성인간호학 정형외과 OS 골절 케이스스터디 CASESTUDY 간호과정 간호진단 간호사정 문헌고찰

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1. Intertrochanteric fracture

Intertrochanteric fracture은 대퇴골 상부에서 옆으로 돌출된 부위의 골절로 대퇴 경부 골절보다 10~12세 더 고령에서 일어나며 여자에게 더 많다. 대부분 경미한 외상(낙상)에 의해 발생되는 경우가 많으며, 반신마비환자는 마비가 있는 쪽에 많다. 증상으로는 변형, 부종, 점상출혈, 압통, 통증, 감각변화, 정상 기능 상실과 비정상적인 움직임 등이 있다. 치료로는 정복(비수술적, 수술적)과 고정(외부고정, 내부고정)이 있으며, 석고붕대와 견인장치도 사용된다. 대퇴부 골절의 간호로는 수술 전 준비, 수술 후 관리(합병증 예방, 운동 등)가 중요하다.
2. Femur OR/IF

대퇴골 골절의 수술적 치료(Femur OR/IF)는 대퇴골 간부 골절, 대전자간 골절, 대전자하 골절 등에 적용된다. 수술 전 간호로는 수술부위 shaving, 유치 도뇨관 삽입, 발칸 침대 준비, 금식 등이 필요하다. 수술 후 간호로는 C-line과 A-line 확인, 수술부위 관찰, 도뇨관 유지, Hemo-vac 관리, 냉요법, 호흡운동, 관절운동 등이 중요하다. 또한 수술법에 따른 보행 시기 결정, 드레싱, 식이 관리 등이 필요하다.

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1. Intertrochanteric fracture

Intertrochanteric fractures are a common type of hip fracture that occur in the proximal femur, specifically in the area between the greater and lesser trochanters. These fractures are typically seen in elderly individuals with osteoporosis, often resulting from low-energy trauma such as a fall from standing height. The management of intertrochanteric fractures is crucial as they can lead to significant morbidity and mortality if not treated appropriately. The primary goals of treatment are to restore the patient's mobility, minimize complications, and facilitate early rehabilitation. Conservative treatment, such as traction or immobilization, is generally not recommended due to the high risk of complications, including bedsores, pneumonia, and deep vein thrombosis. Instead, surgical intervention is the standard of care, with various fixation techniques available, including intramedullary nails, sliding hip screws, and cephalomedullary nails. The choice of surgical approach depends on factors such as the fracture pattern, patient age, bone quality, and surgeon preference. Postoperative rehabilitation, including early mobilization and weight-bearing, is essential for optimal functional outcomes. Overall, the management of intertrochanteric fractures requires a multidisciplinary approach, involving orthopedic surgeons, physical therapists, and geriatric specialists, to ensure the best possible outcomes for the patient.
2. Femur OR/IF

Femur fractures are a common and serious injury that can occur due to high-energy trauma, such as motor vehicle accidents or falls from a significant height. These fractures can be classified into different types, including diaphyseal (shaft) fractures, distal femur fractures, and proximal femur fractures (including intertrochanteric and femoral neck fractures). The management of femur fractures often requires surgical intervention, with the primary goals being to restore limb alignment, facilitate early mobilization, and minimize the risk of complications. The choice of surgical approach depends on the specific fracture pattern, patient factors (such as age and bone quality), and the surgeon's expertise. Common surgical techniques include intramedullary nailing, plate fixation, and external fixation. Intramedullary nailing is often the preferred method for diaphyseal femur fractures, as it provides stable fixation while allowing for early weight-bearing and rehabilitation. Distal femur fractures and proximal femur fractures may require more complex surgical techniques, such as the use of locking plates or specialized implants. Postoperative care, including pain management, thromboprophylaxis, and physical therapy, is crucial for achieving optimal functional outcomes. Overall, the management of femur fractures requires a multidisciplinary approach, involving orthopedic surgeons, trauma specialists, and rehabilitation professionals, to ensure the best possible outcomes for the patient.

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