Contenu connexe



  1. FRX, FX or #
  2. A fracture is any disruptions or break in the continuity of the structure of bone.
  3. Mechanical overload of bone Metabolic bone disease Eg: Osteoporosis Direct force.Eg: Moving object strikes body Indirect force Eg: Muscle contraction Stress
  4.  Biologic conditions- Osteopenia  Neoplasms  OLD AGE  Infections  Post menopausal estrogen loss & protein energy malnutrition  High risk recreation or employment related activity  Incidence – male are mostly affected at the age of 15-25 and females at the age of 65 and more
  5. Fracture Muscles attached to bone are disrupted Muscle spasm- Pull fracture fragments out of position Proximal portion of bone remains in place, distal displaced Fracture fragments displaced sideways or overriding Periosteum & blood vessels of fractured bone disrupted
  6. Soft tissue damage Bleeding from soft tissue & damaged bone endings Hematoma between fracture fragments & beneath periosteum Bone tissue surrounding fracture site dies Intense inflammatory response Vasodilation, edema, pain, loss of function, Infiltration of WBC
  7.  Fracture can be described and classified according to type, communication or non communication with external environment and location of the fracture  Stable fractures – some of the periosteum is intact across the fracture  Unstable fracture – grossly displaced.
  8.  Open fracture(compound fracture): Break in the skin over bone injury Grading of open fracture  Grade I – the wound is smaller than 1cm, contamination is minimal  Grade II- wound is larger than 1cm, contamination is moderate  Grade III – wound exceeds 6-8cm, there is extensive damage to soft tissue, nerve, tendon and there is high degree of contamination
  9.  Closed facture (simple fracture) It has intact skin over the site of injury
  10.  Appearance: 1.Burst fracture - Multiple pieces of bone, mainly in the vertebra
  11. 2. Comminuted fracture - More than one fracture line, more than 2 bone fragments, Fragments crushed, the smaller fragments appear to be floating
  12. 3.Complete fracture - Break across entire section of bone, dividing into distinct fragments
  13. 5. Displaced fracture - Fragments out of normal position at fracture site
  14. 4. Incomplete fracture - Fracture occurs through only one cortex of bone, usually nondisplaced
  15. 6. Nondisplaced fracture - -Fragments aligned at fracture site
  16. 7. Linear fracture (Longitudinal fracture) - Fracture line is intact; Caused by minor- moderate force - Periosteum is not torn away from the bone
  17. 8. Oblique fracture - -Fracture line occurs at 45 degree angle across longitudinal axis of bone
  18. 9. Spiral fracture - -the line of the fracture extends in a spiral direction along the shaft of the bone - Fracture line results from twisting force
  19. 10. Stellate fracture - -Fracture line radiate from one central point
  20. 11. Transverse fracture - -Fracture line occurs at 90 degree angle to longitudinal axis of bone 12. Inter articular fracture  Fracture extending to the articular surface of the bone
  21. 1. Avulsion - Bone fragments are torn away from body of the bone at the site of attachment of ligaments or tendon
  22. 2. Compression fracture - Bone cracks as a result of loading force applied to its longitudinal axis
  23. 3. Greenstick fracture - Incomplete fracture in which one side of the cortex is broken & the other side is flexed but intact
  24. 4. Impacted fracture It is a communited fracture in which one fragment is driven in to other 5. pathologic fracture It is a spontaneous fracture due to an underlying pathologic condition
  25. Anatomic Location 1. Colle’s fracture -Fracture within last inch of distal radius
  26. 2. Pott’s fracture A Pott's fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli
  27.  3.torus fracture – also known as buckling fracture, they are incomplete fractures of the shaft of long bone which is characterized by bulging of the cortex.  4.Transchondral fracture – separation of cartilaginous joint surface from main shaft bone
  28.  Self healing of bone occurs in the following stages Stage I – hematoma or inflammatory stage Stage II – granulation tissue formation or fibro cartilage formation Stage III – callus formation Stage IV – ossification Stage V – consolidation Stage VI – remodeling
  29.  When a fracture occurs, bleeding and edema create a hematoma, which surrounds the ends of the fragments.  The hematoma is extravasated blood that changes from a liquid to a semisolid clot  Time 1 to 3 days  The blood forms a clot among the fracture fragments, providing a small amount of stabilization  Necrosis of adjacent bone occurs in direct relation to the loss of blood supply to the affected region and will extend to the area where collateral circulation begins  Vascular dilation occurs in response to the accumulation of dead cells or debris at the fracture site and exudation of fibrin- rich plasma initiates the migration of phagocytic cells to the area of injury
