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Examination: Surgical Treatment of Patients with Open Tibial Fractures
MAY 1996, VOL 63. NO 5
Examination SURGICAL TREATMENT O F PATIENTS WITH OPEN TlBlAL FRACTURES
1. human errors and falls. 2. right lower legs being pressed/against brake pedals at the moment of impact. 3. crush injuries. 4. projectiles thrown from unshielded mechanical parts. a. 1,2, and3 b, 1 , 3 , a n d 4 c. 2,3, and 4 d. all of the above
1.Trauma is the leading cause of death in people 37 years of age and younger. a. true b. false 2.One study estimates that 30% of all trauma injuries are open tibial fractures from 1. falls from heights. 2. farm accidents. 3. stab wounds. 4. motor vehicle collisions (MVCs). a. 1 and4 b. I , 3, and 4 c. I , 2, and 4 d. all of the above
7.When patients fall from heights, open fractures of the , or may result from direct blows to the plantar surface of the foot. a. femur, tibial plateau, calcaneus b. ischial tuberosity, acetabulum, medial malleoli c. calcaneus, talus, tibial plateau d. distal femur, posterior malleolus, distal tibia
3.Closed tibial fractures with severe soft tissue and neurovascular damage result in high limb amputation rates. a. true b. false
8.0pen tibial fractures from gunshot wounds have a high incidence of nerve transections. a. true b. false
&Delays in necessary limb amputations may cause significant increases in 1. the number of surgical procedures. 2. sepsis. 3. disabilities and death. 4. hospital costs. a. 2 a n d 3 b. I , 2, and 3 c. 2,3, and 4 el. all of the above 5.The total cost of medical and surgical treatments, rehabilitation, and loss of productivity from open tibial fractures from MVCs approaches annually. a. $10 billion b. $20 billion c. $30 billion d. $40 billion 6.Farm-related tibial injuries most often result from
9.Type I11 open tibial fractures have the highest 9 incidence of and a. dislodged joints, arthritis b. paresthesia, pain c. gas gangrene, tetanus d. osteomyelitis, nonunions l a p a t i e n t s with type 111 open tibial fractures are at risk for sudden, life-threatening changes from a. compartment syndromes. b. associated myocardial ischemic attacks. c. Clostridiurn bacterial infections. 8, associated vascular injuries. 11.Intracompartmental pressures that range from indicate the need for fasciotomy procedures. a. lOto20psi b. 30 to 40 mm Hg 899
AORN JOURNAL
MAY 1996, VOL 63, NO 5
pulsatile lavage systems, then followed by some type of fractures. a. an incision, a tourniquet, graft b. drainage, traction, prosthesis c. irrigation, debridement, implant d. cauterization, fluoroscopy, splint
c. 50 to 60 mm H 2 0 d. 70 to 80 mm Hg 12.The cardinal signs of compartment syndrome include all of the following, except a hemorrhage. b. lack of palpable pedal pulses. c. varying degrees of paresthesia. d. pain with passive stretching of muscles. 13.0rthopedic surgeons perform thorough irrigation and debridement procedures on open tibial fracture wounds, ideally within after injuries occur. a. 24 to 48 hours b. three to four hours c six to eight hours d. 10 to 12 hours I f f T h o r o u g h neurovascular examinations of patients’ extremities with open tibial fractures include evaluating of all of the following, except a. motor strength. b. capillary refilling. e. events surrounding the injuries. d. presence of peripheral pulses. 15.In addition to IV cephalozin and gentamicin, patients who incur open tibial fractures from farm accidents also receive IV tetracycline because these wounds are likely to be contaminated with Myobacterium from the soil. a. true 4 false 16.Whenever possible, the objective of surgical treatment for open tibial fractures is to 1. prevent infection through irrigation and debridement procedures and IV antibiotics. 2. restore normal skeletal alignment and bone length (ie, reduction). 3. maintain bone reduction and stability until healing occurs. 4. preserve and restore musculoskeletal function for weight bearing. a. I , 2, and 3 b. I , 3, and4 c. 2,3, and 4 d. all of the above 17.Most open tibial fractures require
with
to stabilize
