Transcript Fractures and Mobility Issues

Nurs 120
Sasha A. Rarang, RN, MSN
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There are about 206
bones in the adult body.
Bones are made up
dense connective tissue
Used for mineral
storage, protection,
support, and
movement, ect.
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Is a discontinuity of the bone and is the most
common type of bone lesion.
Occur when more stress is placed on the bone than it
is able to absorb.
Grouped according to cause, fractures can be
divided into three major categories:
Fractures caused by sudden injury (most common)
Fatigue or stress fractures
Pathologic fractures (Osteoporosis related)
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High-speed motor accidents in adults younger than
45 years of age
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Childhood injuries due to falls, bicycle-related
injuries, and sports injury
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Falls are the most common cause of injury in people
65 yeas of age and older, with fractures of the hip
and proximal humerus particularly common in this
age group.
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The musculoskeletal system includes the bones,
joints, and muscles of the body together with
associated structures such as ligaments and tendons.
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This system which constitutes more than 70% of the
body, is subject to a large number of disorders.
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These disorders affect persons in all age groups and
walks of life and are a major cause of pain and
disability.
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A broad spectrum of musculoskeletal injuries results
from numerous physical forces, including blunt
tissue trauma, disruption of tendons and ligaments,
and fractures of bony structures.
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Many of the forces that cause injury to the
musculoskeletal system are typical for a particular
environmental setting, activity, or age group.
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Fractures are classified according to location, type,
and direction or pattern of the fracture line.
Location; A fracture of the long bone is described in
relation to its position in the bone- proximal,
midshaft, and distal.
Direction: Transverse, oblique, or spiral
Type: Comminuted, segmental, butterfly, or
impacted.
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Other descriptions are used when the fracture affects
the head or neck of a bone, involves a joint, or is
near a prominence such as a condyle or melleoulus.
Fractures are determined by its communication with
the external environment, the degree of break in
continuity of the bone, and the character of the
fracture pieces.
A fracture can be classified as open or closed,
depending if the bone fragments have broken
through the skin
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The force causing the fracture may be direct, such as
a fall or blow, or indirect, such as a massive muscle
contraction or trauma transmitted along the bone
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Results from repeated wear on a bone.
Pain associated with overuse injuries of the lower
extremities, especially posterior medial tibial pain,
is one of the most common symptoms that
physically active persons, such as runners,
experience.
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Occurs in bones that already are weakened by
disease or tumors.
May occur spontaneously with little or no stress.
The underlying disease state can be local, as with
infections, cysts, or tumors, or it can be generalized,
as in osteoporosis, Paget disease, or disseminated
tumors.
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Diagnosis is the first step in the care of fractures and is
based on history and physical manifestations.
X-ray examination is used to confirm diagnosis and
direct the treatment
Treatment depends on the general condition of the
person, the presence of associated injuries, the location
of the fracture, and its displacement, and whether the
fracture is opened or closed.
A splint is a device for immobilizing the movable
fragments of a fracture; the injured part should always
be splinted before it is moved. This is essential for
prevention of further injury.
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Reduction of the fracture; is directed toward replacing
the bone fragments to as near-normal an anatomic
position as possible.
Immobilization; prevents movement of the injured parts
and is the single most important element in obtaining
union of the fracture fragments. Can be accomplished
with the use of external devices such as splints, casts,
external fixation devices, or traction, or by reduction.
Preservation and restoration of the function of the
injured part; this is an ongoing process that includes
unaffected and affected extremities during the period of
immobilization. Exercises designed to preserve function,
maintain muscle strength, and reduce joint stiffness
should be started early.
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There are essentially four stages involved in bone
healing: Hematoma formation, fibrocartilaginous callus
development, ossification, and remodeling.
The degree of the response during each of these stages is
in direct proportion to the extent of trauma.
Healing time depends on the site of the fracture, the
condition of the fracture fragments, hematoma
formation, and other local and host factors.
4-6 Weeks in adolescents and 10-18 weeks for adults.
Function usually returns within 6 months after union is
complete, but may also take longer.
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Pain
Tenderness
Swelling
Loss of function
Deformity
Immobility
Neurological damage (Numbness, loss of sensation)
Loose muscles and muscle spasms
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A crepitus or grating sound may be heard as the bone
fragments rub against each other.
In the case of an open fracture, there is bleeding from
the wound where the bone protrudes.
Blood loss from a pelvic fracture or multiple long bone
fractures can cause hypovolemic shock in a trauma
victim
Nerve function at a fracture site may be temporarily lost.
Numbness in the area and surrounding muscles may
become flaccid, this is called local shock. This may last
from several minutes to an hour and after his brief
period, the pain sensation returns and, with it, muscle
spasms and contractions of the surrounding muscles.
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Angulation
 Felt at the site and is pushed up against soft
tissues producing a tenting effect
Shortening
 Bone fragments that slide and overridge each
other b/c of the pull of muscles on the long axis of
the extremity.
