dislocation & fracture

8/3/2019 Dislocation & Fracture

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DISLOCATIONand

FRACTUREPrepared By:

Abella, Karla S.

Aganus, Jenelee Ann

Albano, Jun Glenys

Borillo, Annah Lou

Calbay, Christian Daniel Uy

BSN 304/ GROUP13A


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DISLOCATION

is a condition in which the articularsurface of the distal and proximalbones that form the joint are nolonger in anatomic alignment.

Complete separation of joint surface


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SUBLUXATION

is a partial dislocation and doesnot cause as much deformity asa complete dislocation.


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TRAUMATIC DISLOCATION

are orthopedic emergencies becausethe associated joint structure,blood supply, and nerves aredisplaced and may be entrapped

with extensive pressure on them.


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CLINICAL MANIFESTATIONS:

Acute Pain

Deformity or change in the positionof the joint

Shortening of the extremityDecrease Mobility


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DIAGNOSTIC TEST

X-RAY

Clinical Assessmentfor ComplicatingInjuries.


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Medical management

AnalgesiaMuscle relaxants

Anesthesia (facilitate closed reduction)Immobilization (splints, casts, or

traction, and maintain in a stableposition)

Neurovascular Status Assessment (every15mins until stable)

Exercise Sessions


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Nursing MANAGEMENT

Providing comfort

Evaluating the clients neurovascular

statusProtecting the joint during healing

Teaching the client how to manage

the immobilizing devices and how toprotect the joint from re injury.


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FRACTURE

is a break in the continuity of the bones


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COMMON FRACTURE SITES:

CLAVICLE

HUMERUS


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COMMON FRACTURE SITES:

RADIUS & ULNA

FEMUR


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FACTORS AFFECTING A BONEs

FRACTURE POTENTIAL

AGE Puberty- because bones are not fully

formed yet & bones are more flexible.


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FRACTURE POTENTIAL

SEX Statistically, between the ages of 6 years

and 40, males get more fractures than females.

It is supposed that this is because malestend to engage in more dangerous work and


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FRACTURE POTENTIAL

HEALTH Some diseases can cause bones to become

weak and thus become more susceptible tofractures. These diseases can be metabolic,infectious, or neoplastic in nature and they can

affect a bone's structural integrity. A breakcaused b such a disease is called a atholo ical


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FRACTURE POTENTIAL

MUSCLE TENSION A fracture that would normally occur

when muscles are tense may not occurwhen the muscles are relaxed. Bones

have a certain degree of flexibility tothem, but when their surroundin


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CAUSES

Direct Blow

Crushing ForcesSudden Twisting MotionsExtreme Muscle Contractions


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TYPES OF FRACTUREBROAD CLASSIFICATION

SIMPLE (CLOSED)- a fracture thatremains contained; does not breakthe skin


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COMPOUND (OPEN)- a fracture inwhich damage also involves the skinor mucus membranes


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COMMINUTED- a fracture in whichbone has splintered into severalfragments


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TYPES OF FRACTURECLASSIFICATION AS TO PATTERNS

TRANSVERSE- a fracture that isstraight across the bone


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OBLIQUE-a fracture occurring at anangle across the bone


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SPIRAL- a fracture that twists aroundthe shaft of the bone


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TYPES OF FRACTURECLASSIFICATION AS TO APPEARANCE

COMMINUTED- a fracture in whichbone has splintered into severalfragments


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IMPACTED- a fracture in which abone fragment is driven intoanother bone fragment


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COMPRESSION- a fracture in whichbone has been compressed


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DEPRESSED- a fracture in whichfragments are driven inward


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OTHER TYPES OF FRACTURE

AVULSION- a fracture in which afragment of bone has been pulledaway by a ligament or tendon and itsattachment


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PATHOLOGIC- a fracture that occursthrough an area of diseased bone;can occur without trauma or fall


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GREEN STICKS- a fracture in whichone side of a bone is broken and theother side is bent


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THE 5 PsPAINPULSEPALLORPARESTHESIA

PARALYSIS- are seen in all types of fracture


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Loss of FunctionDeformity either visible or

palpableShorteningCrepitus- grating sensation when

examined with handsSwelling & discoloration


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DIAGNOSTIC TEST

X-RAY

CT & MRI SCAN


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EMERGENCY MANAGEMENTIt is important to immobilize the body

part before the patient is moved,whenever a fracture is suspected.