18.0perating room personnel should be ready to treat impending or existing shock or hemorrhage in patients with open tibial fractures by having appropriate equipment and supplies available. a true b. false 19.Type I11 open tibial fractures can cause all of these associated conditions, except a. Harvey’s contractures. b. damage to blood vessels and nerves. c. secondary hemorrhage. d. severe damage to soft tissues. =.The surgeon inflates the pneumatic tourniquet on the leg with the open tibial fracture to prevent further tissue damage during surgery. a- true b. false
21Surgeons conduct layer-by-layer debridements of open tibial fracture wounds, which include all of the following, except a. excision of devitalized fascia and muscle. b. conservative excision of skin edges. c. preservation of soft tissue attachment to bone. d. detachment of skin from underlying soft tissue. 22.Transection of the necessitates a primary limb amputation of the affected extremity to decrease the occurrence of nonhealing leg ulcers and infections. a. sciatic nerve b. lateral plantar nerve c. posterior tibial nerve d. lateral femoral cutaneous nerve =.According to the article, allow open tibial fracture wounds to heal and best meet the requirements of adequate bone stability with minimal soft tissue exposure and damage. a. intermedullary nails 901
AORN JOURNAL
MAY 1996, VOL 63. NO 5
b. external fixation devices c. plating systems d. continuous traction devices
aAPostoperative nurses closely monitor patients' nutritional statuses and urine outputs with the knowledge that patients with myonecrosis may develop related to extensive tissue damage from their open tibial fracture injuries. a. osteomyelitis b. nonunions c. acute renal failure d. protein malnutrition #If
large amounts of bone loss occur, surgeons implant into fracture wounds to temporarily fill defects. a. bone chips b. oxidized cellulose c. absorbable gelatin sponges d. antibiotic beads
=Extensive soft-tissue loss requires the use of muscle flaps (eg, local fascia1 cutaneous, remote pedicle) followed by split-thickness skin grafts to provide adequate coverage to extensive open tibial fracture wounds. a. true b. false
=.When free or pedicle muscle flaps are used, surgeons delay bone grafting procedures for approximately to allow for healing of muscle flaps. a. five to 10 days b. 15 to 20 days c, four weeks d. six weeks =Patients who develop gas gangrene may receive radiolabeled monoclonal antibody treatment as an adjunct therapy to imgation and debridement procedures and oral antibiotic therapy. a. true b. false =What is a source of pain around pin sites of external fixation devices that interferes with thorough cleansing and may result in small areas of skin necrosis? a. osteomyelitis b. skin tension c. loose pins d. tight dressings =Wadding material from shotgun shells causes severe foreign body reactions in patients with open tibial fractures from gunshot wounds. a. true b. false
Pain is Number One Fear of Patients Facing Surgery The November 1995 issue of Anm?hesio/og.yreports that pain is the number one fear of Americans facing surgery. In a survey conducted by Total Research Corp, Princeton, NJ, 500 Americans were polled, 27% of whom had undergone surgery during the previous five years. More than half (57%) reported that their primary concem was the pain they might experience after surgery. Four percent of all respondents reported they had canceled or postponed a surgical procedure because of this fear. Of those individuals who had surgery, 77% reported pain afterward, with 80% of those saying they experienced moderate to extreme pain. Nearly three quarters (7 1 %) said they experienced pain even after receiving pain medications. Eighty percent reported receiving pain medication on time, although
one third of the individuals had to ask for the medication and 16% had to wait for medication. Thirteen percent of the postsurgical patients used a patientcontrolled pump that enabled them to self-administer pain medication. According to the article, medical professionals and the public should increase their awareness of postsurgical pain management to reduce the incidences and severity of postsurgical pain. The authors suggest that this can be accomplished by increasing the number of acute pain management programs and establishing aggressive public and patient education programs. C A Wartielld, C H Kahn, Xcute pain management, 'Anesthesiology 83 (November 1995) 1090-1094.
