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BONE INJURIES - Coggle Diagram
BONE INJURIES
Nursing Implementation
Maintain bed rest or limb rest as indicated. Provide support of joints above and below the fracture site, especially when moving and turning.
- Secure a bed board under the mattress or place the patient on the orthopedic bed.
- Support fracture site with pillows or folded blankets. Maintain a neutral position of the affected part with sandbags, splints, trochanter roll, footboard.
Prevents unnecessary movement and disruption of alignment. Proper placement of pillows also can prevent pressure deformities in the drying cast.
- Use sufficient personnel when turning. Avoid using an abduction bar when turning a patient with a spica cast.
Hip, body, or multiple casts can be extremely heavy and cumbersome. Failure to properly support limbs in casts may cause the cast to break.
- Observe and evaluate splinted extremity for resolution of edema.
Coaptation splint (Jones-Sugar tong) may be used to immobilize fracture while excessive tissue swelling is present. As edema subsides, readjustment of splint or application of plaster or fiberglass cast may be required for continued alignment of the fracture.
- Maintain position or integrity of traction.
Traction permits pulling on the fractured bone’s long axis and overcoming muscle tension or shortening to facilitate alignment and union. Skeletal traction (pins, wires, tongs) permits greater weight for traction pull than can be applied to skin tissues.
- Ascertain that all clamps are functional. Lubricate pulleys and check ropes for fraying. Secure and wrap knots with adhesive tape.
Ensures that traction setup is functioning properly to avoid interruption of fracture approximation.
- Keep ropes unobstructed with weights hanging free; avoid lifting or releasing weights.
An optimal amount of traction weight is maintained. Ensuring free movement of weights during patient repositioning avoids sudden excess pull on fracture with associated pain and muscle spasm.
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Symptoms
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Swelling, bruising, or tenderness around the injury
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Types
Incomplete: Fracture involves only a portion of the cross-section of the bone. One side breaks; the other usually just bends (greenstick).
Complete: Fracture line involves entire cross-section of the bone, and bone fragments are usually displaced.
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Open: Bone fragments extend through the muscle and skin, which is potentially infected.y
Pathological: Fracture occurs in diseased bone (such as cancer, osteoporosis), with no or only minimal trauma.
Pathophysiology
The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed, forming a fracture hematoma.
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Within a few days, blood vessels grow into the jelly-like matrix of the blood clot.
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