A patient who has been casted for a fracture of the left ulna asks the nurse when the cast will come off. The nurse's response is based on the knowledge that the cast will be removed when which physiologic parameter has been met?
1. The remodeling phase of the bone healing process has been completed, allowing for application of mechanical stress.
2. A cartilage collar can be clearly felt at the site of the original break.
3. A specific amount of time has passed, predetermined by the severity of the break.
4. The X-ray of the fractured bone shows that the ends are well joined.
4
Rationale 1: Remodeling of the bone occurs after the cast is removed.
Rationale 2: During cellular proliferation and callus formation, a cartilage "collar" is evident around the fracture site, but this does not signify that the bone has healed sufficiently to remove the cast.
Rationale 3: While the amount of time a fracture requires casting varies, the severity of the fracture is only one factor that is considered.
Rationale 4: Ossification is the final laying down of bone after the fracture has been bridged and the fragments are united. Mature bone replaces the callus, and the fracture site feels firm and appears united on radiograph. It is at this point that a cast may be removed.
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