NU 126 EXAM 4 GUIDE WITH
COMPLETE SOLUTION
Intertrochanteric fracture vs subtrochanteric fracture - ANSWER inter: occurs
70% of the time
Sub: occurs 30% of the time
**commonly affect the femoral neck
***ALL FRACTURES NEED AN XRAY TO CONFIRM**
Mobility Exemplar Fractures - ANSWER break or disruption in continuity of
bone that affects mobility and causes pain
TYPES:
1. Complete (no altered alignment) or Incomplete
2. Open (compound open skin) or Closed (simple no wound )
3. Fragility (pathologic/ minimal trauma) (spontaneous)
4. Fatigue or stress
5. Compression (especially in geriatric patients)
Stages of bone healing - ANSWER 1. hematoma formation: hematoma at the
site of the fracture, within 24-72 hours post injury.
2. Fibrocartilage Callus Formation: Granulation tissue invade the hematoma,
causing the formation of fibrocartilage which is the foundation for bone
healing. Occurs within 3days- 2weeks
,3. Bony Callus Formation: The fracture site is surrounded by new vascular
tissue known as a callus, which is the beginning of a non-bony union. takes
3-6 weeks
4. Reabsorption : the callus is gradually reabsorbed and transformed into
bone. takes 3-8 weeks
5. Consolidation and remodeling: of bone continue to meet mechanical
demands. This takes up to 4-6 sometimes up to 1 year depending on the
severity of the injury, age and health of the patient.
Early Complications: Shock - ANSWER **more common in pelvic fractures
and displaced or open femoral**
-causes hypovolemia/ shock from hemorrhage caused by tearing of the
femoral artery from bone fragments. (unstable pelvic fractures)
Early Complications: Fat Embolism - ANSWER Fat emboli enters circulation.
- occurs mostly with long bone (femur) fractions.
-has a rapid onset within 12-72 hours
-s/s
1. hypoxia
2.tachypnea
3. dyspnea
4.tachycardia
5. substernal chest pain
6. low-grade fever
,7.crackles
8. petechial (after 2-3 days after onset of symptoms)
9. Neurological deficits (restlessness, agitation, seizures, focal deficit, and
encephalopathy
Early Complications: Compartment syndrome - ANSWER - Caused by an
elevation of pressure within an anatomic compartment.
-Perfusion to tissues is impairs--> cell death--> tissue death/necrosis-->
permeant dysfunction
- develops quickly
-occurs commonly in young adults
-s/s
1.Pain
2.pallor
3.Pulselessness**
4.parathesis
5.paralysis
**Notify the surgeon**
Early Complications: VTE and PE - ANSWER -More common in lower
extremity and pelvis fractures
-The elderly are especially at risk
Delayed Complications: Delayed union, malunion, and nonunion - ANSWER
, -Delayed union: normal healing of bone
-malunion: healing of bone is misaligned
-nonunion: failure to have the bone reunite
Delayed Complications: Avascular necrosis of bone - ANSWER -the bone
loses its blood supply and dies
Delayed Complications: Complex regional pain syndrome (CRPS) - ANSWER
Is defined as dysfunctional peripheral and CNS response.
-affect women more
- s/s
1. severe burning pain
2.local edema
3.hyperesthia
4.stiffness
5.discoloration
6.vasomotor changes
**can prevent with early ambulation after surgery with pain control**
Delayed Complications: Heterotrophic Ossification - ANSWER benign bone
growth in atypical location
-s/s
1.decreased ROM
2.Pain
COMPLETE SOLUTION
Intertrochanteric fracture vs subtrochanteric fracture - ANSWER inter: occurs
70% of the time
Sub: occurs 30% of the time
**commonly affect the femoral neck
***ALL FRACTURES NEED AN XRAY TO CONFIRM**
Mobility Exemplar Fractures - ANSWER break or disruption in continuity of
bone that affects mobility and causes pain
TYPES:
1. Complete (no altered alignment) or Incomplete
2. Open (compound open skin) or Closed (simple no wound )
3. Fragility (pathologic/ minimal trauma) (spontaneous)
4. Fatigue or stress
5. Compression (especially in geriatric patients)
Stages of bone healing - ANSWER 1. hematoma formation: hematoma at the
site of the fracture, within 24-72 hours post injury.
2. Fibrocartilage Callus Formation: Granulation tissue invade the hematoma,
causing the formation of fibrocartilage which is the foundation for bone
healing. Occurs within 3days- 2weeks
,3. Bony Callus Formation: The fracture site is surrounded by new vascular
tissue known as a callus, which is the beginning of a non-bony union. takes
3-6 weeks
4. Reabsorption : the callus is gradually reabsorbed and transformed into
bone. takes 3-8 weeks
5. Consolidation and remodeling: of bone continue to meet mechanical
demands. This takes up to 4-6 sometimes up to 1 year depending on the
severity of the injury, age and health of the patient.
Early Complications: Shock - ANSWER **more common in pelvic fractures
and displaced or open femoral**
-causes hypovolemia/ shock from hemorrhage caused by tearing of the
femoral artery from bone fragments. (unstable pelvic fractures)
Early Complications: Fat Embolism - ANSWER Fat emboli enters circulation.
- occurs mostly with long bone (femur) fractions.
-has a rapid onset within 12-72 hours
-s/s
1. hypoxia
2.tachypnea
3. dyspnea
4.tachycardia
5. substernal chest pain
6. low-grade fever
,7.crackles
8. petechial (after 2-3 days after onset of symptoms)
9. Neurological deficits (restlessness, agitation, seizures, focal deficit, and
encephalopathy
Early Complications: Compartment syndrome - ANSWER - Caused by an
elevation of pressure within an anatomic compartment.
-Perfusion to tissues is impairs--> cell death--> tissue death/necrosis-->
permeant dysfunction
- develops quickly
-occurs commonly in young adults
-s/s
1.Pain
2.pallor
3.Pulselessness**
4.parathesis
5.paralysis
**Notify the surgeon**
Early Complications: VTE and PE - ANSWER -More common in lower
extremity and pelvis fractures
-The elderly are especially at risk
Delayed Complications: Delayed union, malunion, and nonunion - ANSWER
, -Delayed union: normal healing of bone
-malunion: healing of bone is misaligned
-nonunion: failure to have the bone reunite
Delayed Complications: Avascular necrosis of bone - ANSWER -the bone
loses its blood supply and dies
Delayed Complications: Complex regional pain syndrome (CRPS) - ANSWER
Is defined as dysfunctional peripheral and CNS response.
-affect women more
- s/s
1. severe burning pain
2.local edema
3.hyperesthia
4.stiffness
5.discoloration
6.vasomotor changes
**can prevent with early ambulation after surgery with pain control**
Delayed Complications: Heterotrophic Ossification - ANSWER benign bone
growth in atypical location
-s/s
1.decreased ROM
2.Pain
