Complications of Fractures
- Immediate immobilization of fractures
- Minimal fracture manipulation
- Adequate support for fractured bones during turning and positioning
- Monitoring of high-risk patients – adult males between 20 to 30 years of age and those with altered mental status
- Assisting in early identification of the syndrome
Goals of management:
- Support the respiratory system
- Correct homeostatic imbalance
- Perform arterial blood gas analysis (ABG) to determine the degree of respiratory impairment, as respiratory failure is the most common cause of death.
- Respiratory support is provided with oxygen given in high concentrations.
- To prevent or treat pulmonary edema controlled volume ventilation with positive end-expiratory pressure (PEEP) may be employed.
- To treat the inflammatory lung reaction and to control cerebral edema corticosteroids may be given.
- Vasoactive medications to support cardiovascular function. This is to prevent hypotension, shock and interstitial pulmonary edema.
- Accurate intake and output records to facilitate adequate fluid replacement therapy.
- For pain and anxiety for the patient on a ventilator morphine may be given.
- Calm reassurance is provided to allay apprehension.
- The nurse must be able to recognize the early indications of fat embolism syndrome and report them to the physician immediately for medical management.
Compartment syndrome is a term used to describe a condition caused by an elevated pressure in a confined space in the body. Most fractures of tibia, forearm, foot and hand are associated with this condition. Compartment syndrome develops when tissue perfusion is less than required in the muscles.
Clinical manifestations of Compartment Syndrome:
- Deep, throbbing and unrelenting pain. With compartment syndrome, pain is aggravated by stretching the muscle group within the compartment and is not relieved by analgesia. It is important to remember that pain in this condition is out of proportion to injury.
- Swollen and hard muscle upon palpation
- Paresthesia, alteration in sensation e.g. “pins & needles,” in the cutaneous nerves of the affected compartment – this is another typical sign
- Paralysis of the limb – this is usually a late finding
- The affected area may feel very tense and firm as well
In compartment syndrome, the major arteries of the body are not occluded. To successfully occlude the arteries, tissue pressure should be above the systolic BP. Thus, peripheral pulses are present with compartment syndrome by may be obscured by edema. Pulselessness is a sign of arterial occlusion and not compartment syndrome.