CHAPTER 6 Musculoskeletal System^267
or lower arm. Fat globules may be released from the yellow bone marrow into the
bloodstream and embolize to other areas of the body. The risk for this is highest in
the elderly and in men between 18 and 40. Decrease in mobility following fracture
will increase the risk for DVT. Smoking, obesity, heart disease, and lower extrem-
ity surgery all increase this risk. Delayed union is when a fracture has not joined
within 6 months, despite appropriate treatments. Nonunion is a fracture site that
fails to completely heal. Misalignment is when the fracture site heals, but the
anatomic alignment is not as it should be.
Muscle wasting may occur in the area that has been immobilized. Physical ther-
apy can be very helpful for the patient to regain full functional strength of the area.
HALLMARK SIGNS AND SYMPTOMS
- Local bleeding—may or may not see skin level discoloration; it depends on
amount of blood loss and distance between fracture and skin - Edema at site due to inflammatory reaction to tissue damage
- Abnormal range of motion—need intact bone in order for muscle to pull and
create movement; if fracture occurs near joint, swelling may limit ROM - Shortening of the leg and external rotation is common following hip fracture
INTERPRETING TEST RESULTS
- X-ray shows fracture—may be displaced or not.
- CT scan shows fracture—useful when patient’s body part cannot be turned
or positioned for imaging (e.g. the neck). - Bone scan will show increased cellular activity in area of fracture—useful
for sites where fracture not easily seen or for hairline fractures not previously
diagnosed.
TREATMENT
- Immobilize broken bone—to stabilize area, initially may be done with splint
until fracture reduced (replaced into proper position) and cast applied or fix-
ation device applied surgically. - Open reduction is the surgical repair and direct visual realignment of fracture.
- Pain management as needed.