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الموضوع: Fractures

  1. #1

    Fractures

    Fractures



    Definition : It is break in the continuity of the bone.

    Types of fractures :
    1- Complete fractures :
    Break across the entire cross section of the bone & is frequently displaced.

    2- Incomplete fracture ( Green stick fracture)
    Break part of cross section of the bone.

    3- Commiuted fracture:
    Produce several bone fragment.

    4- Close fracture (Simple fracture)
    Dos not cause a break of skin.

    5- Open fracture :
    Break down of the bone cause injury of the skin.

    Grades of open fractures :
    N Grade I : clean wound less than 1 cm long
    N Grade II : larger wound without extensive soft tissue damage.
    N Grade III : highly contaminated wound with extensive soft tissue damage.

    6- Compressed fracture
    7- Avulsion fracture
    8- Depressed fracture

    Clinical Manifestations :
    1- Pain: increase in severity until the bone fragment immobilized.
    2- Loss of function : due to dysfunction of muscles which attached to fractured bone.
    3- Deformity : result from tissue swelling , displacement , angulation or rotation of the fragments in a fractured extremity .
    4- Shortening : due to fractured bone that muscle attached to it .
    5- Crepitus : It is a great sensation when the extremity examined by the hand . It is produced due to rubbing of bone fragment against each other.
    6- Swelling & dislocation : swelling produced due to truma that produced fracture .

    Emergency Management Of Fracture :

    *-Call for help. ( Ambulance 101)
    *- Assess the patient's level of consciousness
    *- Assess the site of fracture for bleeding.
    *- If bleeding is present try to stop it by applying local pressure.
    *- Clean the wound with antiseptic solution or normal saline.
    *- Cover the wound with gauze.
    *-Try to immobilize fractured extremity.
    *- Avoid movement for the extremity to prevent fracture complications .
    *- Assess neurovascular for the fractured extremity .
    *- Transfer the patient as a complete unit.



    Medical Management :

    1-Reduction : its returning the fractured bone to its anatomical position .
    2-Close reduction :
    Return the bone to its anatomical position with out surgery before the cast applied.
    3-Open reduction :
    Return the bone to its anatomical position and fix it by surgical procedure by internal fixation or external fixation.
    4- Immobilization :
    By applying cats or internal or external fixation after the bone return to anatomical position.

    NURSING MANAGEMENT:

    1- NURSING MANAGEMENT FOR PATIENT WITH CLOSED FRACTURE .:
    1-Encourage the patient to return to his usual activity.
    2- Describe approaches to control swelling and pain as elevate the affected limb and analgesia as prescribed.
    3-Report pain uncontrolled by elevation or analgesia.
    4- Consume diet to promote bone healing.

    2- NURSING MANAGEMENT FOR PATIENT WITH OPEN FRACTURE:
    1-Adminesture tetanus as prophylaxis if indicated.
    2- To prevent gas gangrene serial irrigation and débridement are used.
    3-Antibiotics IV administered as prescribed
    4- To decrease edema elevate the limb.
    5- Frequently vital signs assessment.
    6- Neurovascular assessment frequently.

    FACTORS AFFECTING FRACTURE HEALING :
    1- Factors enhance fracture healing :

    Immobilization of the fractured limb.
    Maximum bone fragment contact
    Sufficient blood supply
    Proper nutrition
    Exercise
    Hormones : growth hormone , vitamin D , thyroid hormone

    Factors that inhibit fracture healing:

    Extensive local truma.
    Bone loss
    Inadequate immobilization
    Infection
    Local malignancy
    Metabolic bone disease
    Age
    Avascular necrosis
    التعديل الأخير تم بواسطة الحكيم أدهم أحمد ; 04-06-2006 الساعة 03:03 PM

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  3. #3

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