Lecture on Fractures

Introduction

• Speaker: Cathy from Level Up RN
• Main Topic: Fractures
• Includes a quiz at the end
• Reference: Level Up RN medical-surgical nursing flashcards

Types of Fractures

1. Closed Fracture
   • Does not break the skin surface.
2. Open Fracture
   • Breaks the skin surface; higher risk of infection.
3. Transverse Fracture
   • Occurs perpendicular to the long axis of the bone.
4. Impacted/Compression Fracture
   • Bones are crushed together.
5. Comminuted Fracture
   • Results in two or more pieces.
6. Oblique Fracture
   • Occurs at an angle to the bone.
7. Spiral Fracture
   • Caused by twisting motion; potential sign of abuse.
8. Greenstick Fracture
   • Partial fracture common in children; bone bends and cracks.

Risk Factors for Fractures

• Osteoporosis
• Paget's disease
• Long-term steroid use
• Substance abuse
• Trauma (e.g., falls)
• Bone cancer

Signs & Symptoms

• Pain
• Swelling
• Ecchymosis
• Deformity
• Muscle spasms

Diagnosis

• X-ray
• CT Scan
• MRI

Treatment Options

Medications

• Analgesics (pain relief)
• Antibiotics (for open fractures)
• Muscle relaxants (for muscle spasms)

Procedures

• Closed Reduction: Bones realigned without surgery, followed by immobilization (cast, splint, traction).
• External Fixation: Screws and pins inserted into bone, attached to an external frame.
• Open Reduction and Internal Fixation (ORIF): Surgical insertion of screws, pins, rods to correct the fracture.

Nursing Care

• Emergency: Remove clothing/jewelry, control bleeding, immobilize fracture.
• Neurovascular Check: Pain, sensation, skin temperature, color, capillary refill, pulses, movement.
• Monitor for Complications:
  • Osteomyelitis (bone infection)
  • Venous thromboembolism (blood clot)
  • Fat embolism
  • Compartment syndrome

Complications

Fat Embolism

• Occurs often with long bone/hip fractures.
• Symptoms: Dyspnea, confusion, tachypnea, tachycardia, petechiae, decreased O2 saturation.
• Treatment: Supportive care (bed rest, IV fluids, oxygen).

Compartment Syndrome

• Increased pressure in muscle compartment impairs circulation.
• Five Ps:
  1. Pain (intense, unrelieved by meds)
  2. Paresthesia (pins and needles)
  3. Paralysis
  4. Pallor (paleness)
  5. Pulselessness
• Symptoms: Hard, swollen extremity.
• Treatment: Fasciotomy or amputation may be necessary.
• Do not apply cold (causes vasoconstriction) or elevate extremity (impairs circulation).

Quiz Questions

1. What type of fracture is caused by a twisting motion and is a sign of possible abuse?
   • Answer: Spiral fracture
2. A patient with a hip fracture has petechiae, dyspnea, and decreased oxygen saturation. What complication is suspected?
   • Answer: Fat embolism
3. What are the five Ps of compartment syndrome?
   • Answer: Pain, paresthesia, paralysis, pallor, pulselessness

Conclusion

• Upcoming topic: Immobilization devices (traction and cast)