Adequate splinting, including jointsadjacent to the fracture, is essential.

The neurovascular status distal to the

injury should be assessed to determineadequacy of peripheral tissue perfusionand nerve function.


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EMERGENCY MANAGEMENT

With an open fracture, the wound iscovered with a clean or steriledressing to prevent contaminationof deeper tissues. No attempt ismade to reduce the fracture.

In the emergency department, the

patient is evaluated completely


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medical MANAGEMENT

REDUCTION - Restoration of the fracturefragments to anatomic alignment androtation.

Closed Reduction- accomplished bybringing the bone fragments intoapposition through manipulation andmanual traction.

Open Reduction- requires a surgicalapproach.


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medical MANAGEMENT

IMMOBILIZATION May be accomplished by external or

internal fixator.

After the fracture has been reduced,the bone fragments must be immobilized,or held in correct position and alignmentuntil union occurs.

MAINTAINING & RESTORING FUNCTION To promote bone and soft tissue

healing.


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NURSING DIAGNOSES

Risk for fluid volume deficit r/themorrhage and shock

Impaired gas exchange r/t immobilityand potential pulmonary emboli orfat emboli

Risk for peripheral neurovascular

dysfunctionRisk for injury r/t thromboembolismPain r/t injury


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Nursing management

CLOSED FRACTURE Encourage the client to return to

their usual activities as rapidly aspossible.

Teach the client how to control

swelling and pain associated with thefracture and encourage him to be activewithin the limits of the fractureimmobilization.


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Nursing management

CLOSED FRACTURE Teach patients how to use

assistive devices safely.

Patient teaching includes self-care, medication information,monitoring for potentialcomplications, and the need forcontinuing health care supervision


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Nursing management

OPEN FRACTURE Prevent infection of the wound,

soft tissue and bone. Tetanusprophylaxis can be administered ifindicated

Prompt, thorough woundirrigation and debridement in the

operating room are necessary


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Nursing management

OPEN FRACTURE Elevate the extremity to reduce

edema.

Assess neurovascular status

frequently.


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Fracture healing& complications

EARLY

1. SHOCK Hypovolemic or traumatic shock resulting

from hemorrhage and from loss ofextracellular fluid into damaged tissues mayoccur in fractures of the extremities, thorax,

pelvis or spine.


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medical MANAGEMENT

Restoring blood volume andcirculation

Relieving the patients painProviding adequate splintingProtecting the patient from

further injury and othercomplications


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EARLY

2. FAT EMBOLISM SYNDROME

At the time of fracture, fat globules maymove into the blood because the marrow pressureis greater than the capillary pressure or becausecatecholamines elevated by the patients stressreaction mobilize fatty acids and promote the

development of fat globules in the bloodstream.The fat globules or emboli occlude the small bloodvessels that supply the lungs, brain, kidneys, andother organs.


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HypoxiaTachypnea

TachycardiaPyrexiaRespiratory distress (tachypnea,

dyspnea, crackles, wheezes,precordial chest pain, cough, largeamounts of thick white sputum, andtachycardia)


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Chest x-ray shows a typicalsnowstorm infiltrate

Cerebral disturbances manifested bymental status changes varying fromheadache, mild agitation, and

confusion to delirium and comaPatient appears pale with systemic

embolization


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Petechiae are noted in the buccalmembranes and conjuctival sacs, on

the hard palate, and over the chestand anterior axillary folds

Patient may develop a temperature

of more than 39.5 CFree fat may be found in the urine if

emboli reach the kidneys


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PREVENTIONImmediate immobilization of

fracturesMinimal fracture manipulationAdequate support for fractured

bones during turning andpositioning

Maintenance of fluid andelectrolyte balance


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MANAGEMENT

Support the respiratory system, to preventrespiratory and metabolic acidosis, and tocorrect homeostatic disturbances. It is

provided with oxygen given in highconcentrations

Controlled-volume ventilation with positive end-expiratory pressure may be used to prevent or

treat pulmonary edemaCorticosteroids may be given to treat

inflammatory lung reaction and to controlcerebral edema


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MANAGEMENT

Vasoactive meds to support cardiovascularfunction are administered to preventhypotension, shock, and interstitialpulmonary edema

Accurate fluid intake and output recordsfacilitate adequate fluid replacementtherapy

Morphine may be prescribed for pain andanxiety for the patient who is on a

ventilatorNurse provides calm reassurance to allay

apprehensionPatients response to therapy is closely

monitored

F h li


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EARLY

3. COMPARTMENT SYNDROME It is a complication that develops when

tissue perfusion in the muscle is less thanthat required for tissue viability.


