Search

Lisfranc's injuries are one of the most commonly missed fractures in a multitrauma patient. Failure to recognize and treat such an injury can lead to acute (e.g., compartment syndrome of the foot) and chronic problems (e.g., arthritis). A list of reminders is included to help with the recognition and treatment of Lisfranc's injuries (Table 1).

External fixators are an effective way of fixing broken bones while at the same time optimising patients' mobility. In this article Julie Santy describes the major issues nurses need to be aware of to contribute effectively to patient care.

A case report is presented that describes the initial care of a severely injured patient who was hemodynamically unstable. The discussion highlights the process used to recognize life-threatening injuries, to differentiate internal sources of hemorrhage, to provide damage-control surgery, and to stop further bleeding with an interventional radiologic examination. The emergency nursing care of a patient with unstable pelvic trauma is included.

To improve our practice performance for patients admitted to the emergency department with fractured ankles, our Clinical Quality Improvement Team (CQI) developed the Fractured Ankle Critical Path, for patients needing open reduction and internal fixation, but for whom surgery could or should be deferred as determined by the orthopaedic surgeon. Members of the team included an orthopaedic trauma surgeon, an emergency department physician, case managers, and representatives of the Home Care Department at Rhode Island Hospital. The critical path includes a Home Care referral procedure, an R.I. Hospital Fracture and Orthopaedic Information Sheet, and a Fractured Ankle Home Care Protocol. The goal of the Fractured Ankle Critical Path is to decrease length of stay while maintaining positive outcomes.

When burn injury and skeletal trauma are two components of the multiple trauma injury, specific difficulties arise requiring a constant reevaluation of risks and benefits for each planned therapeutic maneuver. Unfortunately there is a scarcity of published literature that addresses this specific topic. This article focuses on these issues and discusses the therapeutic options available. The object of this article is to summarize available information, and offer recommendations to assist the clinician in treating this challenging clinical problem.

Falls often lead to the fracture of bones in the elderly population. Fall incidence is increasing with the concomitant rise in the elderly population. Recently, some nontraditional methods of fall prevention have been explored. This article provides some background information about the ancient practice of Tai Chi as well as a brief review of the current literature exploring the effectiveness of Tai Chi in health promotion and fall prevention.

Cost-effective delivery of quality patient care is a major focus of the orthopaedic advanced practice nurse's practice. Long-term skeletal traction therapy for select fractures of the pelvis remains a treatment option for certain patients. The purposes of this article are to describe the development of a joint proposal for home skeletal traction therapy and to analyze the cost savings involved by reviewing a case study of a home traction patient.

Following orthopaedic trauma, fracture blister formation creates a disruption in skin integrity for the injured patient and unique care challenges for the nurse and physician. These blisters may delay surgery, alter the optimum treatment plan, promote wound infection, delay wound healing, and ultimately prolong recovery. This article presents a review of the current literature and includes a discussion of the anatomy of the skin, pathophysiology of fracture blisters, and a review of current research. The complications, prevention, treatment, and implications for nursing care are also examined.

Having obvious psychical defect, the fractured patients were different from other orthopedical patients. The characteristics of disease courses of 63 patients were analyzed in this study. The result indicated that at the time of pre-operation, the end of first post-operation week, and the end of second post-operation week there were significant difference in patients' psychical condition (P < 0.05). At the end of third post-operation week, the physical trauma were cured and their psychical condition turned to be almost normal. It may related to the nurse patient relationship model, active-passive model, and guidance-cooperation model which were used during deliria period, recovering period, and smooth period. Using these models effectively may improve the recovery of the patients physically and psychologically.

Craniofacial injuries are the result of deceleration, blunt, or penetrating trauma. Depending on the mechanism of injury, craniofacial fractures can be minor and go undetected, or they can produce devastating facial deformities. With the advent of intermaxillary fixation devices, surgeons can manipulate facial bone structures and repair soft tissue damage in the majority of patients with craniofacial trauma injuries. Most patients experience optimal results from their craniofacial surgical procedures and return to normal lives after surgery.

