6/7/2023 0 Comments Fracture definitionThe patient is evaluated for fat embolism after long bone fractures, for infection in open fractures, for excessive blood loss and hypovolemic shock, and for delayed union or nonunion during healing and follow-up. All procedures and related sensations are explained, and reassurance given. Pain is assessed and managed with prescribed analgesics and noninvasive measures. Vascular and neurological status of the limb distal to the fracture site is monitored before and after immobilization with traction, casting, or fixation devices. Stabilizing the patient on a rigid board, with full spinal protection, is necessary until x-ray studies reveal the spine is stable. Unnecessary or improper movement may injure or even transect the spinal cord. Open reduction with internal fixation may be required and is performed when the patient is judged to be hemodynamically stable.įirst aid for fractures of the spine requires extreme care in moving the patient. Hip fractures require gentle handling and immobilization to prevent displacement of the fracture, aggravation of bleeding, or disruption of a pelvic hematoma. If the bone does not heal, a weak electric current applied to the bone ends (bone stimulation) may promote healing. Pins are placed in the bone, and the bone ends are held in place by pulleys and weights until union occurs. Skeletal traction may be used instead of a cast or external fixator for certain fractures, such as femoral shaft fractures. The bone may then be immobilized by external fixation until the wound heals. When the wound is clean, a sterile dressing is secured by a bandage. If the area is grossly contaminated, mild soap solution may be used provided it is thoroughly washed away with generous amounts of sterile saline. The wound is then washed and cleaned with sterile saline. Initially, the open fracture should be covered with a clean or sterile dressing and the fracture site immobilized. In open or compound fractures, bleeding must be arrested before the fracture is treated. Afterwards the limb is restored to complete function by physical therapy and exercise. The bone is kept in position by a cast or splint until union has taken place. Radiography should be used to identify the fracture and the exact position of the bone fragments. Applying a cold pack to the fracture site and elevating it above the level of the heart may limit pain and swelling. Immediate first aid includes splinting of the fracture site and joints above and below it to limit further movement and displacement. Signs include loss of the power of movement, pain with acute tenderness over the site of fracture, swelling and bruising, deformity and possible shortening, unnatural mobility, and crepitus or grating heard when the ends of the bone rub together. In a fracture due to muscular contraction, the bone breaks from a sudden, violent contraction of the muscles. In a fracture due to indirect violence, the bone is fractured by a force applied at a distance from the site of fracture and transmitted to the fractured bone, as a fracture of the clavicle by a fall on an outstretched hand. In a fracture due to direct violence, the bone breaks at the spot where the force was applied, as in fracture of a crushed tibia. In a pathological fracture, bones break, spontaneously and without trauma, due to certain diseases and conditions like cancer, osteomalacia, syphilis, and osteomyelitis. Fractures may be due to pathologies, direct or indirect violence, or muscular contraction.
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