fracture for Emergency and Critical Care Nursing students.pptx

Fracture

1. FRACTURE Birhanu D. (MSc, EM & CCN) 10/8/2024 # 1

2. Fracture Definition A fracture is a disruption or discontinuity in bone fragment or in the structure of bone. 10/8/2024 # 2

3. Classification Type Communication or Non Communication with External Environment Anatomic Location of Fracture 10/8/2024 # 3

4. TYPES OF FRACTURE Avulsion Fracture: Is a fracture of bone resulting from strong pulling effect of tendons or ligaments at the bone attachment 10/8/2024 # 4

5. Cont… Communited Fracture: It is a fracture with more than two fragments, the smaller one appear to be floating 10/8/2024 # 5

6. Cont… Displaced Fracture: It fragment fragment. involves a displaced fracture that overrides the other bone 10/8/2024 # 6

7. Cont… Greenstick Fracture : it is an incomplete fracture with one side splintered and other side bent. 10/8/2024 # 7

8. Cont… Impacted Fracture: It is a communited fracture in which more than two fragments are driven into each other. 10/8/2024 # 8

9. Cont… Intra Articular: it is a fracture extending to the articular surface of the bone. 10/8/2024 # 9

10. Cont… Longitudinal Fracture: It is a incomplete fracture in which the fracture lines runs along the longitudinal axis of the bone. 10/8/2024 # 10

11. Cont… Oblique Fracture: It is a fracture in which the line of a fracture extends in a oblique direction 10/8/2024 # 11

12. Cont… Pathologic Fracture: it is a spontaneous fracture at the site of a bone diseases. 10/8/2024 # 12

13. Cont… Spiral Fracture: it is a fracture in which the line of fracture extends in the spiral direction along the direction of the bone. 10/8/2024 # 13

14. Cont… Stress Fracture: it is a fracture that occurs normal or abnormal bone that is subjected to repeated stress. 10/8/2024 # 14

15. Cont… Transverse Fracture: it is a fracture in which the time of fracture extends across the bone shaft at the right way to longitudinal axis. 10/8/2024 # 15

16. Others… Stable Fracture: Occurs when a piece of periosteoum is intact across the fracture& other external or internal fixation has reduced the fragment Unstable Fracture : Is grossly displaced during injury and is a site of poor fixation 10/8/2024 # 16

17. Clinical Manifestations Localized pain and tenderness Decreased function Inability to bear weight or use of the affected part Edema and Swelling Muscle Spasm Deformity 10/8/2024 # 17

18. Cont… Ecchymosis and Contusion Loss of function Crepitation 10/8/2024 # 18

19. Fracture Healing Process Fracture Hematoma Granulation Tissue Callus Formation Ossification Consolidation Remodelling 10/8/2024 # 19

20. Pics… 10/8/2024 # 20

21. Cont… Fracture Hematoma when fracture occurs, bleeding creates a hematoma which surrounds the ends of fragments. Hematoma is extra vasated blood that changes from a liquid to semisolid clot. Occurs after 72 hrs of injury. 10/8/2024 # 21

22. Cont… Granulation Tissue Active phagocytosis absorbs the products of local necrosis. The hematoma converts to granulation It produces the tissue. basis of new bone substances called osteoid 10/8/2024 # 22

23. Cont… Callus Formation As minerals (Ca, P & Mg) and new bone matrix are deposited in the osteoid an unorganized network of bone if formed that is woven about the fractured parts. Callus is primarily cartilage osteoblasts, composed of calcium and phosphorus. It usually appears at the end of second week after injury. 10/8/2024 # 23

24. Cont… Ossification It occurs from 3 weeks to 6 months after the fracture and continues until fracture has healed. It is sufficient to prevent movement at the fracture site. at this stage patient may be allowed to limited mobility. 10/8/2024 # 24

25. Cont… Consolidation As callus continues to develop the distance between bone fragments diminishes and eventually closes . 10/8/2024 # 25

26. Cont… Remodelling Excess bone tissue is reabsorbed in the final stage of bone healing and union is completed. Gradual return of the injured bone to its pre injury structural strength and shape occurs. 10/8/2024 # 26

27. DIAGNOSTIC EVALUATION History Collection Physical Examination X- Ray C.T. Scan MRI 10/8/2024 # 27

28. COLLABORATIVE CARE FRACTURE REDUCTION Closed Reduction Open Reduction Traction FRACTURE IMMOBILISATION Splints and Casts DRUG THERAPY 10/8/2024 # 28

29. CLOSED REDUCTION It is a non surgical manual realignment of bone fragments to their previous anatomic position It is usually performed under local or general Anesthesia, fixation After Reduction, traction, casting, external injured part to splints are used to immobilize the maintain alignment 10/8/2024 # 29

