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Orthopaedics - Define the term fracture.

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Introduction

ORTHOPAEDICS 1. Define the term fracture. With aid of a diagram, illustrate the types of fractures. Fracture means the breakage of a bone, either complete or incomplete. (Oxford medical dictionary) For types of fracture see diagram (A) 2. Describe the stages of fracture healing. The stages of fracture healing are as follows; After fracture - wound bleeds and fills with clot. After one week - clot retracts and is removed by phagocytes. Capillaries and Fibroblasts go to damaged area. These cells have osteogenic potential which lays Osteoid. After three weeks - Cartilage and Osteoid is forming around the breakage. Six to twelve weeks - Osteoid ossifies to form Callus (a cuff of provisional woven bone). Six to twelve months - Cortex to cortex union (bone directly joining the fractured surfaces. 3. Identify the signs and symptoms that lead you to beleive a bone is fractured. - Pain. Most common symptom, but people have different pain thresholds, so sometimes hard to tell. Also depends on the site and how instable it is. - Swelling. Gross swelling normally means a vascular rupture. - Weakness - Loss of function. May be unable to move the limb or have difficulty. E.g. An old lady may be able to walk on a fractured neck of femur, but will limp. - Loss of sensation or motor power. Suggests nerve or vascular damage. - Tenderness - Deformity. Limb may be bent or shortened, or with the spine or tibia, it may be out of alignment. ...read more.

Middle

Choose a patient from the orthopaedic list and describe their total care from entering the department to leaving the recovery room. The patient that I chose to follow from entering the department to leaving the recovery room, was a 67 year old woman. She suffers from diet controlled diabetes, had a right total hip operation in 2001, and had come to theatre today for a left knee replacement. On arrival to our department. The patient was checked in at reception. This included checking; - the armband corresponded with her paperwork. - date of birth, hospital number, full name, address, ward and consultant. - when she last ate, which was 10oclock the previous night. - checked operational site was marked. - no jewellry - no allergies - suffers from back problems - pain - dentures in situ - blood H.B. 11.4 - ted stockings in situ - xrays available - no blood ready in fridge, so hospital blood bank informed to make readily available There was some difficulty with language when speaking to the patient, as she was an Indian lady. But we managed to get her to understand our questions. On arrival to the anaesthetic room. Monitoring was placed on the patient, to include Pulse Oxymetre, E.C.G. and Blood pressure cuff, telling the patient before each action, what was about to be done. The O.D.P. squeezed the arm of the patient to block venous return for the anaesthetist to place a 16 gauge venflon into the patients left hand, as she was right handed, after injecting some lignacaine first to numb the area, to cause less discomfort. ...read more.

Conclusion

Skin clips are used on the skin. The Ioban drape is then removed, the wound is cleaned with Betadine and then dressed with a 15cm Velband, absorbant pad and a 15cm Crepe. The torniquet is removed and time noted. PCA is attached to the Y connector, and the recovery staff are called for. When they arrive, a handover is given, to let them know what operation was performed, what sutures were used, informed of it being Spinal anaesthesia, and what drain and dressings were used. Monitoring is removed, and another 500ml of Gelofusine attached to IV line. The patient is transferred back onto the bed and the oxygen is transferred to a cylinder brought on the bed. In recovery. Once the patient is in recovery, the monitoring is immediately re-applied and observation results recorded every 5 minutes on a post-operative check sheet. Oxygen is connected to the pipeline on 4 litres, and the drain is opened. Other checks on the post-operative checklist include; Wound - no oozing observed. I.V.I. - Gelofusine in progress. Drains - 900mls Time received Time noted of when PCA was attached Note made of operation and anaesthesia. The patient is sat up and made comfortable, giving her the PCA button and explained to how to use it. After half an hour has passed, 1 ltr of Saline is attached to I.V., the ward are called to collect the patient, and another hand over given before the patient leaves the department. ...read more.

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