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Fractures (Types of fractures (Transverse (broken across shaft of bone…
Fractures
Types of fractures
Transverse
broken across shaft of bone (Fields, K.B (2016)
Oblique
angle across shaft of bone (Fields, K.B (2016)
Open
broken bone with break in skin (Fields, K.B (2016)
Greenstick
one side of bone is broken and other side is bent (Fields, K.B (2016)
Spiral
twists around shaft of bone (Fields, K.B (2016)
Comminuted
splintered into several fragments Fields, K.B (2016)
Impacted
pressure to another bone (Fields, K.B (2016)
Linear (stress)
repeated loading of bone and muscles , very thin break (Fields, K.B (2016)
Diagnostics
X-ray
CT Scan
MRI
MRI
is identified to be the most sensitive and specific image test in diagnosing a stress fracture to the lower extremities. (Wright, A. A., Hegedus, E. J., Lenchik, L., Kuhn, K. J., Santiago, L., & Smoliga, J. M. (2016)
Coagulation Profile
CBC
Urine Creatinine
H&P
Clinical Manifestations
Loss of function
(Hinkle & Cheever 2018)
Deformity
( Hinkle & cheever 2018)
Pain
(Hinkle & cheever 2018)
Crepitus
(Hinkle & cheever 2018)
Local Edema & Ecchymosis
(Hinkle & cheever 2018)
Shortening
(Hinkle & cheever 2018)
Management
Medical Management
Reduction
Closed
Cast
Pinning
Traction
Splint
Open
Internal fixation devices- metallic pins, wires, screws, plates, nails,or rods
Nursing Management
monitor for signs and symptoms of infection
keep the incision clean and change the dressing as needed (if dressing dirty clean and change the dressing)
asses for compartment syndrome
elevate the extremity if not contraindicated to reduce edema
demonstrate the use of mobility aid aids and any assistive device that they may need
educate the patient on wound care of the incision or pin if they are discharged home
teach pt ROM exercise of the unaffected extremity to prevent DVTs and have pt use of SED if ordered
administer pain medication as needed and nonpharmacological treatment for the patient
if the patient has surgery teach turn and cough technique preoperatively and reinforce teaching postoperatively
encourage pt use incentive spirometry to help release the gas that accumulates in the body during surgery and later causing the patient discomfort
monitor for skin integrity and pressure ulcers (have an air mattress if appropriate for the patient)
medications
ibuprofen
morphine
diazepam
arixtra
cefazolin
aspirin
oxycodone
Etiology
Indirect trauma: involves forces acting at a distance from the fracture site such as tension (traction), compressive, and rotational force
Direct trauma:consists of direct force applied to the bone
Direct mechanisms include tapping fractures (eg, bumper injury), penetrating fractures (eg, gunshot wound), and crush fractures
(Hinkle &Cheever 2018)
Occur when the force applied to a bone exceeds the strength of the involved bone
Both intrinsic + extrinsic factors are important. (Hinkle & Cheever2018)
Pathophysiology
Insufficiency fracture: fracture on a weakened bone
A normal load is present upon a weakened bone in conditions such as osteoporosis, rheumatoid arthritis, irradiation, corticosteroid therapy, etc.
↓
Bone elasticity is compromised due to diseased state
↓
Imbalance in bone resorption vs bone formation causes fracture under normal conditions
(Matcuk et al., 2016)
Fatigue fracture: fracture on a normal bone
An abnormal load is present on a normal bone
↓
The bone begins to deform through the bone's elastic range
↓
Stress beyond the elastic range creates micro-fractures
↓
Micro-fractures coalesce into a discontinuity within the bone creating a fracture
(Matcuk et al., 2016)
Incidences
Fractures are common in the aged population, and the incidence of most types of fracture is associated with increasing age and the Gender. Only a minority of fractures are caused by extremely serious accidents (Hinkle & cheever 2018)
Most fractures occur in people older than age 65 (9 of 10) and in females (3 of 4).
White women are affected twice as often as black and Hispanic women. (Hinkle & Cheever 2018)
Risk Factors
Traumatic injury, commonly caused by
falls
, motor vehicle accidents, penetrating injuries, and
Age (most common cause)
Bone-weakening conditions, such as osteoporosis, bone tumors,(cancer metastasis) and metabolic diseases, such as hypoparathyroidism, hyperparathyroidism, and Paget disease (
pathologic fractures)
Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarths textbook of medical- surgical nursing. Philadelphia: Wolters Kluwer.
“Lippincott Advisor for Education.” Lippincott Advisor for Education, advisor- edu.lww.com/
Fields, K. B. Overview of tibial fractures in adults. (2016). In: UpToDate, Eiff, P. (Ed.).
Lewis,S.L.,Dirksen,S.R.,Heitkemper,M.M., Bucher,L.,Harding,M.M., (2017) Medical Surgical Nursing Assessment and Management of Clinical Problems.
Matcuk G, Mahanty S, Skalski M, et al. Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options. Emergency Radiology. 2016;23(4):365-375. doi:10.1007/s10140-016-1390-5.
Wright, A. A., Hegedus, E. J., Lenchik, L., Kuhn, K. J., Santiago, L., & Smoliga, J. M. (2016). Diagnostic Accuracy of Various Imaging Modalities for Suspected Lower Extremity Stress Fractures: A Systematic Review With Evidence-Based Recommendations for Clinical Practice. The American Journal of Sports Medicine, 44(1), 255–263.
https://doi.org/10.1177/0363546515574066
Daniachi D, Netto AdosS, Ono NK, Guimarães RP, Polesello GC, Honda EK. Epidemiology of fractures of the proximal third of the femur in elderly patients. Rev Bras Ortop 2015; 50 (04) 371-377
References
