FRACTUREBreak in the continuity of the bone. When force is
applied that exceeds the tensile strength or compressive strength
of the bone.
TYPESClosed (simple) The bone is broken, but the skin is not
lacerated.Open (compound) If the skin is open. The bone may or may
not be visible in the wound.
CLINICAL MANIFESTATION
Local Swelling Loss of function or abnormal movement of affected
part Deformities such as shortening, rotation Crepitation Pain/
local tenderness Anesthesia and flaccidity (few minute to hrs) -
This is due to a temporary loss of nerve function at the site
associated vascular injury.
COMPLICATIONS Osteomyelitis The open area is a rich culture
medium for infection. It retards healing by destroying newly formed
bone and interrupting its blood supply. S. aureus is the usual
cause. Osteomyelitis The open area is a rich culture medium for
infection. It retards healing by destroying newly formed bone and
interrupting its blood supply. Delayed union Increased healing
time; may result from a breakdown in the early stages of healing
which may occur from Inadequate immobilization, breakdown in
hematoma formation or poor alignment.
Nonunion fragments fail to unite over a 5-month period. May be
due to varying factors like: health, degree of trauma, underlying
disease, infection and movement. Infection causes continuous
bleeding and breakdown of osteoid matrix. Movement causes repeated
bleeding and decalcification at the fragmented ends
Malunion union of the fragments in an abnormal position that may
modify function. Internal Bleeding - (Usually from closed Fx) The
bleeding may occur from the bone itself or from surrounding soft
tissues. Embolism Fat Embolism -Fractures of long bones may release
enough fat (and other substances in bone marrow) to travel through
the veins, they attract platelets which become part of the
microembolus and deplete circulating platelets. Pulmonary
EmbolismOsteoarthritis - Fractures that extend into joints usually
damage cartilage (a smooth, tough, protective tissue that reduces
friction as joints move). Damaged cartilage tends to scar, causing
osteoarthritis and impairing motion in the joints.Nerve Damage -
Bone fragments may rupture and compress nerves that may also be
damaged by dislocation or direct trauma Embolism Fat &
Pulmonary Embolism Fractures of long bones may release enough fat
to travel through the veins, they attract platelets which become
part of the microembolus and deplete circulating platelets Nerve
Damage - Bone fragments may rupture and compress nerves that may
also be damaged by dislocation or direct trauma
Subluxation if the contact bone between the opposing bone
surface is partially lost.
Dislocation temporary displacement of one or more bones in a
joint in which the opposing bone surface loss contact entirely.
Myoglobinuria (Rrabdomyolysis) Severe muscle trauma. An excess
myoglobin (intracellular muscle protein) in the urine. Muscles
damage, with disruption of sarcolemma, releases myoglobin which
would lead to renal failure
COMPARTMENT SYNDROME - Pressure build within the compartment due
to bleeding.- swelling reaches the point at which the fascia
permits no outward enlargement - increasing pressure is directed
inward and compresses components in the compartments.
NURSING DIAGNOSIS
1. Acute pain r/t stimulation of free nerve endings 2 to soft
tissue injury. 2. Risks for peripheral neurovascular dysfunction
r/t reduction/interruption of blood flow. 3. Impaired Gas Exchange
r/t altered blood flow/fat emboli. 4. Impaired physical mobility
r/t skeletal instability 2 to physical trauma. 5. Impaired Tissue
integrity r/t insertion of traction pins wires and screw/ physical
immobilization 6. Situational low Self Esteem r/t loss of body
parts/ change in functional abilities. 7. Ineffective peripheral
tissue perfusion r/t reduced arterial venous blood flow; tissue
edema; hematoma formation.
DIAGNOSTIC TESTRadiologic exam- to determine location extent of
fracture/trauma; may reveal preexisting undiagnosed fracture. Bone
scan, tomograms, CT, MRI scan Visualized fractures, bleeding and
soft tissue damage. May be prepared for diagnostic tool because of
superior ability to image some types of injuries. Arteriogram May
be done when occult vascular damage is suspected. Urine creatinine
clearance - Muscle trauma increases load of Cr for renal clearance.
Creatinine level and urea nitrogen level should be analyzed when
renal function is elevated. NORMAL VALUE .6-1.3 mg/dLBlood Urea
Nitrogen - Urea normally freely filtered through renal glomeruli,
small amount reabsorbed in the tubule and the remainder excreted in
the urine. -NORMAL VALUE 8-25 mg/dlBlood Urea Nitrogen - Urea
normally freely filtered through renal glomeruli, small amount
reabsorbed in the tubule and the remainder excreted in the urine.
-NORMAL VALUE 8-25 mg/dlHemoglobin - main component of erythrocyte
& serve as the vehicle for transportation of O2 and CO2. -
NORMAL VALUES Male: 14-16.5 g/dL Female: 12-15 g/dLHematocrit -
Determinations are important in identifying anemia. - Fasting is
not required. - NORMAL VALUES - Male: 42%-52% Female: 35%-47%WBC-
Immune defense system of the body.- Cell count assess each
leukocytes distribution.- increase WBC, normal response to
trauma.NORMAL VALUE 4,500 11, 000 cells/L
activated Partial Thromboplastin Time (aPTT) - Test screens
deficiencies & inhibitors of all factors except factor VII
& XIII. - Screen for coagulation disorders. - NORMAL VALUE
20-36 seconds
Prothrombin Time (PT) - Measures the amount of time it takes for
clot formation - within 2 sec (+ or - ) of the control is
considered normal.NORMAL VALUES - Male: 9.6 -11.8 seconds Female:
9.5 -11.3 seconds PT > 30 seconds at risk for HEMORRHAGE