  30.  Hematoma  Liquid to semisolid clot  Time 1 – 3 days  Stabilize  Necrosis due to decrease blood supply  Collateral circulation begins  Vascular dilation occurs  Phagocytic cells migrate to the area
  31.  During this stage, active phagocytosis absorbs the products of local necrosis.  The hematoma converts to granulation tissue.  Granulation tissue (consist of new blood vessels, fibroblasts(type of cell that synthesizes the extracellular matrix and collagen) and osteoblasts) produces the basis for new bone substance called osteoid during 3 to 14 days post injury
  32.  As minerals (calcium, phosphorus and magnesium and new bone matrix) are deposited in the osteoid, an unorganized network of bone is formed that is woven about the fracture parts  Granulation tissue matrix will convert into callus  Callus is primarily composed of cartilage, osteoblasts, calcium and phosphorus  Duration - 2 to 6 weeks  Proper alignment is essential during this stage by traction or cast  Callus formation can be verified by x-ray
  33.  Bone develops in this stage – osteogenisis  Ossification of callus occurs from 3 weeks to 6 months after the fracture and continuous until the fracture has healed.  Callus ossification is sufficient to prevent movement at the fracture site when the bones are gently stressed  Patient can be converted from skeletal traction to cast or the cast can be removed to allow limited mobility.
  34.  As callus continuous to develop, the distance between bone fragments diminishes and eventually closes.  This stage is called consolidation and ossification continues  6 to 8 months
  35.  Excess bone tissue is re absorbed in the final stage of bone healing and union is completed  Gradual return of the injured bone to its pre injury structural strength and shape occurs  Bone remodel in response to physical stress  Initially stress is provided through exercise  8 months to 1 year
  36. Favorable factors  Location – good blood supply at the bone ends, flat bones  Minimal damage to soft tissue  Anatomic reduction possible  Effective immobilization  Weight – bearing on long bone  Proper nutrition  Hormone functioning – growth hormone, thyroid, calcitonin and vitamin d
  37. Unfavorable factors  Fragments widely separated  Fragments distracted by traction  Severe communited fracture  Severe damage to soft tissue  Bone loss from injury or surgical excision  Motion/rotation at fracture site as a result of inadequate fixation  Infection  Impaired blood supply to one or more bone fragments  Location – decreased blood supply, mid shaft  Smoking and alcoholism  Poor nutrition
  38.  Drugs – corticosteroids inhibit the repair  Age – elderly persons heal more slowly  Intra articular fracture  Avascular necrosis  Metaboilic bone diseases  Local malignancy
  39.  Deformity – due to loss of bone continuity. Deformity is the cardinal sign of fracture.  Edema or Swelling – due to accumulation of serous fluid at the fracture site and extravasations of blood into the surrounding tissue  Bruising ( Ecchymosis) – due to subcutaneous bleeding at the fracture site  Muscle spasm can cause limb shortening  Pain – continuous pain due to spasm, overriding of fracture fragments or damage to the adjacent structure  Tenderness
  40.  Loss of function – result from pain and discontinuity. Paralysis may cause due to nerve damage.  Neurovascular changes – due to damage to peripheral nerves or the associated vascular structure. Tingling or no palpable pulsed distal to the fracture  Shock – frank and occult hemorrhage can lead to shock  Crepitation – grating sound occurs if limb is moved gently. Testing for crepitus can produce further tissue damage so should minimized as much as possible
  41.  Warmth over injured area resulting from increased blood flow to the area  Impairment or loss of sensation or paralysis in affected area  Evidence of fracture on x-ray film
  42.  History collection  Physical examination  x ray  CT scan
  43. Goals:  Assessment of injury  Emergency management  Reduction and stabilization of fracture  Monitoring complications  Eventual remobilization & rehabilitation  Pharmacological management and nutritional supplementation
  44. A. Thorough initial assessment:  Assess the cause of fracture, type of fracture and the severity of fracture  Assess early complication: Arterial damage (Pain, pallor, paresthesia, Absent pulse, Poor capillary refill, cyanosis)
  45. Neurovascular assessment  Color and temperature  cyanotic and cool/cold: arterial insufficiency  cyanotic and warm: venous insufficiency  Capillary refill  Peripheral pulses (↓ indicates vascular insufficiency)  Check for Edema, Sensation, Motor function, Pain
  46. B. EMERGENCY MANAGEMENT OF FRACTURES • 1. Immobilize any suspected fracture. • 2. Support the extremity above and below when moving. Assess color, warmth, circulation and movement. • 3. Suggested temporary splints: hard board, stick, rolled sheets.
