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Skeletal Disruptions
Alterations in Protection: Skeletal Disruptions and Diseases
62
Nursing
Undergraduate 2
11/14/2010

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Term
Typical Parts of Long Bone
Definition
Epiphysis (ends)
Diaphysis (shaft)
Term
3 Types of Bone Cells
Definition
Osteoblasts
Osteocytes
Octeoclasts
Term
Osteoblasts
Definition
Bone forming cells
Term
Osteocytes
Definition
Mature bone cells in matrix
Term
Osteoclasts
Definition
Remove old bone cells for repair, remodeliing or absorption.
Term
Fracture
Definition
Disruption or break in the continuity of the structure of the bone usually resulting from trauma.
Term
Butterfly Fracture
Definition
Chunk(s) chipped out of the side of a bone.
Term
Segmental Fracture
Definition
Bone broken in multiple large pieces usually from blunt force trauma.
Term
Comminuted Fracture
Definition
Shattered bone.
Term
Oblique Fracture
Definition
Break across the shaft of a bone at an angle.
Term
Transverse Fracture
Definition
Break that is completely across the shaft at 90 degrees.
Term
Clinical Manifestations of Fractures
Definition
Pain, swelling, tenderness
Loss of function
Numbness
Deformity
Discoloration/ecchymosis
Crepitation
Muscle spasms
Term
Stages of Bone Healing
Definition
1. Hematoma formation
2. Cellular proliferation
3. Callus formation
4. Ossification
5. Remodeling
Term
Hematoma Formation
Definition
First stage of bone healing. Begins in the first 48-72 hours after fracture. Clotting factors initiate formation of fibrin meshwork. Granulation tissue replaces clot.
Term
Cellular proliferation
Definition
2nd stage of bone healing. Osteoblasts connect to lay down matrix by forming a firbrocartilaginous callus, which is softer and flexible. Begins distal to the fracture to access blood supply. Forms a "collar" around the fracture site.
Term
Callus Formation
Definition
3rd stage of bone healing. Fibrocartilaginous callus calcifies as mineral salts are deposited, forming a bridge that connects bone fragments. 3rd -4th week after injury. Formed by osteoblasts, Ca+, P and cartilage.
Term
Ossification
Definition
Involves the final laying down of bone. Fracture fragments are firmly united and mature bone replaces the callus. Excess callus is gradually resorbed by osteoclasts. Cast can be removed.
Term
Remodeling
Definition
Resorption of excess bony callus in the marrow space and encircles external part of fracture site. Site gains strength as it is put more into use.
Term
Ecchymosis
Definition
Bruising from soft tissue damage.
Term
Factors that affect bone healing
Definition
Age
Blood Supply
Degree of Immobilization
Presence of Infection
Amount of bone loss
Poor Nutrition
Term
How to diagnose fractures
Definition
History & physical exam
X-rays
CT
Term
Goals of Fracture Tx
Definition
Anatomic Realignment of bone fragments
Immobilization to maintain realignment
Restoration of normal or near normal function.
Term
Reduction Treatment
Definition
Realignment of bone fragments using either closed or open (surgical) fixation.
Term
Traction
Definition
Type of reduction for fractures. Weight used as counter to body's pull in opposite direction of injury.
Used to reduce muscle spasms
Forces on distal portion or joint.
Max of 9lbs used.
Goal: Immobilization or Realignment
Term
Goals of Fracture Treatment
Definition
Anatomic Realignment of bone fragments
Immobilization to maintain realignment
Restoration of normal or near normal function.
Term
Immobilization Tx
Definition
Casting or splinting: plaster or fiberglass which follows closed reduction.

Traction

External or Internal Fixation.

Body jacket for spinal injuries.
Single hip - lumbar or femoral fractures.
Term
Compartment Syndrome
Definition
Condition of compromised circulation related to progressively increased pressure in confined space, usually the fascia. Will compress muscles, vessels, tissue and/or nerves d/t swelling.

Two causes:
1. Decreased compartment size (ie. dressings, casts, etc. too tight.)
2. Increased compartment content d/t bleeding or edema.
Term
Clinical Manifestations of Compartment Syndrome
Definition
Pain
Pallor
Pulselessness
Pressure
Paralysis
Parasthesia
Term
Nursing Management of Compartment Syndrome
Definition
Notify MD immediately
Assess for myoglobinuria - released from muscles to kidney and leads to ARF
Prepare for Fasciotomy - surgical opening to relieve pressure
No cold compresses - d/t vasoconstriction
Do not elevate above the heart.
Look for dark, reddish-brown urine - sign of ARF.
Term
Fat Embolism Syndrome Clinical Manifestations
Definition
CP
Signs of Resp Failure
Elevated Temperature
Change in Mental Status (from drop in PaO2)
Petechia - rash >50% will get on chest
"Snowstorm" or whiteout on CXR.
Happens 12-72 hours after injury.
Term
Management of Fat Embolism Syndrome
Definition
Directed at prevention
Immobilization of fracture (long bones) ***
Corticosteroids to reduce inflammation
Monitor fluid status
Monitor chest pain and respiratory
Term
Malunion
Definition
Improper alignment or healing of bone and results in deformity.
Term
Delayed Union
Definition
Failure of bone to unite w/in expected timeframe. Can be caused by infection.
Term
Non-union
Definition
Failure to heal completely before process stops. Pt will continue to have pain.
Term
Factors for Venous Thrombosis (r/t fractures)
Definition
Incorrectly applied casts or traction
Local pressure on a vein
immobility

