4 fractures 2010
DESCRIPTION
pathophysiologyTRANSCRIPT
FracturesFractures
Objectives
Describe the sequence of fracture healingDifferentiate between open and closed
reduction, cast immobilization, and tractionDescribe neurovascular assessment of
injured extremityExplain common complications associated
with fracture injury and healing
DescriptionDescription
A disruption or break in the continuity of the structure of bone
Traumatic injuries account for the majority of fractures
A disruption or break in the continuity of the structure of bone
Traumatic injuries account for the majority of fractures
DescriptionDescription
Described and classified according to:TypeCommunication or
noncommunication with external environment
Anatomic location
Described and classified according to:TypeCommunication or
noncommunication with external environment
Anatomic location
Classification by Fracture Types
Classification by Fracture Communication
Classification by Fracture Location
DescriptionDescription
Described and classified according to:Appearance, position, and
alignment of the fragmentsClassic namesStable or unstable
Described and classified according to:Appearance, position, and
alignment of the fragmentsClassic namesStable or unstable
DescriptionDescription
Closed (simple)Open (compound)
Closed (simple)Open (compound)
DescriptionDescription
Stable fracturesOccur when a piece of the
periosteum is intact across the fracture
External or internal fixation has rendered the fragments stationary
Stable fracturesOccur when a piece of the
periosteum is intact across the fracture
External or internal fixation has rendered the fragments stationary
DescriptionDescription
Stable fracturesTransverseSpiralGreenstick
Stable fracturesTransverseSpiralGreenstick
DescriptionDescription
Unstable fracturesComminutedOblique
Unstable fracturesComminutedOblique
Clinical ManifestationsClinical Manifestations
Patient history indicates a mechanism of injury associated with: Immediate localized pain Function Inability to bear weight or use affected
part Guarding May not be accompanied by obvious bone
deformity
Patient history indicates a mechanism of injury associated with: Immediate localized pain Function Inability to bear weight or use affected
part Guarding May not be accompanied by obvious bone
deformity
Fracture HealingFracture Healing
Reparative process of self-healing (union) occurs in the following stages:
1. Fracture hematoma
2. Granulation tissue
3. Callus formation
4. Consolidation
5. Ossification
6. Remodeling
Reparative process of self-healing (union) occurs in the following stages:
1. Fracture hematoma
2. Granulation tissue
3. Callus formation
4. Consolidation
5. Ossification
6. Remodeling
Bone Healing
1. Fracture haematoma bleeding & oedema create haematoma which
surrounds the ends of the fragments Occurs within 72 hrs 2. Granulation tissue active phagocytosis absorbs products of local
necrosis Granulation tissue (new blood vessels,
fibroblasts & osteoblasts) produces the basis for new bone substance
Occurs 3-14 days post injury
Bone Healing (cont.)
3. Callus formation As minerals are deposited, an
unorganised network of bone is formed that is woven about the fracture parts
Callus is composed of cartilage, osteoblasts, calcium & phosphorus
Begins to appear by end of 2nd week
Bone Healing (cont.)
4. OssificationOssification (development of bone) of the
callusSufficient to prevent movement at fracture
siteOccurs from 3 weeks to 6 months
Bone Healing (cont.)