Trauma injuries to the acetabulum and the associated pelvic region are second only to head injuries in mortality and morbidity for surgical patients. Surgeons in the past avoided exposing and stabilizing complex fractures of the acetabulum because of the intricate anatomy of the pelvic region. Recent advances in surgical techniques have increased the use of open reduction internal fixation of acetabular fractures. Early internal fixation of acetabular fractures allows rapid mobilization of severely injured patients and provides trauma patients optimal, long-term, functional results.

1. The incidence of pelvic fractures has greatly increased; automobile and motorcycle crashes, pedestrian accidents, and falls from great height are the most common causes. Pelvic fractures caused by high-energy trauma often result in significant morbidity and mortality with mortality rates variously reported at 10% to 50%, dependent upon fracture classification and associated injuries. Mortality occurs from associated trauma to viscera, abdominal organs, and abdominal vessels, and from early complications of hemorrhage. 2. The difficulty in management of patients with pelvic fractures is determining whether fractures are stable or unstable. Single breaks with no displacement in the pelvic ring, which includes injuries to the ischium, ilium, pubis, and sacrum, are stable fractures and account for one third of all pelvic fractures. 3. Increasingly widespread use of surgical stabilization internally via rigid fixation of pelvic fractures has helped reduce the morbidity and mortality related to these fractures. Other benefits that have resulted include shortened hospitalization, decreased complications, and earlier mobility.

The principles of the management of fractures are fairly straightforward and yet there are many practical points to consider. This article, the second in a three-part series, considers the basic steps in treatment and the necessary nurse-aid intervention for fractures at specific sites.

Fractures occur in the bones of any age group, even the newborn, and are caused in any number of different ways. This article is the first in a three-part series that will examine the causes and types of fractures, the symptoms and presenting factors, nurse-aid intervention and the healing process.

Acetabular fractures are often associated with multiple life-threatening injuries. The initial assessment of the patient sets baseline data for all further nursing assessments. Optimal patient care requires that the nursing staff be knowledgeable about the anatomy of the acetabulum, the classification of fracture type, the influence of the mechanism of injury, and potential complications. A basic understanding of the surgical approach and relevant post-operative care is mandatory. Patients with acetabular fractures present a complex nursing challenge. Although nursing involvement may be limited to initial assessment and stabilization prior to transport to a different hospital, a knowledgeable nurse can make a difference in patient outcome.

Nursing care of patients with pelvic fractures has changed dramatically in the past two decades. Fracture care that necessitated long periods of immobility and consequent complications has been influenced by new classification systems, the use of external fixation, and the more recent use of internal fixation. The evolution of pelvic fracture patient care has greatly influenced nursing care of these patients.

Nursing management of patients with orthopedic fractures resulting from motor vehicle accidents is a frequent challenge for nurses in an emergency department setting. The nurse must have knowledge of the mechanics of injury, the classification of the resulting fracture types, and the usual medical interventions. In addition, emergency department nurses should follow plans of care that are based on nursing diagnoses so that appropriate nursing interventions can be determined and consistently provided. Initiation of these care plans must not be delayed until the patient is admitted to an inpatient nursing unit, but should be begun in the emergency unit setting. This article presents information that the emergency room nurse needs in order to make plans for nursing care, and discusses seven nursing diagnoses that are almost always appropriate for patients seen in the emergency department who are experiencing orthopedic fractures resulting from motor vehicle accidents.

This retrospective, descriptive study examined the wishes, concerns, and experiences of patients who had been placed in a halo brace to treat a cervical fracture. Thirty-eight subjects who had a halo brace applied during the past 8 years completed the questionnaire. Data obtained reflected physiologic as well as psychosocial needs of these patients. Responses were categorized based on nursing diagnoses. Results demonstrated the need for more specific information given to patients before discharge from the hospital to facilitate adjustment to the halo brace and activities of daily living.