2. Objectives
After completion of the class students will be
able to
• Define fracture
• Enlist the Causes of fracture
• Describe the types of fracture
• Discuss the Pathophysiology of fracture
• Enumerate the Clinical manifestations
• Explain the medical & nursing management
of the fracture
3. DEFINITION
• A fracture is a break in the continuity of
bone and is defined according to its type and
extent.
• Fracture is a break in any bone in the body.
7. a. CLOSED FRACTURE (simple fracture) is one that
does not cause a break in the skin.
b. AN OPEN FRACTURE (compound, or complex,
fracture) is one in which the skin or mucous membrane
wound extends to the fractured bone.
Open fractures are graded according to the following
criteria:
• Grade I is a clean wound less than 1 cm long.
• Grade II is a larger wound without extensive soft tissue
damage.
• Grade III is highly contaminated, has extensive soft
tissue damage, and is the most severe.
8. Classification: based on displacement
NON - DISPLACED FRACTURE
The bone cracks either part or all the
way through, but does not move and
maintains proper alignment
DISPLACED FRACTURE
The bone snaps into two or more
parts and moves so that the two
ends are not lined up straight
10. Transverse Fracture
A fracture in which the
# line is perpendicular
to the long axis of the
bone
Oblique Fracture
A fracture in which the #
line is at oblique angle
(45)to the long axis of
the bone
11. Spiral Fracture
A severe form of
oblique fracture in
which the # plane
rotates along the long
axis of the bone. These
#s occur secondary to
rotational force
12. Comminuted Fracture :
The bone is broken into
many fragments.
Segmental fracture
There are two fractures
in one bone , but at
different angles
13. Classification: Based on Etiology
1. TRAUMATIC
2. PATHOLOGICAL
– Tumors
– Bone cysts
– Osteomyelitis
– Osteoporosis
– Rickets
14. Pathophysiology
Due to any etiology(crushing movement)
|
Fracture occurs , muscle that were attached to bone
are disrupted and cause spasm
|
Proximal portion of bone remains in place, the distal
portion can become displaced in response to both
causative force & spasm in the associated muscles
15. continue..
In addition, the periosteum and blood vessels in
the cortex and marrow are disrupted
|
Soft tissue damage occurs, leads to bleeding and
formation of hematoma between the fracture
fragment and beneath the periosteum
|
Bone tissue surroundings the fracture site dies,
creating an intense inflammatory response
16. release chemical mediators histamines,
prostaglandins
|
Resulting in vasodilatation, edema, pain,
loss of function, leukocytes and
infiltration of WBC
continue..
17. • Pain
• loss of function
• deformity
• Muscle spasm
• crepitus
• swelling and discoloration
19. • STAGE OF HAEMATOMA
Last up to 7 days. Deprived of blood supply
some osteocytes die, while others sensitive to
form daughter cells.
• STAGE OF GRANULATION TISSUE( 2-3 wks)
Proliferation and differentiation of
daughter cells into vessels, fibroblast etc.
fracture still mobile.
20. • STAGE OF CALLUS (4-12 WEEKS)
Mineralization of granulation tissue. First sign of
union. Fracture is no more movable. Callus
radiologically visible usually 3weeks after #.
• STAGE OF CONSOLIDATION(1-2 YEAR)
Callus or woven bone is replaced by mature bone
with a typical lamellar structure.
• STAGE OF MODELLING(MANY YEARS)
Bone is gradually strengthened
21. COMPLICATIONS OF FRACTURE
Immediate
Hypovolemic Shock
Early complications
• fat embolism
• Adult respiratory distress syndrome
• compartment syndrome
• Crush syndrome
• deep vein thrombosis
• infection
24. According to the research conducted by López
and Flors they found that patients with multiple
fractures will have Respiratory symptoms were
the most frequent , followed by neurological
symptoms .
The average time of presentation of the
syndrome after admission was 42 hours. The
overall incidence of Fat embolism syndrome
after bone fractures was 0.14%, and mortality
was 10.5%.
26. MEDICALAND SURGICAL MANAGEMENT
1. Reduction
Reduction of a fracture (“setting” the bone) refers to restoration
of the fracture fragments to anatomic alignment and rotation.
Correction of bone alignment through a surgical incision.
External/Internal fixation devices (metallic pins, wires,
screws, plates, nails, or rods) may be used to hold the
bone fragments in position until solid bone healing
occurs.
30. Closed reduction
• closed reduction is accomplished by bringing the
bone fragments into apposition (ie, placing the
ends in contact) through manipulation and
manual traction, with no surgical intervention.
• Extremity is held in the desired position while the
physician applies a cast, splint, or other device.
• X - rays are obtained to verify that the bone
fragments are correctly aligned.
• Traction (skin or skeletal) may be used to effect
fracture reduction and immobilization.
31. 2.Immobilization
• Immobilization may be accomplished by
external or internal fixation.
• Methods of external fixation include
bandages, casts, splints, continuous traction,
and external fixators.
• Metal implants used for internal fixation serve
as internal splints to immobilize the fracture.