5. Consolidation As callus develops, the distance between
bone fragments diminishes & eventually closes
• 6. RemodellingExcess bone tissue is reabsorbed & union
is completed
Bone Healing
Collaborative Care
Overall goals of treatment:• Anatomic realignment of bone fragments
(reduction)• Immobilization to maintain alignment• Restoration of normal function
Fracture Reduction
Closed reduction• Nonsurgical, manual realignmento Open reduction• Correction of bone alignment through a
surgical incision
Fracture Immobilization
Casts• Temporary circumferential immobilization
device• Common treatment following closed
reduction
Fracture Immobilization
External fixation
• Metallic device composed of pins that are inserted into the bone and attached to external rods
Fracture Immobilization
Internal fixation
• Pins, plates, intermedullary rods, and screw
• Surgically inserted at the time of realignment
Traction
Application of a pulling force to an injured part of the body while counter-traction pulls in the opposite direction
Fracture Reduction - Traction
Skin traction (short-term)Skeletal traction (longer periods)
Purpose of Traction
Prevent or reduce muscle spasmImmobilizationReductionTreat a pathologic condition
Neurovascular Assessment
ColourTemperatureCapillary refillPeripheral pulsesOedemaSensationMotor functionPain
Complications of FracturesInfectionComplications of FracturesInfection
Open fractures and soft tissue injuries have incidence
Osteomyelitis can become chronic
Open fractures and soft tissue injuries have incidence
Osteomyelitis can become chronic
Complications of FracturesInfectionComplications of FracturesInfection
Open fractures require aggressive surgical debridement
Post-op IV antibiotics for 3 to 7 days
Open fractures require aggressive surgical debridement
Post-op IV antibiotics for 3 to 7 days
Complications of FracturesCompartment SyndromeComplications of FracturesCompartment Syndrome
Condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space
Condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space
Complications of FracturesCompartment SyndromeComplications of FracturesCompartment Syndrome
Two basic etiologies create compartment syndrome:Decreased compartment size
Restrictive dressingsSplintsCasts
Two basic etiologies create compartment syndrome:Decreased compartment size
Restrictive dressingsSplintsCasts
Complications of FracturesCompartment SyndromeComplications of FracturesCompartment Syndrome
Two basic etiologies create compartment syndrome: Increased compartment content
BleedingOedema
Two basic etiologies create compartment syndrome: Increased compartment content
BleedingOedema
Complications of FracturesCompartment SyndromeComplications of FracturesCompartment Syndrome
Clinical Manifestations Six Ps:
1. Paresthesia
2. Pain
3. Pressure
4. Pallor
5. Paralysis
6. Pulselessness
Clinical Manifestations Six Ps:
1. Paresthesia
2. Pain
3. Pressure
4. Pallor
5. Paralysis
6. Pulselessness
Complications of FracturesVenous ThrombosisComplications of FracturesVenous Thrombosis
Veins of the lower extremities and pelvis are highly susceptible to thrombus formation after fracture, especially hip fracture
Veins of the lower extremities and pelvis are highly susceptible to thrombus formation after fracture, especially hip fracture
Complications of FracturesVenous ThrombosisComplications of FracturesVenous Thrombosis
Precipitating factors:Venous stasis caused by incorrectly
applied casts or tractionLocal pressure on a vein Immobility
Precipitating factors:Venous stasis caused by incorrectly
applied casts or tractionLocal pressure on a vein Immobility
Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)
Characterized by the presence of fat globules in tissues and organs after a traumatic skeletal injury
Characterized by the presence of fat globules in tissues and organs after a traumatic skeletal injury
Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)
Fractures that most often cause FES:Long bonesRibsTibiaPelvis
Fractures that most often cause FES:Long bonesRibsTibiaPelvis
Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)
Tissues most often affected:LungsBrainHeart Kidneys Skin
Tissues most often affected:LungsBrainHeart Kidneys Skin
Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)
Clinical ManifestationsUsually occur 24 to 48 hours after injury Interstitial pneumonitis
Produce symptoms of ARDS
Clinical ManifestationsUsually occur 24 to 48 hours after injury Interstitial pneumonitis
Produce symptoms of ARDS
Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)
Clinical ManifestationsSymptoms of ARDS:
Chest painTachypneaCyanosis PaO2
Clinical ManifestationsSymptoms of ARDS:
Chest painTachypneaCyanosis PaO2
Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)
Clinical ManifestationsSymptoms of ARDS:
DyspneaApprehensionTachycardia
Clinical ManifestationsSymptoms of ARDS:
DyspneaApprehensionTachycardia
Complications of FracturesFat Embolism Syndrome (FES)Complications of FracturesFat Embolism Syndrome (FES)
Clinical ManifestationsRapid and acute courseFeeling of impending disasterPatient may become comatose in a
short time
Clinical ManifestationsRapid and acute courseFeeling of impending disasterPatient may become comatose in a
short time