Question

Case Study 2 JL, a 50-year-old woman, fell and broke the left tibia at the ankle. She is in the emergency department, waiting for the fracture to be immobilized. The leg hurts and she notes that the ankle is swelling. A diagnosis of a simple fracture and sprain (damage to ligaments) is made. 1. What is the cause of pain and swelling? What can JL expect in the days to come as inflammation resolves and healing begins? 2. What is the rationale for immobilizing the fractured bone? 3. She is told to come back to the fracture clinic in 24 hours to have her cast checked. What could happen to the inflamed tissue if the edema increases in the casted area? 4. She reports feeling fatigued and anorexic, and has a low-grade temperature. What is the cause of these symptoms?

Answer 1

FRACTURE --complete or partial break in the bone

SPRAIN--A stretching or tearing of ligaments (fibrous connective tissue that joins bones and joints)

Ligaments hold bones together and tendons attach muscles to bones

signs and symptoms of fracture and sprain :

• pain or tenderness
• Swelling
• Bruising
• Deformity
• Bone poking out of skin
• Inability to walk or bear weight on the injured part
• Grinding noise at the injury site
• Fainting, dizziness, shock because of blood loss if any and also as a psychological reaction to trauma

1.PAIN AND SWELLING

• SWELLING --injury causes soft tissue damage ---->increased movement of fluid and WBC in to the affected area--->swelling
• Pain--due to direct damage to the body and also swelling causes compression of nerves and release of chemicals which cause pain
• Redness, swelling, tenderness is because the blood vessels widen up as a natural process to ease blood flow and delivery of oxygen, vitamins, minerals to the wound
• Swelling is initially good in initial phases because it initiates healing factors that help to migrate cells to the affected area but swelling is also bad because it destructs and distends to the tissues and destroys the anatomy
• Swelling is seen in the initial phases but it should reduce in several days like after a week of injury... If it not reduced in a week it is of great concern
• Advice the patient to keep the affected limb above heart level, exercise, to wriggle toes and fingers..... This helps to reduce swelling
• JL should experience reduced swelling and pain as the healing process is started
• Worsening redness and swelling indicates poor healing

2.ratiinale for immobilising the fractured bone

• broken bone can increase pain and bleeding and can damage soft tissues around injury. This can lead to complications in repair and healing of injury in later stages
• Fracture limb should be immobilised to prevent further damage
• To reduce swelling
• To provide comfort
• To reduce pain
• To support the affected limb
• To reduce neuro vascular injuries associated with contusion, sprains, laceration, fracture, dislocation, painful joints because of inflammatory diseases
• Both fracture site and joints (above and below) should be immobilized
• First aid of fractures is mostly about immobilising the limb because it is a life saver

3.edema in the casted area:

• cast wraps all the way round the injury.made of fibre glass or plaster
• Should be removed in a hospital setting only
• if there is swelling in the casted area there are chances of developing COMPARTMENT SYNDROME
• COMPARTMENT SYNDROME -----it is a serious condition that involves increased pressure in the muscle compartment. It can lead to muscle and nerve damage and problems with blood flow
• Thick layer of tissues (called fascia) usually separates muscles (in the arms and legs) from each other.. Inside each layer of fascia is a confined space called compartment
• Compartment includes muscle tissues, nerves and blood vessels.
• Fascia usually do not expand..
• If there is swelling ---> pressure increases ----> presses the muscle tissues, nerves and blood vessels ----> blood flow to the compartment reduces -----> muscle tissue may die and further damage may make the legs dysfunctional

4.fatigue, anorexia, fever after a fracture :

FATIGUE --

• -it is a physiological and psychological response of patient
• Physical and emotional energy is used in trying to deal with pain, hospitalisation, hindered mobility etc all these cause the person to fell fatigued
• Loss of sleep is also a reason
• Improper diet is also a reason
• If there was a blood loss at the time if fracture incident, this also might cause the person to feel fatigue

ANOREXIA

• it is also a physiological and psychological response
• It is a self limiting problem
• It is a part of normal recovery process
• It should resolve in 6 weeks
• But meanwhile patient should be encouraged to have good food because if they their dietary requirements are not met,healing doesn't occur and also anaemia may result in further complications

FEVER

• this is of great concern because fever indicates underlying infection
• Pain, warmth, redness, swelling are present in the injured area
• Infection should always be at top priorities because it delays healing and leads to further damage
• Pushing sockets may also form, if it bursts pushing may drain from it
• Doing all the procedures in a sterile manner, following cleanliness even at home, antibiotics would prevent infection