At the end of this session the students will be able to: define fracture classify fracture list out the causes of fracture explain the clinical features of fracture specify the diagnostic studies for identification of fracture elaborate the process of fracture healing explain the management of fracture describe various approaches of treatment of fracture discuss the nursing management for fracture enlist the complications

1. 1

2. Presented by : Samikshya Karmacharya
BSc. Nursing 3rd year
KUSMS
2

3. At the end of this session the students
will be able to:
define fracture
classify fracture
list out the causes of fracture
explain the clinical features of fracture
specify the diagnostic studies for
identification of fracture
elaborate the process of fracture
healing
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4. explain the management of fracture
describe various approaches of
treatment of fracture
discuss the nursing management for
fracture
enlist the complications
summarize the main points.
4

5.  A disruption or break in the continuity of the
structure of bone with may be either across the
cortex or through the articular surface is called
fracture.
5

6. On the basis of:
 Etiology.
 Displacement.
 Relationship with external
environment.
 Pattern.
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7. Fracture
Traumatic Pathological
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8. Fracture
displaced undisplaced
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9.  Closed fracture  Open fracture
9

10. 10

11. ATYPICAL FRACTURES
 green stick
 torus
 impacted
 stress or fatigue
 hairline or crack
11

12. Fall injury
Accidents(motor vehicle accidents,
RTA)
Direct blow
Repetitive forces
Pathology: inflammation, neoplasm,
generalize disease
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13. Symptoms:
Complain of fall or
trauma
Pain at the site of the
fracture
Difficulty in moving the
limb
13

14. LOOK:
Swelling
Bruising
Skin
Deformity
Signs of shock
FEEL:
Local tenderness
Peripheral pulse
Localized edema and
echymosis
MOVE:
Crepitus
Loss of function
14

15. Neurovascular assessment:6Ps
Watch for compartment syndrome:
(Occurs when injured tissue swells
within the fascia and connective tissue
inside of a limb causing an increase in
the pressure in that compartment.)
15

16. 16

17. 17

18. History taking
Physical examination
Imaging: X-ray ,MRI, CT scan
Lab studies:
Complete Blood Count
Hematocrit
Renal function test
Erythrocyte sedimentation rate
C -reactive protein
18

19. 19

20. 1. Hematoma formation
occurs within 72 hours and lasts up
to 7 days.
blood leaks out through torn blood
vessels and forms hematoma between
and around the fracture.
the periosteum and local soft tissues
are stripped from the fractures ends
resulting in ischemic necrosis.
20

21. active phagocytosis absorbs products
of local necrosis.
granulation tissue (new blood vessels
fibroblast, osteoblast) produces the
basis for new bone substance.
occurs 3-14 days past injury.
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22. as minerals are deposited, an unorganized
network of bone is formed, that is woven
around the fracture parts known as callus,
composed of cartilage, osteoblasts,
calcium and phosphorus.
begins to appear by end of 2nd week.
22

23. (development of bone) ossification of
the callus
sufficient to prevent movement at
fracture site
occurs from 3 weeks to 6 months.
23

24. as callus develops, the distance
between bone fragments diminishes
and eventually closes
6. Remodeling
excess bone tissue is reabsorbed and
union is complete.
24

25. 25

26. AT THE SITE OF THE ACCIDENT:
apply firm pressure in bleeding site using clean
piece of cloth
Wash the wound with clean tap water or saline
and cover it with clean cloth.
 splinting
 if a piece of bone devoid of all soft tissue is
present .Wash it and cover with clean cloth.
ice therapy can be done to reduce pain and
swelling
elevate the injured part to reduce swelling
safely transport him to the hospital.
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27. 27

28. 28

29. Wound care
Splinting
 Debridement: 3E: (Exploration,
excision and evacuation)
Prophylactic antibodies
Tetanus toxoid
Analgesics
Radiography
29

30. Fundamental principles of fracture treatment
Reduction
Retention / immobilization
Rehabilitation
30

31. a. Reduction:
technique of setting a displaced fracture to a
proper alignment.
 may be done non-operating or operatively so
called closed and open reduction respectively.
31

