Closed Reduction Acetate

8/3/2019 Closed Reduction Acetate

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When outside forces are applied to bone it has the potential to fail. Fractures occur

when bone cannot withstand those outside forces. It is a complete or incomplete

disruption in the continuity of bone structure. Clinical manifestations of fracture include

acute pain, loss of function, deformity, shortening of the extremity, crepitus and localized

edema and ecchymosis.

Initial treatment for fractures of the arms, legs, hands and feet in the field include

splinting the extremity in the position it is found, elevation and ice. Immobilization will

be very helpful with initial pain control.

Common medical management for fracture is Fracture Reduction. It refers to the

restoration of the fracture fragments to anatomic alignment and positioning. Either closed

reduction or open reduction may be used to reduce a fracture. The specific method

selected depends on the nature of the fracture however; the underlying principles are the

same. Usually, the physician reduces a fracture as soon as possible to prevent loss of

elasticity from the tissues through infiltration by edema or hemorrhage. In most cases,

fracture reduction becomes more difficult as the injury begins to heal.

Some fractures require open reduction. Through a surgical approach, the fracture

fragments are anatomically aligned. Internal fixation devices may be used to hold the

bone fragments in position until solid bone healing occurs.

In most instances, closed reduction is accomplished by bringing the bone

fragments into anatomic alignment through manipulation and manual traction.


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The goals of reduction are:

To restore position (alignment, rotation and length) to the bone or joint, to decrease pain, to prevent later deformity, to encourage healing and normal use of the bone and limb. In the case of a

fracture, it is also important for the bone ends to meet correctly (apposition).

Define related terms:

Fracture - is a complete or incomplete disruption in the continuity of thebone structure and is defined according to the type and extent.

Reduction- is a medical procedure to restore a fracture or dislocation to thecorrect alignment.

Open Reduction- refers to the method wherein the fracture fragments areexposed surgically by exposing the tissues.

Closed Reduction- refers to the manipulation of the bone fragments withoutsurgical exposure of the fragments.

Traction- is the application of a pulling force to a part of the body.
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Immobility- done after fracture has been reduced to maintain properposition and alignment until union occurs.

X-Ray- determine bone densities, texture, erosion, and changes in bonerelationships.

MRI (Magnetic Resonance Imaging) - obtains images of internal organsand tissues not readily visible on standard X-Rays.

Arthroscopy- allows direct visualization of a joint to diagnose jointdisorders.

Splint- device designed specifically to support and immobilize a body partin a desired position.

Cast- rigid external immobilizing device molded to contours of a body part.

Sling- bandage used to support an arm.


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Indication and Purposes of Closed Reduction:

Closed Reduction is used to reduce a fracture. No skin incision or cuts isrequired in the procedure. The doctor may suggest a closed reduction if your bone

is broken in one place and has not broken the skin.

It is usually attempted first especially if the bones in a joint are intact butout of position or dislocated. With Closed Reduction, the bone will often slip back

into its place. Sometimes pressure is also applied to guide the bones into correct

position. Muscle spasm is often difficult to overcome without pain control

(analgesia) or sedation.

PATIENT PREPARATION:Plan for care and recovery time after the operation is over, especially if you are to

have general anesthesia. Allow for time to rest and try to find other people to help you

with your day-to-day duties.

Follow the instructions provided by the doctor. Do not eat or drink anything after

midnight and the morning before the procedure. Do not even drink coffee, tea, or water

after midnight.

No particular preparation is needed for a sedative.


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PREPARATIONS for the Nurse:- Obtain consent from the patient that closed reduction will be done.- The nurse gives the patient information about the underlying pathologic

condition and the purpose and expectations of the prescribed treatment

regimen to promote patients active participation and compliance with

treatment program..

- Check if X-Ray, MRI or arthroscopy has already been done because itidentifies the fracture and identifies the diagnosis.

- Make sure that it is not an open fracture because with such, no attempt ismade to reduce the fracture.

- Patient must be evaluated completely before procedure for correctdiagnosis.

- The nurse completes an assessment of the patients general health,presenting signs and symptoms, emotional status, understanding of the

need of procedure and condition of the body part involved in the

procedure.

- Immobilize the body part affected before the patient is being movedbecause it controls pain associated with the underlying condition.

- Splinting is essential to support body part in position.- Nurse monitors circulation, motion and sensation on the affected

extremities comparing them with the opposite extremity for early

recognition of diminished circulation and function.

- Restrict patient from doing weight- bearing activities until the fracture hashealed.


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- Tell patient that a local anesthetic, opioid analgesic, muscle relaxantsedative or general anesthesia will be administered depending on the

doctors order to overcome procedure without pain and assist the patient

during closed reduction procedure.

- The injured extremity must be handled gently to avoid additional damage.

PROCEDURE:

CLOSED REDUCTION

Patient is being positioned and draped, then given a sedative or general anesthesia.

A general anesthetic will relax the muscles and make the patient feel as if you are in a

deep sleep. It will prevent you from feeling pain during the operation. The doctor pushes

the broken bone into a position where it can heal properly. The extremity is held in the

aligned position while the physician applies a cast, splint or other devices. Support is

being given to the extremity or body part being casted or splinted.

Reduction under anesthesia with percutaneous pinning may also be used. The

immobilizing device maintains the reduction and stabilizes the extremity for bone

healing. X- Rays are obtained to verify that the bone fragments are correctly aligned.

Although rarely done, Closed Reduction may be accomplished by Traction (skin

or skeletal) at or across the fracture to relax and lengthen the muscles and thenmanipulating the bone fragments back into normal position and holding this newly

achieved position may be used until the patient is physiologically stable to undergo

surgical fixation.


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POST- PROCEDURE CARE:

- Check Vital signs as frequently as clinical condition indicates.- Monitor neurovascular status for compression of nerve, diminished

circulation, or development of compartment syndrome (palpable tightness

of muscle compartment).

- Tell patient to recognize and report symptoms needing attention, such asnumbness, decreased function, increased pain or elevated temperature.

The patient may go home later in the day depending on how the patient is doing

and on the treatment. They may have a splint, dressing, or cast to help keep the bone in

place while it heals.

The patient can ask the doctor what steps should be taken and when to come back

for a checkup.

SUPPORTIVE CARE:

- If patient applied with cast, teach cast care instructions.- Relieve pressure caused by immobilizing device as prescribed.- Relieve pressure on skin to prevent development of pressure ulcers;

employ frequent positioning, skin care and special mattresses.

- Prevent development of thromboembolism, Encourage active and passiveankle exercises.

- Evaluate patient for proper body alignment and pressure from equipmentthat may cause pain.


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- Encourage non- pharmacologic measures for pain reduction such asdistraction and guided imagery.

- Administer prescribed medications as indicated.- Assist with activities of daily living as needed.- Teach the family ways to assist the patient while promoting independence

in self-care.

- Perform active and passive exercises to all non-immobilized joints.- Encourage patient participation in frequent position changes, maintaining

supports to fracture during position changes.

- Minimize prolonged periods of physical inactivity, encouragingambulation when prescribed.

- Teach relaxation techniques to decrease anxiety.

Closed Reduction Acetate

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