DVT."

A patient with HIV is more likely to get a surgical infection than a child is.

Females are more likely to get infections from fractures than men are.

Common infecting organisms are Pseudomonas, Staphylococcus, and Clostridium.

A patient with an open fracture is less likely to get an infection than a patient with a closed, displaced fracture.

A patient who underwent surgical correction for a fracture is more likely to get an infection than a patient who only received a cast.

Proper hygiene of the wound may includes surgical debridement, drainage, and culture for identifying the infecting organism.

Infections can really only cause cellulitis and osteomyelitis.

If the infection is severe or unresponsive to antibiotics, amputation may be necessary.

"Depending on the amount of tissue damage, you will either undergo an external or an internal fixation."

"In external fixation, the bone is placed into alignment, and nails, screws, wires, plates, or rods are used to keep it in place."

"In internal fixation, metal pins and screws are placed into the bone above and below the fracture, then attached to a metal bar outside the skin."

"The full name for the internal fixation procedure is 'open reduction and internal fixation.'"

"Reduction is the process of the bone being put into correct alignment."

"External fixation allows for shorter hospital stays, earlier return to full function, and fewer instances of the bone not healing or healing incorrectly."

"My cast will be made of fiberglass, which means that it 'breathes' better and is more compatible with X-rays."

"I should try to avoiding putting pressure on the cast until about 48 hours from now."

"If my cast gets wet, I should dry it will a blow driver on the cool setting. I should, however, try to avoid getting it wet in the first place."

"I should stop by the store on the way home and get a waterproof cast cover."

"If it itches under my cast, I can use a coat hanger to scratch it."

"I should use a pillow to elevate my arm above my heart, and place ice wrapped in cloth on top of the cast in order to prevent swelling."

"I do not need to contact my doctor if it feels like the cast is too tight. This is a normal feeling with new casts."

"I should look at the skin around my cast daily, and call my doctor if it looks raw or infected."

Performing neurovascular assessments

Palpating the cast for "hot spots"

Promptly reporting drainage

Education about proper cast care.

Protecting pressure sites with padding and protective dressings

Assess lung flow using a peak flow meter or spirometer

"This device uses weights, ropes, and pulleys to apply force to a fractured bone and maintain proper alignment of the bone for healing."

"Skin traction devices use splints, bandages, and boots placed on the injured limb.

"Skin traction is used only when a small amount of weight is needed for traction."

"Skin traction devices are only used to control muscle spasms or maintain alignment of a fracture before or after internal fixation."

"I'm already in a skin traction device, so I cannot be in a skeletal traction device."

"The weights cannot be removed."

The weights for skeletal traction devices can be removed under certain circumstances, but under no circumstance should the weights for skin traction devices be removed.

Signs of infection at the pin site for skeletal traction devices should be reported.

In patients in skin traction devices, frequently assess the skin for evidence of pressure, shearing, or pending breakdown.

In patients in skeletal traction devices, you should protect pressure sites with padding and protective dressings, as indicated.

Maintain the pull line by centering the client on the bed, ensuring that the weights hang freely, and ensuring that nothing is lying on or obstructing the ropes.

Be sure that the patient's foot is not wedged or placed flush with the floorboard of the bed.

Perform neurovascular assessments frequently

You do not need to assess the lungs, but you do need to assess for common signs of immobility.

Routinely take vital signs.

Elevate his leg with a pillow.

Wrap ice in a bag and place it over the fractured area.

Help the patient maintain his proper body alignment.

Help the client perform passive and active exercises in the unaffected limbs.

Teach the patient how to use his crutches.

Assess the patient's injured limb for signs of compartment syndrome every 1-2 hours.

Keep a cast saw readily available

Inform the patient that he should not let his cast get wet once he's discharged.

Initiate a 1-2 hour repositioning schedule.