32. 32

33. necessary to maintain bone in reduced
position
the main aim is to:
 prevent displacement or angulation
prevent movement which might
interfere with union and relieve pain
may be done by:
 external immobilization: plates
 internal fixation using rods, plates
screws, wires etc.
33

34. 34

35. 35

36.  begin at the time of injury and goes until
maximum possible function have been regained.
 steps of rehabilitation:
 joint mobilization
 muscle re-education exercises
 functional use of limbs
36

37. 1. Closed reduced followed by
immobilizations:
no any incision is made for moderate size
wound.
fracture is manipulated under a type of X-
ray machine called fluoroscopy or just and a
cast is then usually applied.
37

38. 38

39. 2. Close reduction and percutaneous
fixation
done for fractures, which though can
be reduced by closed manipulation,
but are unstable and are likely to
displace subsequently.
reduced under image intensifier, and
fixed with percutaneous devices such
as K-wire, rush pins etc. which hold
fracture in position
39

40. 40

41. the fracture fragments are surgically
exposed by dissecting the tissues and
fractured bones are put together, stabilizing
with implants such as screws, plates,
staples, rods etc.
intra-articular fractures.
also used when other methods have failed
and in fractures which are so unstable that
will redisplace in due course.
41

42. 42

43. used to counter the forces which will not
allow reduction to happen or would cause
redisplacement.
these are the muscle forces and the force of
gravity.
 helps to bring the bone in proper
alignment after reduction
43

44. 44

45. Replaced with metal
devices
Indicated when there
is complete
disruption of joint
Done in femoral neck
fracture, hip fracture,
finger joints etc
45

46. 46

47. 1. Assessment:
History taking
Injured extremity: Presence of fracture
and other associated complication
Vital signs
Neurological status: 6'p's
Intake and output
Laboratory reports
Routine pre operative history
47

48. 2.Interventions:
Provide emergency care
Wash wound with antiseptic solution
Cover with sterile drape
Provide prophylactic antibiotics, tetanus
toxoid , analgesics etc as prescription.
Wound debridement
Send for radiographic imaging and tests
Administer IV fluids, oxygenation
48

49. Pre operative care
Consent
Removing accessories
Collection of laboratory reports
Administration of IV fluids & medications
Catheterization
Patient education: treatment, management,
complications etc
49

50. Post operative care
- Monitor:
Vital signs
Gaseous exchange
Fluid intakes and urine outputs
-provide IV therapy , analgesics, antibiotics
-Provide skin care
-If endoprosthetic replacement is done,
maintain adduction of the limb
-Encourage fluid and food intakes
50

51. Promote physical mobility
Teach using assistive aids and devices
Promote deep breathing and coughing
exercises
 Early detection and management of
complications
51

52. Immediate:
Hypovolemic
shock
Major vessels
injury
Injuries to
muscles, tendons,
joins, viscera etc
Early:
Shock
Respiratory distress
syndrome
Fat embolism
syndrome
Infection
Compartment
syndrome
52

53. Late:
Late union
Non union
Malunion
Avascular necrosis
Shortening
Joint stiffness
53

54. 54

55. Draw a flow chart of fracture healing
process
55

56.  Janice L. H , Kerry H. C, Brunners and Suddarths
Textbook of Medical and Surgical Nursing , 13th ed,
Wolters Kluwer Pvt, Ltd., India,( 2014) , P: 1156-60
 Mandal G.N , Textbook of Medical Surgical
Nurisng, 4th ed, Makalu Publication House,
Dilibazzar (2015) , p: 239-46
 Jayant J., Prakash K., Essentials of Orthopedics and
applied physiotherapy, 2nd ed , Elsevier Pvt.
Ltd.,India (2000), p:83-86
 Maheswori J. , Essential or orthopedics , 4th ed,
Jaypee Brothers Medical Publishers Pvt. Ltd., New
Delhi,( 2010), P:84-134
56

57.  Fracture’ retrieved on 2016/2/29 available at:
 http://www.nlm.nih.gov/medicineplus/ency/p
atienteducation/com-fracture-management/
 http://www.trackbruceland.com/ck-traction-
applications/
 http://cmsrusanatory.blogspot.com/2013/4/6
Ps- of-compartment-syndrome
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