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Deep, throbbing unrelenting pain,which is not controlled by opioids

Hypoesthesia (diminished sensitivityto stimulation)

Absence of feeling

Swollen and hard musclesParesthesia generally occurs before

paralysis


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MEDICAL MANAGEMENT

Elevation of the extremity to the heart level,release of restrictive devices, or both.

Fasciotomy (surgical decompression with

excision of the fibrous membrane that coversand separates muscles) may be needed torelieve the constrictive muscle fascia.

After fasciotomy, wound is left open to permit

muscle tissues to expand; it is covered withsterile saline dressings.


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MEDICAL MANAGEMENT

Limb is splinted in a functional positionand elevated, and prescribed passiveROM exercises are usually performedevery 4 to 6 hours.

When the swelling has resolved andtissue perfusion has been restored, the

wound is debrided and closed (possiblywith skin grafts).


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OTHER EARLY COMPLICATIONS

Deep Vein ThrombosisThromboembolismPulmonary EmbolusDisseminated Intravascular

CoagulopathyInfection

F t h li


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DELAYED

1. Delayed Union and Nonunion Delayed union occurs when healing

does not occur at a normal rate forthe location and type of fracture.

Nonunion results from failure of theends of a fractured bone to unite.


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MEDICAL MANAGEMENT

Physician treats nonunion with internalfixation, bone grafting, electrical bonestimulation, or a combination of these

therapies.After grafting, immobilization and non-

weight bearing are required while thebone graft becomes incorporated and the

fracture heals.


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MEDICAL MANAGEMENT

In some situations, pins that act as cathodesare inserted percutaneously, directly intothe fracture site, and electric impulse are

directed to the fracture continuously.Another method is non-invasive inductive

coupling


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NURSING MANAGEMENT

Provide emotional support and

encourage compliancePain managementMonitor for signs of infection

Reinforce information to the client

Fract re healing


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DELAYED

2. Avascular Necrosis of Bone This occurs when the bone loses

its blood supply and dies. It mayoccur after a fracture with

disruption of the blood supply.


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CLINICAL MANIFESTATIONS

PainLimited MovementX-ray reveals calcium loss and

structural collapse


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Medical management

Bone Grafts

Prosthetic replacementArthrodesis (joint fusion)

Fracture healing


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DELAYED

3. Reaction to Internal Fixation

Devices Internal fixation devices may beremoved after bony union ha takenplace. In most patients, however, the

device is not removed unless itproduces symptoms.


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PainDecreased Function


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Medical management

Removal

Protection of the bone fromrefracture related toosteoporosis, altered bone

structure, and trauma.

Fracture healing


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DELAYED

4. Complex Regional Pain Syndrome

It is a painful sympathetic nervoussystem problem. It occursinfrequently, and when it does, it ismost often in an upper extremity after

trauma and is seen more often inwomen.


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Severe burning painLocal edema

HyperesthesiaStiffnessDiscolorationVasomotor skin changes (fluctuating

warm, res, dry and cold, sweaty,cyanotic)Trophic changes (glossy, skinny skin;

increased hair growth)


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Medical management

Elevation of extremity after injury orsurgery

Selection of an immobilization devicethat allows for the greatest ROMand functional use of the rest of theextremity

Reduce painAvoid using the involved extremity

for blood pressure measurements orvenipunctures

Fracture healing


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DELAYED

5.Heterotrophic Ossification

It is the abnormal formation ofbone, near bones or in muscles, inresponse to soft tissue trauma afterblunt trauma, fracture, or total

joint replacement.


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Muscle is painful

Normal muscular contractionand movement are limited


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Medical management

Early mobilization has been

recommendedIndomethacin may be used

prophylactically if deep

muscle contusion hasoccurred


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dislocation & fracture

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