Can be an issue in heart of lungs (emboli)
Term
Nursing Management of Fractures
Definition
Neurovascular assessement
Pt. education re: cast care, preop teaching, post-op teaching
Prevention of complications assoc w/immobility
Pain management
Mobility training w/assistive aids
Prevention of muscle atrophy
Term
Intracapsular Hip Fracture
Definition
Femoral head is broken within the joint capsule (at the neck). More sever d/t lack of blood supply.
Term
Extracapsular hip fracture
Definition
Fracture that is outside the joint capsule. Trochanter fracture has beeter blood suppy.
Term
Manifestations of hip fracture
Definition
Severe pain and tenderness
Difficulty bearing weight
External rotation
Muscle Spasms
Groin pain with intracapsular
Shortening of the affected extremity (disformity)
Term
Hip Fracture Txs
Definition
Buck's traction
Casting
Surgical Management - #1 choice for both
Traction for 8-12 wks.
Term
Education for hip fracture
Definition
No tub bath
No driving
Limit movement - ADLs
Rick of infection
Signs and Symptoms of dislocation
Pain management
Term
Osteomyelitis
Definition
Severe infection of the bone, bone marrow and surround soft tissue.
Most commonly caused by Staph aureus.
More common in men.
Can be caused by fixation or implants.
Term
Sequestron
Definition
Infected dead bone where new forms around it and becomes separated. Can be caused by cancer.
Term
Dx of Osteomyelitis
Definition
Pain (not always)
Low fever
Slow wound healing
Term
Scoliosis
Definition
Altered bone development.
Lateral deviation of the spinal column that may or may not include rotation or deformity of the vertebrae.
Can be idiopathic (70-80%) of nonidiopathic
Most common deformity in adolescent
girls.
May be r/t cerebral palsy or genetics.
Right thoracic curve is most common.
Term
Metabolic Bone Disruptions
Definition
Osteoporosis
Osteomalacia
Paget's Disease
Term
Definition of Metabolic Bone Disruptions
Definition
Characterized by abnormal bone structure caused by altered or inadequate biochemical reactions - r/t hormones, nutrition or hereditary factors.
Changes chemical or physical structure of bones.
Term
Osteoporosis
Definition
Disease where bone tissue is normally mineralized but mass is decreased.
Bone resorption (by osteoclasts) exceeds bone formation.
Females are 8x more likely to develop.
Progressive disease that drops density of bone.
Term
Risk factors of Osteoporosis
Definition
Gender (Females 1:2 will fx d/t low Ca+ and smaller frame)
Increasing age.
Genetics
White or Asian ethnicity
Cigarettes and ETYOH - 2x the risk
inactivity
certain medications and steroid use
Low testosterone levels
Anorexia or bulemia.
Term
Osteomalacia
Definition
Rare bone disease in adults where bone becomes abnormally soft d/t disturbed C+ and phosphorus balance r/t Vit D deficiency.
Softening of spine, pelvis and LE.
Similar to Ricketts in children.
Term
Vit D deficiency causes
Definition
Poor diet
Intestinal malabsorption of Vit. D
Renal Tubular diseases
lack of exposure to UV rays.

Results in low Ca+ and phosphorus
Term
Manifestations of Osteomalacia
Definition
Back Pain
LE Pain
Muscle Pain
Term
Paget's Disease
Definition
Idiopathic chronic bone disease in adults - mostly men where there is an abnormal and accelerated bone resorption and formation in one or more bones.
Chronic will eventually enlarge and soften affected bones.
Term
Bones affected by Paget's Disease
Definition
Long bones
Spine
Pelvis
Term
Types of bone tumors
Definition
Osteosarcoma
Ewing's sarcoma
Chondrosarcoma
Term
Osteosarcoma
Definition
Usually secondary to breast, lung, prostate, kidney or lymph cancer.
Most common bone tumor
Occurs 10-25yo, mostly males.
Most common sites: distal femur, proximal tibia, proximal humerus (all around the knee) - 50%
Surgery is tx of choice w/amputation and chemo w/60% survival rate.
Term
Ewings's Sarcoma
Definition
Primary bone tumor in children (5-15 yo)
Found iin diaphysis of the femur and pelvis in the medullary cavity.
Fractures r/t bone destruction.
Poor prognosis.
Need biopsy to confirm dx.
50% spread to lungs, bones, and marrow.
Term
Chondrosarcoma
Definition
Maglinant bone tumor that affects middle-aged and elders adults.
Slow growing, late metastisis so does not respond well to Chemo.
Common: Legs, arms and pelvis.
Surgery is most common tx.
Term
Strains
Definition
Resutls from excessive stretching of muscle and fascial sheath (tendons).
Pain in lower back and spine.
Term
Sprains
Definition
Injury to ligaments (bone to bone) - mild to severely torn.
Joint injury. - most common is ankle
Term
Tx for Sprains and Strains
Definition
RICE
R - Rest
I - Ice - help w/pain and spasms
C - Compression
E - Elevate - 24-48 hrs to reduce swelling.
Term
Subluxation
Definition
Partial or incomplete displacement of the join surface
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