  47. • 4. Apply sling if forearm fracture is suspected or the suspected fractured arm maybe bandaged to the chest. If the fractured extremity is leg bone, the unaffected extremity can be used as a splint by bandaging both legs together. • 5. Open fracture is managed by covering it with clean/sterile gauze to prevent contamination
  48.  6. DO NOT attempt to straighten or realign or reduce a fractured extremity. Move the affected limb as little as necessary  7.Elevate the injured part to decrease edema  8.Apply cold packs to reduce hemorrhage , edema and pain
  49. C.FRACTURE REDUCTION/ BONE SETTING: Reduction - It is refers to restoration of the fracture fragments to its actual anatomic alignment a. Closed reduction b. Open reduction
  50.  it is a non surgical, manual realignment of bone fragments to their previous anatomic position  The extremity is held in the desired position while the physician applies a cast, splint or other device  Traction and counter traction are manually applied to the bone fragments (to restore position, length and alignment) for immobilization and fracture reduction.
  51.  It is usually performed under LA or GA.  X-ray is obtained to verify that the bone fragments are correctly aligned.
  52.  The surgeon makes an incision and realigns the fracture fragments under direct visualization.  It is treatment of choice for compound fracture or accompanied by severe neurovascular injury  Open reduction is usually performed in combination with internal fixation for femoral and joint fractures  Screws, plates, pins, wires, rods or nails may be used to maintain alignment of fracture fragments.
  53.  Before the surgery patient will get a course of prophylactic intravenous antibiotics  Internal fixation devices are biologically inert metal devices (stainless steel, vitallium or titanium) Variety of internal fixation devices are available  Plates and nails  Intramedullary rods  Transfixation screws  Prosthetic implants ex- femur head, hip prosthesis etc
  54.  External fixation is a metallic device composed of metal pins that are inserted in to bone and attached to external rod to stabilize the fracture while it heals  It is used for immobilization  It maintain position for unstable fracture and for weakened muscles  Common sites – face and jaw, extremities, pelvis, ribs, fingers and toes
  55. PLASTER CAST • Rigid immobilizing device made of plaster of Paris or fiberglass • Provides immobilization of the fracture, to correct a deformity, to apply uniform pressure, to support and stabilize
  56. Purposes 1. TO immobilize a body part in a specific position. 2. TO exert uniform compression to the tissue. 3. TO provide early mobilization of UNAFFECTED body part. 4. TO correct deformities. 5. TO stabilize and support unstable joints
  57. Nursing Management Cast types: 1. Long arm 2. Short arm 3. ARM cylindrical cast and leg cylindrical cast 4. Short leg 5. Long leg 6. Hip Spica 7. Body cast 8. Sugar tong 9. Posterior sling cast
  58.  Short arm cast – extends from below the elbow to the palmar crease, secured around of the thumb.  If thumb is included, it is known as a thumb spica or gauntlet cast.  Long arm cast – extends from the axillary fold to the proximal palmar crease. The elbow usually is immobilized at a right angle.  Short leg cast – extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position  Long leg cast – extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.  Body cast – it encircles the trunk  Hip spica cast – encloses the trunk and lower extremity
  59. Casting Materials • Plaster of Paris Takes 1-3 days to dry completely.. Material of choice for primary casting. Moldable, economic, familiar to surgeons. Easy to reinforce and remove. Rarely cause skin irritation. Not water resistant. Relatively heavy May break down around a walking heel. Repairs are difficult.