32. Traction
Traction is the use of weights, ropes and pulleys to apply force
to tissues surrounding a broken bone.
33. Traction
1. Skin traction-
• Bucks traction used for knee , hip bone
fracture
• Weight usually 5-7 pounds attach to skin
2. Skeletal traction –
• Needs invasive procedure
• Weight is up to 10 kg attached to bone
35. Why Do We Splint?
• To stabilize the extremity
• To decrease pain
• Actually treat the injury
36. Possible items for Splinting
• Soft materials. Towels, blankets, or pillows,
tied with bandaging materials or soft cloths.
• Rigid materials. A board, metal strip,
folded magazine or newspaper, or other
rigid item.
37. Guidelines for Splinting
1. Support the injured area.
2. Splint injury in the position
that you find it.
3. Don’t try to realign bones.
4. Check for color, warmth, and
sensation.
5. Immobilize above and below
the injury.
38. The splint should go beyond the joints above and
below the fractured or dislocated bone to prevent
these from moving
39.
40. 3. Maintaining and restoring
function
• Restlessness, anxiety, and discomfort are
controlled with a variety of approaches, such as
reassurance, position changes, and pain relief
strategies, including use of analgesics.
• Exercises are encouraged to minimize disuse
atrophy and to promote circulation.
• Participation in activities of daily living (ADLs)
is encouraged to promote independent
functioning and self-esteem.
41. NURSING MANAGEMENT
Patients with closed fractures:
• Encourage patient not to mobilize
fracture site.
• Exercises to maintain the health of
unaffected muscles for using
assistive devices (eg, crutches,
walker).
42. Continue….
• Teach patients how to use assistive
devices safely.
• Patient teaching includes self-care,
medication information, monitoring for
potential complications, and the need for
continuing health care supervision.
43. Patients with open fractures:
• Administers tetanus prophylaxis if
indicated.
• Wound irrigation and debridement in
the operating room are necessary.
• Intravenous antibiotics are prescribed
to prevent or treat infection.
• Wound is cultured.
44. Continue….
• Fracture is carefully reduced and stabilized by
external fixation.
• Any damage to blood vessels, soft tissue,
muscles, nerves, and tendons is treated.
• Heavily contaminated wounds are left
unsutured and dressed with sterile gauze to
permit swelling and wound drainage.
45. CARE OF CLIENT WITH CAST
Before application of a cast preparation of the
client includes:
• Detailed explanation of the procedure
• Skin preparation involves through cleansing
of the skin
• Presence of unremovable particle or dust
should be reported to the physician
• Roll the cast material are individually
submerged in clean water and excess water is
squeezed from the roll ,apply bandage is
applied to encircle the injured the body parts
46. Continue…
• As the water evaporates the cast will dry
• Do not cover the cast
• Windowing or bivalving a cast means cutting a
cast along both sides then splitting it to decrease
pressure on underlying tissue.
• Window may also be cut into cast to allow the
physician or nurse to visualize wounds under
the cast or removes drains.
48. Continue..
• Neurovascular assessment: It should be
performed every 30 minutes for 4 hours.
• Assess the cast extremity for color, warmth,
pulse distal to the cast, capillary refill.
• Movement of the distal fingers or toes,
awareness of light touch distal to the cast,
change in the sensation.
• Assess the degree of pain
49. Assessment of the cast:
The skin around the cast edges should
be observed for damage or swelling.
“Hot spots” areas of the cast that feel
warmer than other section may
indicate tissue necrosis or infection
under the cast.
“Wet spots” may indicate drainage
under the cast
50. CARE OF EXTERNAL FIXATION
• Assessment- pain, nerve supply,infection,pin
site etc.
• Small bleeding from pin site is normal
• Critical, If extend more than 24 hours
• Administer antibiotics, analgesic medicine
51. CARE OF TRACTION
• Assessment – skin breakdown, pain,
neurovascular ,constipation
• Stool softener
• Plenty of fluids
• Provide bedpan and urinals for elimination
• Encourage clients activity
53. Acute pain related to tissue trauma as
evidenced by guarding of affected area.
• Goals: Patient reports satisfactory relief of
pain.
• Intervention:
– Assess the onset, duration, location, severity and
intensity of pain.
– Administer the analgesic according to physician
order.
– Provide comfort devices like sand bags for
immobilization of affected parts and to reduce
pressure on nerves and tissues.
54. Impaired physical mobility related to application of traction or
cast, pain as evidenced by assessment
• Intervention:
– Provide range of motion exercises to the patient.
– Perform passive or assisted ROM exercise.
– Provide assistance while using walker or
crutches if required.
– Prevent from complication which usually
occurs due to immobility.
•
55. Risk for peripheral neurovascular dysfunction related
to vascular insufficiency and nerve compression
secondary y to edema and application of traction,
splints or casts.
• Goal: Experience no peripheral neuro
vascular dysfunction
• Intervention:
– Elevate the affected limb above the level of heart
to reduce edema.
– Check for periferal pulse, capillary
refill,temperature
– Immobilize or support the affected body part to
prevent pressure and injury.
