Question

L.G. , a 23-year-old man, is brought to ED following injury to his right arm during a rugby game. A bone in his forearm is protruding through his skin. The ERS immobilized the arm at the scene. L.G. rates his pain as a 9 on a scale of 0-10. How would you classify this fracture? Explain. For what other clinical manifestations associated with a fracture will you assess L.G.? L.G. asks you how long it will take for his bone to heal. You quickly review fracture healing so that you can answer his question better. Describe the six stages of bone healing. An x-ray confirms • Complete transverse break of the right radius • Oblique fracture of the right ulnar bone. L.G. is scheduled for an immediate debridement and open reduction/repair of these fractures. How will you explain the planned treatment to L.G.? What type of immobilization would you expect L.G. to return from surgery with? What type of medication would you expect the health care provider to order for L.G. postoperatively? What vaccination should he have received in the ED if he were not up-to-date? What will you teach L.G. about his nutritional needs related to bone healing? L.G. returns to the orthopedic unit following an open reduction and fixation of his arm fractures. His right arm has a split cast on it that is secured with an Ace wrap. It is elevated above the level of his heart. The surgeon has written an order for hourly neurovascular checks. What will you assess when performing these checks?

Answer 1

The six stages of bone healing are

First stage:there is formation of hematoma

Second stage:the hematoma turns to granulation tissue,thus is the base for formation of new bone

Third stage: Callous forms at this granulated area consisting of calcium, phosphorus, cartilage and the osteoblasts

Fourth stage:joining of the fractured bone occurs called as ossification .It roughly taken 3 weeks to months to ossify

Fifth stage:The bone unites called as consolidation

Sixth stage:the remodels here

The planned treatment can be explained in the following way

• Explain the patient about the type of fracture in lay man term that there is a break horizontally and from upper to lower end in an angle probably from one end to other end.In order to correct t this a surgery is needed.This can help in faster healing

A splint can be applied to immobilize the part .Here as the procedure is in the arms cast can be used to immobilize.

Here the vaccination of Tetanis toxoid is reviewed because the injury and the surgery can put a patient at risk for infection.so this vaccine can be administered in the emergency department

The medications post surgery are

• Antibiotics to prevent infection
• Analgesics to relieve pain
• Anticoagulant to prevent clot formation
• Intravenous fluids to replace ant fluid lost

For an effective bone healing the following nutrients are to be gained from the food

• Calcium rich foods
• Dairy products
• Meat
• Nuts
• Vegetables

The neurovascular check includes the following

• Check the capillary refill by pressing the nail bed or finger top for a second
• Skin color to know the blood flow
• Temperature
• Pulse to check circulation
• Sensation to know the neurological status
• Movement of fingers for motor function