  60. • Fiberglass  Lighter in weight  dries in 20-30 minutes.  Water resistant  Stronger & more durable than plaster cast  Easy to apply.  No need to remove during radiographic procedures.  More expensive in cost per roll.  Considered less moldable than plaster.  Can’t be reheated and remolded.  Patient may be allergic to material
  61. Thermoplastics  Comfortable, lightweight, strong, durable.  Easy to remove  Water-resistant and permeable.  Can be reheated for additional molding.  Don’t require padding.  Not as comfortable as plaster or fiberglass.  cost is higher.
  62. Procedure  Preparation for casting  Explanation of procedure  Skin preparation  Apply stockinette over padding  Casting material submerged in water  Squeeze excess water, apply on injured part  It is composed of unhydro calcium sulfate embedded in gauze.  As the cast dries a thermo chemical reaction occurs in which the calcium sulfate recrystallizes and hardens with in 15 min  Finger tips should not pressed into cast  A fresh cast should never cover with blanket because air cannot circulate and heat builds up in the cast
  63. Nursing Management • 1. Allow the cast to air dry (usually 24-72 hours) • 2. Handle a wet cast with the PALMS not the fingertips to avoid dents.
  64. Nursing Management • 3. Keep the casted extremity ELEVATED using a pillow to reduce swelling. • 4. Turn the extremity for equal drying. DO NOT USE DRYER for plaster cast – Encourage mobility and range of motion exercises
  65. Nursing Management • 5. Petal the edges of the cast to prevent crumbling of the edges. • 6. Examine the skin for pressure areas and Regularly check the pulses and skin color.
  66. Nursing Management • 7. Instruct the patient not to place sticks or small objects inside the cast. • 8. Monitor for the following: pain, swelling, discoloration, coolness, tingling or lack of sensation and diminished pulses. • 9.Hot spots (progressively painful areas) occurring along the cast may indicate infection under the cast
  67. Windowing or Bivalving a cast  Cutting the cast along both sides & splitting to decrease pressure  To visualize wounds under cast/remove drain  Allow pulse assessment  For wound care: Remove half of the cast Neuro vascular assessment:  Extremity: color, warmth, pulse distal to cast, capillary refill( Circulatory function)  Movement of distal finger/toes, light touch, sensation ( Nerve function)  N.V assessment every 30mts for 4hrs.after cast application
  68.  Cast material water resistance varies: - Plaster casts are not water resistant. - Synthetic casts are but undercast material in not. - Thermoplastic casts are and have no undercast material.
  69.  Application of a pulling force to an injured body part or extremity while a counter traction pulls in the opposite direction Purpose:  Reduce, realign & promote healing of fracture  Decrease muscle spasm  Prevent soft tissue damage  Prevent or treat deformity  Rest an inflamed or painful joint  Reduce & treat dislocation  Prevent contracture
  70. Based on principle Fixed traction Sliding traction
  71.  Traction is applied to the leg against a fixed point of counter pressure.
  72.  When the weight of all or part of the body, acting under the influence of gravity, is utilized to provide counter-traction.
