dislocation & fracture
TRANSCRIPT
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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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FACTORS AFFECTING A BONEs
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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FACTORS AFFECTING A BONEs
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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FACTORS AFFECTING A BONEs
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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TYPES OF FRACTUREBROAD CLASSIFICATION
COMPOUND (OPEN)- a fracture inwhich damage also involves the skinor mucus membranes
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TYPES OF FRACTUREBROAD CLASSIFICATION
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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TYPES OF FRACTURECLASSIFICATION AS TO PATTERNS
OBLIQUE-a fracture occurring at anangle across the bone
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TYPES OF FRACTURECLASSIFICATION AS TO PATTERNS
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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TYPES OF FRACTURECLASSIFICATION AS TO APPEARANCE
IMPACTED- a fracture in which abone fragment is driven intoanother bone fragment
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TYPES OF FRACTURECLASSIFICATION AS TO APPEARANCE
COMPRESSION- a fracture in whichbone has been compressed
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TYPES OF FRACTURECLASSIFICATION AS TO APPEARANCE
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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OTHER TYPES OF FRACTURE
PATHOLOGIC- a fracture that occursthrough an area of diseased bone;can occur without trauma or fall
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OTHER TYPES OF FRACTURE
GREEN STICKS- a fracture in whichone side of a bone is broken and theother side is bent
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CLINICAL MANIFESTATIONS:
THE 5 PsPAINPULSEPALLORPARESTHESIA
PARALYSIS- are seen in all types of fracture
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CLINICAL MANIFESTATIONS:
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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Fracture healing& complications
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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CLINICAL MANIFESTATIONS:
HypoxiaTachypnea
TachycardiaPyrexiaRespiratory distress (tachypnea,
dyspnea, crackles, wheezes,precordial chest pain, cough, largeamounts of thick white sputum, andtachycardia)
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CLINICAL MANIFESTATIONS:
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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CLINICAL MANIFESTATIONS:
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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Fracture healing& complications
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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CLINICAL MANIFESTATIONS:
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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Fracture healing& complications
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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Fracture healing& complications
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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Fracture healing& complications
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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CLINICAL MANIFESTATIONS
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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Fracture healing& complications
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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CLINICAL MANIFESTATIONS
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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Fracture healing& complications
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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CLINICAL MANIFESTATIONS
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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