30. TRACTION Is a application of pulling force to an injured or diseased part of the body or an extremity while counter traction pulls in the opposite direction. 10/8/2024 # 30

31. Purpose To prevent / reduce muscle spasm Immobilizing a joint or part of the body Reduce fracture or dislocation Treat a pathologic joint condition 10/8/2024 # 31

32. Indication Provide immobilization to prevent soft tissue damage Reduce muscle spasm associated with low back pain Expand a joint space during arthroscopic procedures Expand a joint space before major joint construction 10/8/2024 # 32

33. TYPES Skin Traction: Used for short term treatment 48 – 72 hrs until skeletal traction or surgery is possible. The traction weights are usually limited to 05 to 10lb (2.3 to 4.5kg) 10/8/2024 # 33

34. Cont… Skeletal Traction Skeletal traction is used for longer periods than skin traction, to align the injured bones and joints or to treat joint contractures and congenital hip dysplasia. 10/8/2024 # 34

35. FRACTURE IMMOBILIZATION CAST circumferential A cast immobilization is a temporary device. It is a common treatment following closed reduction. cast materials acrylic, fiber glass free. are natural (POP), synthetic, 10/8/2024 # 35

36. TYPES SHORT ARM CAST: used for stabling wrist bones and meta carpels LONG ARM CAST: used for stable forearm or elbow fractures and unstable wrist fracture. 10/8/2024 # 36

37. Cont… BODY JACKET CAST: used for immobilization and support for stable spine injury of the thoracic or lumbar spine 10/8/2024 # 37

38. Cont… HIP SPICA CAST: is used for treatment of femoral fractures. It includes two casts Body Jacket Cast and Long Leg Cast For Lower Extremities SHORT LEG CAST LONG LEG CAST 10/8/2024 # 38

39. Cont… 10/8/2024 # 39

40. OPEN REDUCTION It is the through a correction of bone alignment surgical incision. It usually includes internal fixation of the fracture with the use of wires, screws, pins, plates, intramedullary rods or nails. 10/8/2024 # 40

41. TYPES Open Reduction Internal Fixation Closed Reduction External Fixation 10/8/2024 # 41

42. P IC .. 10/8/2024 # 42

43. Pics…. Plates 10/8/2024 # 43

44. Pics… Screws 10/8/2024 # 44

45. Pics… Intra medullary Nails 10/8/2024 # 45

46. Pics… 10/8/2024 # 46

47. DRUG THERAPY Antibiotics Muscle Relaxants Analgesics Inj. TT 10/8/2024 # 47

48. Emergency Management Treat life threatening injuries first Ensure A, B and C Control external Bleeding with direct pressure Splint joints above and below fracture site Check Neurovascular Status distal to injury Elevate injured limb if possible Do not attempt to straighten fracture 10/8/2024 # 48

49. Cont… Do not manipulate protruding bone ends Apply ice packs to affected area Obtain X-rays of affected part Administer TT prophylaxis Shift immediately to health care centre 10/8/2024 # 49

50. Complications Infection Compartmental Syndrome Venous Thrombosis Fat Embolism Syndrome 10/8/2024 # 50

51. Compartmental Syndrome It is a condition in which elevated intra compartmental pressure within a confined myofasial compartment comprises the neurovascular function of tissue within the space. 10/8/2024 # 51

52. 10/8/2024 # 52

53. Types Decreased compartment size resulting from restrictive dressing. Increased compartment size related to bleeding or odema 10/8/2024 # 53

54. Clinical Manifestations Parasthesia Pain distal to injury Pressure increased Pallor, coolness Paralysis Pulselessness Myoglobinuria 10/8/2024 # 54

55. Care Elevate body part above chest level Remove or loosen tight bandage Surgical decompression - Fasciotomy 10/8/2024 # 55

56. Fat Embolism Syndrome It is characterized by the presence of systemic fat globules from fractures that are distributed into tissues and organs after a traumatical skeletal injury 10/8/2024 # 56

57. 10/8/2024 # 57

58. Clinical Manifestations Usually occurs 12 to 72 hrs. after injury Chest pain Tachypnea Cyanosis Tachycardia Memory loss Restlessness Confusion and Head ache 10/8/2024 # 58

59. Diagnostic Evaluation Fat cells in blood, urine or sputum PaO 2 less than 60 mm Hg ST segment changes 10/8/2024 # 59

60. Treatment Careful immobilization Fluid Resuscitation to prevent Shock Correction of Acidosis Corticosteroids Oxygen Administration 10/8/2024 # 60