903 AORN JOL'RNAL
Examination SURGICAL TREATMENT O F PATIENTS WITH OPEN TlBlAL FRACTURES
1. human errors and falls. 2. right lower legs being pressed/against brake pedals at the moment of impact. 3. crush injuries. 4. projectiles thrown from unshielded mechanical parts. a. 1,2, and3 b, 1 , 3 , a n d 4 c. 2,3, and 4 d. all of the above
1.Trauma is the leading cause of death in people 37 years of age and younger. a. true b. false 2.One study estimates that 30% of all trauma injuries are open tibial fractures from 1. falls from heights. 2. farm accidents. 3. stab wounds. 4. motor vehicle collisions (MVCs). a. 1 and4 b. I , 3, and 4 c. I , 2, and 4 d. all of the above
7.When patients fall from heights, open fractures of the , or may result from direct blows to the plantar surface of the foot. a. femur, tibial plateau, calcaneus b. ischial tuberosity, acetabulum, medial malleoli c. calcaneus, talus, tibial plateau d. distal femur, posterior malleolus, distal tibia
3.Closed tibial fractures with severe soft tissue and neurovascular damage result in high limb amputation rates. a. true b. false
8.0pen tibial fractures from gunshot wounds have a high incidence of nerve transections. a. true b. false
&Delays in necessary limb amputations may cause significant increases in 1. the number of surgical procedures. 2. sepsis. 3. disabilities and death. 4. hospital costs. a. 2 a n d 3 b. I , 2, and 3 c. 2,3, and 4 el. all of the above 5.The total cost of medical and surgical treatments, rehabilitation, and loss of productivity from open tibial fractures from MVCs approaches annually. a. $10 billion b. $20 billion c. $30 billion d. $40 billion 6.Farm-related tibial injuries most often result from
9.Type I11 open tibial fractures have the highest 9 incidence of and a. dislodged joints, arthritis b. paresthesia, pain c. gas gangrene, tetanus d. osteomyelitis, nonunions l a p a t i e n t s with type 111 open tibial fractures are at risk for sudden, life-threatening changes from a. compartment syndromes. b. associated myocardial ischemic attacks. c. Clostridiurn bacterial infections. 8, associated vascular injuries. 11.Intracompartmental pressures that range from indicate the need for fasciotomy procedures. a. lOto20psi b. 30 to 40 mm Hg 899
AORN JOURNAL
MAY 1996, VOL 63, NO 5
pulsatile lavage systems, then followed by some type of fractures. a. an incision, a tourniquet, graft b. drainage, traction, prosthesis c. irrigation, debridement, implant d. cauterization, fluoroscopy, splint
c. 50 to 60 mm H 2 0 d. 70 to 80 mm Hg 12.The cardinal signs of compartment syndrome include all of the following, except a hemorrhage. b. lack of palpable pedal pulses. c. varying degrees of paresthesia. d. pain with passive stretching of muscles. 13.0rthopedic surgeons perform thorough irrigation and debridement procedures on open tibial fracture wounds, ideally within after injuries occur. a. 24 to 48 hours b. three to four hours c six to eight hours d. 10 to 12 hours I f f T h o r o u g h neurovascular examinations of patients’ extremities with open tibial fractures include evaluating of all of the following, except a. motor strength. b. capillary refilling. e. events surrounding the injuries. d. presence of peripheral pulses. 15.In addition to IV cephalozin and gentamicin, patients who incur open tibial fractures from farm accidents also receive IV tetracycline because these wounds are likely to be contaminated with Myobacterium from the soil. a. true 4 false 16.Whenever possible, the objective of surgical treatment for open tibial fractures is to 1. prevent infection through irrigation and debridement procedures and IV antibiotics. 2. restore normal skeletal alignment and bone length (ie, reduction). 3. maintain bone reduction and stability until healing occurs. 4. preserve and restore musculoskeletal function for weight bearing. a. I , 2, and 3 b. I , 3, and4 c. 2,3, and 4 d. all of the above 17.Most open tibial fractures require
with
to stabilize