  73.  Exact weight required is determined by trial.  For the fracture of femoral shaft an initial weight of 10% of body weight  Foot end is elevated so that the body slides in opposite direction.  1 inch (2.5 cm) for each 1 lb (0.46 kg) of traction weight
  74. Skin traction Skeletal Traction
  75.  Traction force is applied over a large area of skin  Applied over limb distal to fracture site  Used for Short term treatment (48 to 72 hrs)  Tapes, boots or splints are applied directly to the skin and maintain alignment, assist in reduction and to help diminish muscle spasm in the injured extremity  Traction weight – 5-10 Ib (2.3 – 4.5KG)
  76.  Buck’s Traction  Hamilton Russel Traction  Gallow’s or Brayant’s Traction  Modified Brayan’s Traction  Pelvic Traction  Dunlop Traction
  77.  A foam boot is applied to client’s affected limb & attached to weight that is suspended off the foot of the bed. Used for fracture femur, knee or back.  Can be used unilaterally or bilaterally.  Check every 4th hourly for decreased peripheral vascular flow, peroneal nerve deficit, pressure necrosis and allergic reaction towards adhesive material
  78.  Used for fracture of hip or femur  A broad soft sling is placed under the knee
  79.  the treatment of fracture shaft femur in children up to age of 2 yrs.  Weight of child should be less than 15- 18 kg
  80.  Sometimes used as a initial management of developmental dysplasia of hip (1 YR)  After 5 days of Bryant’s traction, abduction of both hips is begun increased by about 10 degree alternate days.  By three weeks hips should be fully abducted.
  81.  Used for conservative management of IVDP  The amount by which foot end should be elevated depends upon patient’s weight , more heavy the patient, more should be elevation.
  82.  USED IN fracture of humerus  Useful when flexion of elbow causes circulatory embarrassment with loss of radial pulse  Apply skin traction to forearm  Abduct shoulder about 45 degree  the elbow is flexed 45 degree.
  83. COMPLICATIONS  Allergic reactions to adhesives.  Excoriation of skin.  Pressure sores over bony prominences.  Common nerve palsy.
  84.  Using pin or wire  7-15 pounds/ 2.3-20.4 kg  more frequently used in lower limb fractures  Should be used for those cases in which skin traction is insufficient.  Generally used when more weight is needed to give traction.  To treat fractures conservatively.
  85. SITES  Upper tibial  Lower femoral  Lower tibial  Calcaneus  Olecrenon  Metacarpel
  86.  Lateral or Upper Femoral Traction  Nintey / Nintey traction  Olecrenone traction  Perkin’s Traction
  87. For the management of central fracture dislocation of the hip Attach weight upto 9 kgs Traction to continued for about 4-6 wks
  88.  Used for fracture proximal third of the shaft of the femur  Traction is given through lower femoral pin, which is more efficient, or by upper tibial pin.
  89. COMPLICATIONS  Infection  Distraction at fracture site  Physical damage  Nerve Injury
  90.  Used for the fracture of tibia or femur.  Skeletal traction is usually applied, but skin traction can be given b/k.
  91.  SKIN TRACTION Head Halter traction  SKELETAL TRACTION Crutchfield tongs Cone or Barton tongs
  92.  Simple type cervical traction  Management of neck pain  Weight should not exceed 3 kg initially  Can only be used a few hours at a time  Head end should be elevated to give counter traction
  93.  Must incise skin and drill cortex to place  Rotate metal traction loop so touches skull in midsagittal plane  Place at the line connecting tips of mastoid processes on both sides.
  94. Nursing Management • 1. ALWAYS ensure that the weights hang freely and do not touch the floor. • 2. NEVER remove the weights without doctors order • 3. Maintain proper body alignment. • 4. Ensure that the pulleys and ropes are properly functioning and fastened by tying square knot.
  95. • 5. Observe and prevent foot drop – Provide foot plate • 6. Observe for DVT, skin irritation & breakdown. • 7. Provide pin site care for clients in skeletal traction- use of chlorhexidine is the most effective, normal saline can be used also.
