Bone Spiral Fracture

Topics: Bone fracture, Orthopedic surgery, Hip fracture Pages: 12 (2639 words) Published: May 5, 2005

Causes –

Trauma – blow to body, fall
Pathologic – if a bone is weakened, fracture may be pathologic, consisting of a collapse of the bone – osteoporosis, bone cancer Stress – if there is usual or repetitive force on a bone because of excessive muscle usage or strain, a stress fracture may occur – seen in athletes


Accident prevention – hand rails, no throw rugs, obstacles on floor, education concerning automobile safety, protective sports equipment

Avoid osteoporosis – small framed, non-obese, white females most at risk; contributing factors – diet low in calcium throughout life, smoking, excessive coffee intake, high protein diet, sedentary life style

Types of fractures:

Complete – complete separation of the bone, two fragments
Incomplete – only part of the bone is broken; not broken into two fragments Simple – skin over break is intact
Compound or open – communication between skin wound and fracture site; high risk of contamination and infection Fracture without displacement – bone ends in good alignment Fracture with displacement – bone segments separated at the point of fracture Greenstick – splintering on one side of the bone (young children) Transverse – break straight across the bone

Oblique – line of fracture angled across bone
Spiral – fracture line partially encircling the bone
Telescoped or impacted – bone ends jammed together
Comminuted – several bone fragments

Healing of Fractures –

Immobilization is necessary for healing

Bone heals during a process called callus formation, in which new blood vessels are formed, dead bone is reabsorbed, new bone matrix is laid down and becomes filled with calcium; this area of healing, the new bone is called the callus.

Process of healing:

Hematoma forms – bone is vascular; blood collects in the periosteal sheath; fastens the broken ends together Fibrin meshwork – further clot formation
Invasion of osteoblasts – invade the fibrin, make it firm; blood vessels develop, supplying nutrients to build collagen; collagen begins to incorporate calcium deposits Callus formation – osteoblasts continue to lay meshwork for bone growth; osteoclasts destroy the dead bone; collagen continues to be impregnated with calcium Remodeling – excess calcium is reabsorbed

Factors interfering with healing – poor nutrition, poor circulation, inadequate reduction of fracture (bone ends not brought well into alignment), insufficient immobilization, infection at the site of injury

If callus formation does not take place, the resulting lack of repair is called non-union of fracture.

S/S of Fracture –

Pain – immediate, severe, aggravated by movement, aggravated by pressure Loss of normal function
Obvious deformity
Crepitus or grating sound/sensation if the limb is moved (don't try to elicit this sign) Edema
Ecchymosis of skin in injured area (more noticeable after 1-2 days) Loss of sensation or paralysis distal to the injury (evidence of nerve impingement) Signs of shock due to severe tissue injury, hemorrhage with large fractures or multiple fractures

Diagnosis – evidence of fracture seen on x-ray

Medical treatment:

Reduction of fracture – bring bone ends into alignment
Immobilization of fracture – cast or hardware

Immediate care of fracture –

Splinting to prevent movement – splint joints both above and below the fracture Preserve body alignment
Elevate part to reduce edema
Application of ice for 1st 24 hours – reduce swelling, pain, bleeding Analgesics
Watch for changes in color, temperature, sensation, movement, pulses/capillary refill Watch for signs of shock

Secondary management of simple fracture:

Reduction of the fracture – methods: manual manipulation (usually done with IV analgesic), traction, open reduction (surgical procedure)

Immobilization – methods: external immobilization with a cast or splint; traction; internal fixation with pins, screws, plates; insertion of prosthesis; or any...
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