Orthopedic Measures
Teresa V. Hurley
Fractures
• What is a fracture?
Fractures
• A disruption or break in the bone from:
– Trauma or pathology
Immediate Intervention: RICE
R = rest and limit movement
I = ice
C = compression to reduce swelling
E = elevate above heart level
Classification
• A. Type
• B. Communicated or noncommunicated
• C. Anatomic Location
Types
• Comminuted: more than two
fragments/floating appearance
• Displaced: fragment overrides the other
bone fragment
• Greenstick: incomplete; one side
splintered the other side bent
• Impacted: comminuted with more than 2
fragments are driven into each other
Types Continued
• Longitudinal: incomplete; fx line along the
longitudinal axis of bone
• Oblique: line of fx extends in oblique
direction
• Spiral: fx line is spiral along the bone shaft
• Transverse: fx line across bone shaft at
right angle to longitudinal axis
• Pathological: spontaneous at site of
disease
Fractures Continued
• Open FX: (compound) communication
through skin to the outside; or from outside
to within
• Closed Fx: noncommunication
Signs and Symptoms
•
•
•
•
•
Pain
Muscle spasms
Deformity
Ecchymosis
Loss of function
– Inability to bear weight or use
• Guarding behavior
• Crepitation
KEEP IN POSITION FOUND TO PREVENT TISSUE AND/OR
NEUROVASCULAR DAMAGE; OR CLOSED TO OPEN FX
Immobilization of Fractures
• Casts
– Usually after closed reduction (non-surgical)
– Plaster of paris, synthetic, fiberglass free, latex-free
polymer, hybirds
– Complete drying within 24 to 72 hours (hair dryer)
– Prevent soiling, wetness, stress
– Handle by palms of hand to prevent finger indications
which are a source of pressure
– Petal rough edges with water-proof tape to prevent
skin breakdown from edges and cast crumbs
Traction
• Pulling force applied to affected part and
counter traction applied in the opposite
direction
– Prevent or reduce muscle spasm
– Reduce fracture or dislocation
– Prevent soft tissue damage by immobilization
Traction Types
• Skin: adhesives directly to skin which is
wrapped with bandages or slings, belts or
splints attached to rope with weights
• Skeletal: directly to bone with wires and
pins
Skin Traction Types
•
•
•
•
•
•
Bucks
Rusell’s
Bryant’s
Pelvic Belt
Pelvic Sling
Head Halter
Skeletal Traction Types
• Overhead arm [90 degrees]
• Lateral Arm
• Balanced Suspension
Union: Bone Healing Process
•
•
•
•
•
•
Hematoma
Granulation tissue
Callus
Ossification
Consolidation
Remodeling
Critical Nursing Assessments
Neurovascular Assessment performed on both
extremities and compared to each other
Peripheral Vascular Assessment
-color (pink, pale, cyanotic)
-temperature (hot, warm, cool, cold)
-capillary refill (blanching within 3 seconds; or
delayed)
-peripheral pulses (strong. diminished, absent)
or absent)
-edema (pitting)
Critical Nursing Assessments
• Peripheral Neurologic Assessment
– Sensation (parathesias, numbness, tingling,
decreased or increased sensation, partial
(paresis) or full (paralysis) loss
– Motor function (motion and strength
– Pain (location, quality, intensity use a scale
from 0 to 10)
Complications
• Infection
• Compartment Syndrome
– Pressure within the myofascial space effects
the neurovascular tissues which may lead to
necrosis
– Examples of etiologies
• Dressings, splints, traction
• Bleeding, edema, snakebites, IV infiltration
• Fractures, crush injuries, burns
SIX P’s of Impending
Compartmental Syndrome
• Paresthesis (numbness and tingling)
• Pain distal to injury not relieved by
analgesics; positive Homan’s sign
• Pallor
• Paralysis
• Pressure
• Pulselessness
Complications
• Fat Embolism Syndrome (24 to 48 hr after
injury)
– Acute respiratory distress
– Chest pain, tachypnea, cyanosis, dyspnea,
tachycardia, decrease Sp02, mental status
changes, restlessness, headaches, confusion
Nursing Diagnoses
• Risk for Peripheral Neurovascular
Dysfunction r/t nerve compression
• Goal: Client will not exhibit neurovascular
impairment
• Assess for the 6 P’s
• Elevate extremity above heart level
• Apply ice compresses
• Notify MD if c/o of increasing pain
unrelieved by analgesics
Nursing Diagnoses
• Acute Pain r/t edema, muscle spasms, bone
fragments
• Goal: Client will have less pain
• Move extremity gently
• Scale to assess pain and evaluate effectiveness
of measures
• Elevate extremity, apply ice and support
• Administer prescribed analgesics and muscle
relaxants
• Report increasing pain to MD unrelieved by
analgesics
Nursing Diagnoses
• Risk for Impaired Skin Integrity r/t casted
extremity and immobility
• Goal: Client will not exhibit skin
breakdown
• Assess potential areas
• Petal edges of cast
• Assess exposed skin areas of traction
sites for pressure producing necrosis
Nursing Diagnosis Continued
• Instruct client not to insert items into cast
as hangers, eating and cooking utensils, to
scratch; use meat baster to puff air
• Instruct client to report areas of warmth,
pain, burning, moisture, foul odor and
areas of increasing drainage