  96. 8. Promote skin integrity – Use special mattress if possible – Provide frequent skin care – Assess pin entrance and cleanse the pin with chlorhexidine solution – Turn and reposition within the limits of traction
  97. Care of Client in Traction Temperature extremity infection Ropes hang freely Alignment Circulation Checks Type & location of Fx Increase fluid intake Overhead Trapeze No weights on bed or floor
  98. 1. Patient education:  Explain procedure of traction, purpose  Explain amount of movement permitted  Explain how to maintain correct body positioning 2. Instructions to maintain traction:  Check traction equipment every shift and as needed: - Traction codes aligned in each pulley - Cords not stretched - Knots tied tightly & secured with tape - Cords hanging free of bed & floor - Weights hanging free of bed & floor - Correct number of weights hanging - Overhead frame & bars are intact - Bed linen not interfering with the line of traction  Maintain correct body alignment & proper bed position for counter traction, if indicated
  99.  Do not lift weights without a specific order  Check weights after position change  Assess client for secondary complications of immobility such as thrombophlebitis, constipation, atelectasis, skin breakdown, urinary problems  Inspect pin entry/ exit sites for redness, swelling, odour, bleeding, discharge  Perform pinsite care twice a day as ordered  Assess neurovascular comprise, pain, skin breakdown, nutrition deficit, signs of infection
  100.  Dietary supplements according to nutritional status  Small, frequent meals  Fracture bedpan, provide privacy  Stool softners & laxatives  Exercise unaffected joints regularly  If slings are used, inspect skin area regularly  Avoid wrinkling of bed sheets
  101.  Pin site care:  Regular removal of exudates with hydrogen peroxide  Rinse pin site with saline  Dry with sterile gauze  Deep breathing exercises 3. Maintain skin integrity:  Turn slightly from side to side  Prevent friction & strain over skin  Inspect skin for contusion
  102. 4. Drug Therapy  Central & peripheral muscle relaxants Eg: Cyclobenzaprine  Open fracture: Tetanus & Diptheria toxoid/ Tetanus immunoglobulin  Bone penetrating antibiotics. Eg: Cephalosporin 5. Nutritional Therapy  Diet: Protein: 1g/kg body wt. Vitamins B,C,D Calcium,phosphorous,magnesium Fluids, Fiber
  103. 1. Nerve injury 2. Infection 3. Compartment syndrome 4. Volkmann’s contracture 5. Fat embolism syndrome (FES) 6. Deep vein thrombosis and pulmonary embolism 7. Cast syndrome 8. Traumatic or hypovolemic shock
  104.  Bone fragments and tissue edema associated with injury can cause nerve damage Check for:-  pallor and coolness of the affected extremity  changes in the client's ability to move the digits or the extremity,  paresthesia or complaints of increased pain.
  105.  Open fracture and soft tissue injuries have a high incidence of infection  Devitalized and contaminated tissue is an ideal medium for many common pathogens.  Management – open fracture requires aggressive surgical debridement, wound irrigation and mechanical removal of contaminants.  Closed suction drainage and skin grafting may be needed  Some time irrigation with antibiotic solution  Antibiotic impregnated beads may be placed in the surgical site  IV ANTIBIOTICS for 3-7 days.
  106. COMPARTMENT SYNDROME:  It is a Condition in which elevated intra compartmental pressure within a confined myofascial compartment and compromises the neuro vascular function of tissues within that space.  Causes  Decreased compartment size: restrictive dressing, splints, cast, excess traction  Increased compartment content: bleeding, edema, IV infiltration
  107.  Due to soft tissue injury  Edema occurs  Elevate compartment pressure  This will obstruct circulation and cause venous occlusion  Ischemia  Muscle and nerve cells are destroyed overtime  Fibrotic tissue replacement  Contractures, disability and loss of function
  109. Diagnosis:  Neurovascular assessment  Myoglobinurea – dark reddish brown urine – myoglobin released from damaged muscle cells can be trapped in renal tubules because of its high molecular weight  Treatment:  Prevention and early recognition  Do not apply cold application  Remove constrictive bandage  Reduce weight in traction
  110.  Bivalve the cast  Shouldn’t elevate the extremity above heart level: Increase venous pressure, Decrease blood flow  Hydration  Pain management  Surgical decompression - Fasciotomy: Incision through skin into muscle compartment
  111. VOLKMAN’S CONTRACTURE:  Limb deformity resulting from unrelieved compartment syndrome  pressure- muscle replaced by fibrous tissue  Deformed foot, stiff claw like deformity
  112.  Prolonged pressure causes ischemia  Muscle is gradually replaced by fibrous tissue that traps tendon and nerves  Result in contracture, disability and loss of function  Commonly occurs after fracture of the elbow and forearm or after crushing injuries of the forearm or it is caused by tight bandage or casts  Contractures can be avoided through prompt recognition of manifestation of compartment syndrome followed by limb splinting and compartment decompression.