18.0perating room personnel should be ready to treat impending or existing shock or hemorrhage in patients with open tibial fractures by having appropriate equipment and supplies available. a true b. false 19.Type I11 open tibial fractures can cause all of these associated conditions, except a. Harvey’s contractures. b. damage to blood vessels and nerves. c. secondary hemorrhage. d. severe damage to soft tissues. =.The surgeon inflates the pneumatic tourniquet on the leg with the open tibial fracture to prevent further tissue damage during surgery. a- true b. false
21Surgeons conduct layer-by-layer debridements of open tibial fracture wounds, which include all of the following, except a. excision of devitalized fascia and muscle. b. conservative excision of skin edges. c. preservation of soft tissue attachment to bone. d. detachment of skin from underlying soft tissue. 22.Transection of the necessitates a primary limb amputation of the affected extremity to decrease the occurrence of nonhealing leg ulcers and infections. a. sciatic nerve b. lateral plantar nerve c. posterior tibial nerve d. lateral femoral cutaneous nerve =.According to the article, allow open tibial fracture wounds to heal and best meet the requirements of adequate bone stability with minimal soft tissue exposure and damage. a. intermedullary nails 901
AORN JOURNAL
MAY 1996, VOL 63. NO 5
b. external fixation devices c. plating systems d. continuous traction devices
aAPostoperative nurses closely monitor patients' nutritional statuses and urine outputs with the knowledge that patients with myonecrosis may develop related to extensive tissue damage from their open tibial fracture injuries. a. osteomyelitis b. nonunions c. acute renal failure d. protein malnutrition #If
large amounts of bone loss occur, surgeons implant into fracture wounds to temporarily fill defects. a. bone chips b. oxidized cellulose c. absorbable gelatin sponges d. antibiotic beads
=Extensive soft-tissue loss requires the use of muscle flaps (eg, local fascia1 cutaneous, remote pedicle) followed by split-thickness skin grafts to provide adequate coverage to extensive open tibial fracture wounds. a. true b. false
=.When free or pedicle muscle flaps are used, surgeons delay bone grafting procedures for approximately to allow for healing of muscle flaps. a. five to 10 days b. 15 to 20 days c, four weeks d. six weeks =Patients who develop gas gangrene may receive radiolabeled monoclonal antibody treatment as an adjunct therapy to imgation and debridement procedures and oral antibiotic therapy. a. true b. false =What is a source of pain around pin sites of external fixation devices that interferes with thorough cleansing and may result in small areas of skin necrosis? a. osteomyelitis b. skin tension c. loose pins d. tight dressings =Wadding material from shotgun shells causes severe foreign body reactions in patients with open tibial fractures from gunshot wounds. a. true b. false
Pain is Number One Fear of Patients Facing Surgery The November 1995 issue of Anm?hesio/og.yreports that pain is the number one fear of Americans facing surgery. In a survey conducted by Total Research Corp, Princeton, NJ, 500 Americans were polled, 27% of whom had undergone surgery during the previous five years. More than half (57%) reported that their primary concem was the pain they might experience after surgery. Four percent of all respondents reported they had canceled or postponed a surgical procedure because of this fear. Of those individuals who had surgery, 77% reported pain afterward, with 80% of those saying they experienced moderate to extreme pain. Nearly three quarters (7 1 %) said they experienced pain even after receiving pain medications. Eighty percent reported receiving pain medication on time, although
one third of the individuals had to ask for the medication and 16% had to wait for medication. Thirteen percent of the postsurgical patients used a patientcontrolled pump that enabled them to self-administer pain medication. According to the article, medical professionals and the public should increase their awareness of postsurgical pain management to reduce the incidences and severity of postsurgical pain. The authors suggest that this can be accomplished by increasing the number of acute pain management programs and establishing aggressive public and patient education programs. C A Wartielld, C H Kahn, Xcute pain management, 'Anesthesiology 83 (November 1995) 1090-1094.
903 AORN JOL'RNAL