Rotation
 Fracture fragments rotate out of their longitudinal
axis resulting from rotational strain produced by
the fracture or unequal pull by muscles that are
attached to the fracture fragments
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Radial nerve injury (loss of sensation
Vascular injury to the brachial artery
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Results from fracture and may cause laceration and
muscle spasm
Pain, inability, bruising, swelling, numbness and
weakness of the arms and wrists
Deformities may occur at the shoulders, upper arms,
elbows
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May cause intraabdominal injuries
 Paralytic ileus
 Hemorrhage and laceration of urethra, bladder and colon
Local swelling
Tenderness
Deformity
Unusual pelvic movement
Ecchymosis (discoloration of the skin from bleeding
underneath) on the abdomen
Pelvic, back, hip and leg pain
Difficulty walking
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Severe symptoms include:
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Heamturia
Dizziness and fainting
Leg numbness and weakness
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Muscle spasms
Shortening of affected extremity
Severe pain and tenderness
 Hip, groin, lower back, suprapubic area, knee
Hip swelling
Walking with a limp
Inability to stand
Leg numbness and weakness
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Common in young adults
May appear deformed, angulated, shortened
Pain around thighs
Inability to perform ROM w/ hip or leg
Fat embolism (series of symptoms that include petechial skin rash,
respiratory failure and cerebral dysfunction due to the presence of
fat droplets in small blood vessels as a result of a long bone
fracture or major trauma)
Nerve and vascular injury
Soft tissue damage
Problems associated w/ bone unity
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Fat Embolism
Problems w/ bone unity
Possible infection w/ open fracture
Compartment syndrome (the compression of nerves and blood
vessels within an enclosed space that results in muscles and nerve
damage and problems w/ blood flow)
Pain
Swelling
Bruising
Deformity
Numbness
Weakness
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Damage to spinal cord (serious problem)
Critical nerve damage
 Pinched nerves
 Paralysis and even death
In osteoporosis PTs w/ vertebral fractures, several vertebras are
involved because of the Dowager’s hump
Bowel and bladder dysfunction
 Indication of disruption of the ANS nerves or injury to spinal cord
 Symptoms include bowel and bladder incontinence
Spine curved forward
Back stiffness and back pain that worsens w/ movement
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Frontal Bone
 Rapid edema that may hide underlying fractures
Perioorbital bone
 Possible frontal sinus and ocular muscle involvement,
putting the ocular muscles at risk of being damaged
Nasal bone
 Dislocate the nasal bones and bleeding may follow
Zygomatic arch
 Depression of the zygomatic arch and ocular muscles at
risk of being damaged
Maxilla
 Segmental motion of maxilla and alveolar fracture of teeth
Mandible
 Tooth fractures, bleeding, limited motion of mandible
Assessment: S&S: Pain, swelling, and tenderness. Can be
from a traumatic injury, stress or long term repetitive
force to a site, disease, immobility for a certain amount of
time, osteopenia, and osteoporosis. Medications like
corticosteroids for long term use create chances for
fracture. You may also notice a deformity at fracture site,
skin lacerations, pallor and cool skin or bluish and warm
skin, muscle weakness, or crackling between two broken
bones (crepitus). The extent of the fracture can be seen on
x-rays, bone scans, CT scans, or MRI.
Diagnosis: Impaired physical mobility related to loss of
integrity of bone structures, acute pain and associated
with reluctance to move, bone fragment movement,
injury of soft tissue, risk for peripheral neurovascular
dysfunction, disruption of skin integrity, limited
movement restrictions as seen by limited joint range of
motion, inability to intentionally move, and inability to
bear weight.
Planning: Patient will have physiologic healing with no
complications, return of skeletal function, maintenance
and realignment by immobilization, will demonstrate
appropriate use of cast or immobilizer, obtain pain
relief, and will achieve maximum rehabilitation
potential.
Implementation:
 Neurovascular assessment of fractured extremity for
any changes. Check pulse, for edema, color,
temperature.
 Minimize pain by proper alignment , support of
extremity, and positioning of patient.
 Keep extremity elevated above heart.
 Look at dressing or casts to monitor for bleeding
and look over bony prominences for skin integrity.
 Fractured mandible: Check for patent airway,
maintain clean oral hygiene, and adequate nutrition.
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Because of limited movement, to prevent constipation,
maintain a high fluid intake and fibrous foods.
Offer information on cast care and how to recognize
complications.
Assist patient with ambulation to help determine the
patient’s abilities. Give referrals to long term
rehabilitation programs.
Fractured hip: keep hip in neutral position when sitting,
walking, or laying down.
Fractured humerus: Protect the axilla of skin
breakdown due to constant sweating with absorption
pads.
Evaluation:
 Patient’s pain alleviated through proper positioning
and alignment.
 Pt is compliant with diet changes and understands
the need for long term rehabilitation.
What constitutes a fracture?
What are the common causes of
injury? Name at least two.
A fracture in which the line of break runs
obliquely to the axis of the bone is an
example of?
a. Displaced fracture
b. Stress fracture
c. Greenstick fracture
d. Oblique fracture
When you using a cane, the most important
thing to remember is?
a. Use cane to hit the nurse to get her
attention
b. 2 point gait
c. Using the cane on your weak side
d. Using the cane on your strong side
In identifying people at risk for fractures, the nurse
recognizes that the person at greatest risk for
impacted fracture is
a. A female client over 40 years old walking her
dog
b. A 21 year old male who plays basketball 6 times
a week for 6 hours
c. A 5 year old male playing at the playground
d. A 90 year old female with a history of falls
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b.
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d.
What constitutes a fracture?
What are the common causes of injury? Name at least two.
A fracture in which the line of break runs obliquely to the axis of the bone is
an example of?
Displaced fracture
Stress fracture
Greenstick fracture
Oblique fracture
When you using a cane, the most important thing to remember is?
Use cane to hit the nurse to get her attention
2 point gait
Using the cane on your weak side
Using the cane on your strong side
In identifying people at risk for fractures, the nurse recognizes that the person at
greatest risk for greenstick fractures is
A female client over 40 years old walking her dog
A 21 year old male who plays basketball 6 times a week for 6 hours
A 5 year old male playing at the playground
A 90 year old female with a history of falls