  113. FAT EMBOLISM SYNDROME:  Presence of fat globules in tissues & organs  Occur in fracture long bones, ribs, pelvis, joint replacement etc.
  114. Mechanical theory  Fat is released from the marrow of injured bone  Travel to pulmonary capillaries  Enter to the systemic circulation  Embolization to other organs
  115. Biochemical theory  Catecholamines released at the time of trauma  Mobilize free fatty acids from the adipose tissue  Causing loss of chylomicron emulsion stability  Chylomicrons form large fat globules  Lodges in the tissues of lungs, brain, heart and kidney
  116.  C/f: 12-72 hrs after injury  lungs: s/s of ARDS: chest pain, tachypnoea, tachycardia, dyspnoea, restlessnes, confusion Changes in mental status Memory loss, restlessness, confusion, elevated temperature and headache, Changes in level of consciousness
  117.  Diagnosis: Blood, urine, sputum, pao2 < 60 mm of Hg, ST changes, X-ray chest  Treatment: Immobilization of a long bone fracture, splint, symptom related, fluid resuscitation, Oxygen, intubation, blood transfusion
  118. DEEP VEIN THROMBOSIS & PULMONARY EMBOLISM  Stasis of blood flow in veins, increased coagulability & injury to vessels  Prolonged immobility/bed rest- stasis  Prevention: Oral anticoagulant, SC low molecular weight heparin, Elastic stockings
  119. CAST SYNDROME/ SUPERIOR MESENTERIC ARTERY SYNDROME:  Occur in body spica cast  Duodenum is compressed between superior mesenteric artery & aorta and vertebral bodies causing decreased blood supply leads to hemorrhage & necrosis of bowel  Develop days- weeks after immobilization
  120.  s/s – dilated stomach, severe abdominal pain, severe back pain, persistent vomiting
  121. 1. Joint stiffness or post traumatic arthritis 2. Avascular necrosis (AVN) 3. Nonfunctional union  Delayed union  Non union  Fibrous union  Malunion 4. Complex regional pain syndrome and disuse
  122. LONG TERM COMPLICATIONS OF FRACTURE: 1. Joint stiffness/ traumatic arthritis:  Occur after injury/prolong immobilization  Leads to joint contracture  Need active & passive ROM  NSAID
  123. 2. Avascular necrosis:  Due to local circulatory compromise  Usually seen on femoral head  Need replacement of femoral head with prosthesis
  124. 3. Nonfunctional union: Malunion:  Results when fracture fragments heal in improper alignment  Occur if client bears weight on affected extremity  Corrected with adjustment of traction or surgical correction Nonunion:  Occurs when fracture healing not occurred 4-6 months after injury  Cause: Insufficient blood supply, stress, excess traction, infection, inadequate immobilization
  125.  X-ray: Gap between fracture fragments  Treatment: Bone grafting, internal/external fixation, electronic bone stimulation.
  126. Delayed union:  Occurs when healing is slowed but not completely stopped  c/f: Increase in bone pain & tenderness Fibrous union:  Fibrous tissue interposed in wide gap between fracture fragments  Cause – loss of bone through surgery or injury  Need additional surgical fixation
  127. 4. Complex regional Pain Syndrome(CRPS):  Painful dysfunction characterized by abnormal pain & swelling of affected extremity  Disorder of central/peripheral nervous system  Treatment: Steroids, analgesics, muscle relaxants, physical therapy, rom exercises, avoid taking blood pressure or performing venipuncture in the affected extremity
  128.  Risk for peripheral neurovascular dysfunction  Acute pain  Risk for infection
  129.  Risk for impaired skin integrity  Impaired physical mobility  Ineffective therapeutic regimen management