Management of fracture

Mgt of #

TOPIC FRACTURES OF LOWER LIMBPRESENTED BY : -- AKRAM KHAN M.SC. NURSING 1ST YEAR(2015)

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206BONES

FRACTUREA fracture is the separation of an object or material into twoor more pieces under action of stress.

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BONE FRACTUREIs a medical condition in whichthere is a break in the continuityof the bone resulted from highforce impact or stress, or trivialinjury as a result of certain medical conditions that weakenthe bones.

TYPES OF FRACTURE

the break may have been felt or heardpain at or near the site of the injurydifficult or impossible normal movement of the limbloss of powerdeformity, abnormal twist or shortening of limbtenderness when gentle pressure is appliedswelling over the fracture, and possibly around ita coarse grating sound if one end of the bone moves against the other. Never actively seek this sign as further injury may result.

Signs and symptoms

Age Female (drop of estrogen) Bone disease Smoking Malnutrition Lack of exercise or physical activity Steroid user

RISK FACTORS

Diagnostic Studies for FractureX-ray examinations:- location and extent of fractures/trauma, may reveal pre-existing and yet undiagnosed fracture(s).Bone scans, tomograms, computed tomography (CT)/magnetic resonance imaging (MRI) scans:Visualizes fractures, bleeding, and soft-tissue damage; differentiates between stress/trauma fractures and bone neoplasms.Arteriograms:May be done when occult vascular damage is suspected.Complete blood count (CBC):Hematocrit (Hct) (signifying hemorrhage at the fracture site or at distant organs in multiple trauma). Increased white blood cell (WBC) count is a normal stress response after trauma.Urine creatinine (Cr) clearance:Muscle trauma increases load of Cr for renal clearance.Coagulation profile:Alterations may occur because of blood loss, multiple transfusions, or liver injury.

Management of FRACTURE

First aid immobilizationControl hemorrhage Control pain morphine -- Care of wounds

RICE Rest Ice Compression Elevation

Principle Of Treatment of #

Outline

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Reduction

Closed reductionSuitable forMinimally displaced fracturesMost fractures in childrenFractures that are likely to be stable after reductionMost effective when the periosteum and muscles on one side of fracture remain intactUnder anesthesia and muscle relaxation, a threefold maneuver applied:

Preparing pat/family.. Pre-post care

Hold

HOLD

To prevent displacementTo promote soft-tissue healing

To alleviate pain by some restriction of movement

To allow free movement of the unaffected parts

Traction Traction is applied to limb distal to the fractureTo exert continuous pull along the long axis of the boneIndications spiral fractures of long bone shafts:Shaft of femurTibiaLower humerusMethodsTraction by gravityBalanced tractionFixed traction

Mechanical Traction Some fractures (eg . fracture of femoral shaft) are difficult to reduce by manipulation because of powerful muscle pullHowever, they can be reduced by sustained muscle mechanical traction; also serves to hold the fracture until it starts to unite

Traction by Gravity

Thomas Splint

Cast Splintage

POPFiber Glass3-D Cortex casts (Polimer)Velcro bandage

INTERNAL FIXATION

Indication

Depending on site and type of # the fixation is used ----Plate & screws long bonesLocking plate Comminuted osteoporotic #Intramedullary nail- Long bone -- # near the middle of shaft Compression screw plate - # neck of femur, femur headTrans fixation of screws small detached fragments Krischner wire bony fragments of # of small bones in hand /footTension band wiring patella or olecranon ,,,,metaphyseal

Metals used ---- non corrosive ---Chromium, nickel, molybdenum , alloy of chromium, molybdenum and nickel , Titanium

Advantages

InfectionRisk of infection depends on:1)The patient devitalized tissue, dirty wound, unfit patient2)The surgeon thorough training, surgical dexterity and adequate assistant are all essential3)The facilities aseptic routineThe infection should be rapidly controlled by intravenous antibioticIf infection cannot be controlled, the implant should be replaced with some form of external fixation

NON-UNION

Factors associated with the occurrence of delayed union and nonunion the severity of the fracture, the location of the fracture,the nature of the blood supply to the bone, the extent of soft tissue damage and its interposition, bone loss,air contact contamination, whether a tumor is involved

Systemic factors for delayed or nonunionsmoking, alcoholism, age,chronic illness (e.g. diabetes mellitus),malnutrition, use of medications (e.g. NSAIDs and steroidsNonunion may increase due to the treatment itself involving :inadequate reduction,poor stabilization,distraction, damage to the blood supply, or postoperative infection.

EXTERNAL FIXATION

Fracture with soft tissue involvementSevere comminuted and unstable # Fracture of pelvis # with nerve and vascular involvementInfected #United #

Advantages

Management of Open FracturesA break in skin and underlying soft tissues leading directly to communicating with the fracture

Treatment- Outline

Open # : Fracture Stabilization

Aftercare

COMPLICATION OF FRACTURE

General ComplicationsShockDiffuse coagulopathyRespiratory dysfunctionCrush syndromeVenous thrombosis & Pulmonary embolismFat embolismTetanus

Nurses responsibilities ?????

Closed Fracture First Aid --- Immediate initial Airway, Breathing and CirculationSplint the fracture Look for other associated injuriesCheck distal circulation is distal circulation satisfactory? Check neurology are the nerve intact? AMPLE history- Allergies, Medications, Past medical history, Last meal, Events Radiographs 2 views, 2sides, 2 joints, 2 times.

What about......... Nursing responsibilities.??

THANK YOU ALL .