Medical & Surgical Management
As in the case of the patient in this study, the operation performed was Debridement Impaction & Application of External Fixator at the left tibia. The principles of fracture treatment include reduction, immobilization, and regaining of normal function and strength through rehabilitation.
In an open fracture, there is a risk of tetanus, gas gangrene and osteomyelitis. The objectives of management are to prevent infection of the wound, soft tissue and bone and to promote healing of soft tissue and bone. Debridement and irrigation is used to remove anaerobic organisms. Devitalized bone fragments are removed. The fracture is then carefully reduced and stabilized by external fixator. Intravenous antibiotics are prescribed to prevent or treat infection.
Fracture treatment involves realigning the bone fragments (reduction) close to their normal or anatomic position and holding the fragments in place (immobilization) so that bone union can occur. Reduction of a fracture refers to the restoration of the fracture fragments to anatomic alignment and rotation. In most cases, fracture reduction becomes more difficult as the injury begins healing. The specific method used on the nature of the fracture in this case is closed reduction.
Open reduction is a method is used if the bone is fragmented or difficult to reduce, and may requires screws and a plate to hold the fragments in place. The doctor makes a cut in the skin covering the break to expose the bone fragments. The bone fragments are moved into their normal position, and screws, a plate with screws, or a rod may be used to hold the realigned bones in place. Extremely severe fractures may require placement of a natural or artificial bone graft. The doctor closes the incision with stitches, and a splint, dressings, plus a splint or cast may also be used to protect the area. After the fracture has been reduced, the bone fragments must be immobilized, or held in correct position and alignment, until union occurs. Immobilization is accomplished by external. Methods of external fixation include bandages, casts, splints, continuous traction, and external fixators. External fixators are used to manage open fractures with soft tissue damage. They provide stable support for severe comminuted fractures while permitting active treatment of damaged soft tisuues. The fracture is reduced, aligned and immobilized by a series of pins inserted in the bone. Pin postions is maintained through attachment to a portable frame. The fixator facilitates patient comfort, early mobility, and active exercise of adjacent uninvolved joints. Complications related to disuse and immobility are minimized.
Open complete comminuted fracture of the tibia, as in the case of the patient, was treated with external fixation. Hip, foot and knee exercises are encouraged within the limits of the immobilizing device. Partial weight bearing is begun when prescribed and is progressed as the fracture heals in 4 to 8 weeks.
Reduction and immobilization are maintained as prescribed to promote bone and soft tissue healing. Swelling is controlled by elevating the injured extremity and applying ice as prescribed. Neurovascular status is monitored, and surgeon is advise if signs of neurovascular compromise are identified. Reassurance, position changes and pain relief strategies controls feeling of restlessness, anxiety and discomfort. Isometric and muscle-setting exercises are encouraged to minimize disus atrophy and to promote circulation. Participation in activities of daily living is encouraged to promote independent functioning and self-esteem. Gradual resumption of activities is promoted within the therapeutic prescription.
M – edication
Intake of pain relievers in case the site is in pain.
E – conomic
The use of nonpharmacotherapy such as exercises and elevation of lower extremity to control edema and pain are encouraged to avoid further expenditure on medication.
T – reatment
Management of such condition would include proper therapy and exercises of the extremities, intake of pain relievers as prescribed and dietary supplements as well.
H – ygiene
Advise to follow proper body hygiene and to maintain cleanliness on site. This would promote less risk for infection.
O – ut Patient/ Follow-up
In cases wherin pain beyond limits of discomfort can be felt, advise to report to physician or surgeon immediately. Uncontrolled swelling and pain, cool and pale toes, signs of infection, loose fixators must be immediately reported to the physician for proper management.
D – iet
Instruct to eat foods that are rich in protein, dietary fiber, carbohydrates, Vitamins A & C to promote wound healing.
The patient in this study had undergone debridement impaction and application of external fixator at the lest tibia. He had a tibial fracture last July 6 due to a blunt injury froma foreign object fall. He was transferred from a hospital at Cabanatuan to East Avenue Medical Center to seek for further advise and proper treatment of his case.
Proper nursing care such as pain relief using nonpharmacotherapy and administration of prescribed drugs were done to promote comfort. Hygiene was also strictly implemented to avoid risk for infection. Nursing assistance was also given to help him in his activities of daily living.
Health teaching is a very important role on the part of the nurses. This is of great significance to the knowledge deficit of patients regarding health and illness.
Strict compliance to the medical treatment, health teachings and medical check-up is advised. With proper nutrition and conformity to the medications & therapy, recovery would be easier and faster.
Definition Of Terms
Debridement – removal of foreign material and devitalized tissue from a wound
Edema – excessive accumulation of fluid in the tissue spaces, due to increased
trabsudation of of the fluid from the capillaries
Fracture – a break in a bone usually caused by trauma
Impaction – a condition in which one fragment of a fractured bone is driven into another and is fixed in that position
Open reduction – a reduction performed after making an incision through the soft
parts in order to expose the fracture or dislocation