Fractures not only cause great trauma to the patient, but also directly or indirectly cause a variety of complications that can further cause pain to the patient.
There are many complications of fracture. The fracture can damage the surrounding blood vessels and nerves at the same time. Open fractures and surgical patients can cause infection and osteomyelitis. Complications such as non-healing fractures, joint stiffness, deformed healing, and ischemic osteonecrosis can occur in late stages. Systemic complications include shock, multiple organ failure, fat embolism, and osteofascial compartment syndrome. Middle-aged and elderly patients with fractures tend to have milder injuries, and open fractures are rare and less likely to cause vascular and nerve damage.
Middle-aged and elderly fracture patients are prone to a variety of complications during the treatment process because of their poor health and often accompanied by important organ disorders such as hypertension and coronary heart disease. Therefore, while treating fractures, special attention should be paid to the prevention of complications.
1. Pneumonic pneumonia
When patients are bedridden for a long time, respiratory secretions are not discharged and accumulate in the lungs, which can lead to lung infection. Elderly people with chronic bronchitis are more likely to develop pneumonia when they are bedridden for a long time. Pneumonia occurs when the patient has a fever, shortness of breath, rales on auscultation of the lungs, and lamellar shadows in the lungs on x-ray.
Prevention
(1) Deep breathing. Bedridden patients should do deep breathing exercises every day. Deep breathing can promote full opening of the lungs and increase lung capacity, which is conducive to keeping the airway open and promoting sputum discharge.
(2) Coughing sputum training. Coughing training should be done every day to fully discharge respiratory secretions. Patients with fractures are often afraid to cough up sputum due to pain. The patient should be encouraged to cough up sputum.
(3) Regular back patting. Pat the patient’s back with hands regularly every day to promote sputum discharge.
2.Venous thrombosis of lower limbs
Bedridden patients have slow venous blood flow in the lower limbs due to muscle inactivity, which can easily form thrombus and block the veins, resulting in swelling and pain in the limbs. The thrombus can be dislodged and travel along the blood vessels, causing embolism of important organs. This is a serious complication that should be taken seriously and actively prevented.
Prevention
(1) Take oral anticoagulant drugs. A small dose of aspirin (50 mg) taken orally daily can inhibit platelet aggregation and prevent thrombosis. Elderly people’s blood is in a hypercoagulable state, therefore, all should take anticoagulants.
(2) Muscle diastolic activity. Repeated muscle contraction and diastole, like a pump, promote venous blood flow and prevent thrombosis.
(3) Avoid pressure on the limb. When plaster or splint is fixed, pay attention to the appropriate degree of tightness, especially to prevent restrictive compression, otherwise the venous reflux is not easy to form thrombosis. Bedridden patients should be frequently assisted to change the position of the lower limb to avoid long-term pressure on the lower limb.
3.Urinary tract infection and stone
Long-term bedridden patients have obvious bone decalcification, and a large amount of calcium salts are excreted from the kidneys. If they do not drink much water, calcium salts will easily form stones or cause infections in the kidneys or bladder.
Prevention
(1) Drink more water. Regular life, regular and quantitative drinking water, to ensure that the daily urine volume of 2000 ml or more.
(2) Pay attention to functional exercise. Even bedridden patients should strengthen the movement of disease-free limbs in bed. The affected limb should actively perform muscle stretching activities. In this way, the bones are constantly subjected to the action of muscle contraction force, decalcification is reduced, and stones can be prevented.
(3) Change of body position. When the condition allows, the position should be changed frequently to prevent the deposition of calcium salts and reduce the occurrence of stones. Patients with compression fractures of the thoracolumbar spine may be assisted to turn regularly. Patients with upper femoral fractures can sit up appropriately after traction or surgical treatment. Although simple, these tasks are important for middle-aged and elderly people in preventing complications.
4. Bed sores
Patients who are bedridden for long periods of time are prone to pressure injuries to the skin and the formation of bedsores. The most likely site is the sacrococcygeal region. Here, the sacrum protrudes backward and the skin has poor blood flow, so once a bedsore appears, it is not easy to heal. Elderly people, especially those with spinal fractures and paraplegia, are more likely to develop bedsores and should pay special attention to them. Bed sores are the most common complication in middle-aged and elderly patients who are bedridden for long periods of time. However, with careful and meticulous care, bedsores can be prevented.
Prevention
(1) It is important to give full play to the patient’s subjective motivation. Patients should use disease-free limbs to take the initiative to straighten their backs and lift their hips, which is beneficial to functional exercise and effective in preventing the occurrence of bed sores.
(2) Keep clean. Bed sheets should be clean, flat and soft. Scrub the skin frequently. In summer, sweating is more frequent, so scrubbing should be done more often.
(3) Turning and massage. When the condition allows, assist the patient to turn over regularly to relieve the pressure on the skin of the sacrococcygeal area. At the same time, massage the skin of sacrococcygeal area to promote blood circulation recovery. The patient can also massage the sacrococcygeal area by stretching the hand when lying down.