Fracture

1. MRS.SHALINI
MSC (N),MEDICAL SURGICAL NURSING
ASSISTANT.PROFESSOR
GANGA COLLEGE OF NURSING
COIMBATORE

2. Fracture
PRESENTED BY
MRS.SHALINI, MSC(NURSING),
ASST.PROFESSOR,
GANGA COLLEGE OF NURSING

3. LEARNING OBJECTIVES
 Define fracture
 Enumerate the classification of fracture
 List the causes for fracture
 Enlist the clinical manifestations of fracture
 List the diagnostic measures used in fracture
 Explain about the various management of fracture

4. DEFINITION
 Fracture is a complete or in complete disruption in the
continuity of bone structure and is defined according
to its types and extent.
A break in a bone

5. CAUSES OF FRACTURE
 Direct blows
•Crushing forces
•Sudden twisting motion
•Extreme muscle contraction
•Pathologic conditions -osteoporosis

6. CAUSES OF FRACTURE
 Bone neoplasms
• Metabolicdisorders-poor mineral absorption &
hormonal changes decreases bone calcification which
results in a weakened bone.
• Bed rest or atropic muscles

8. TYPES OF BONE FRACTURES
•Complete fracture
•Incomplete fracture
•Closed fracture
•Open fracture
•Comminuted fracture
•Compression fracture
•Depressed fracture
•Avulsion fracture
•Greenstick fracture
•Epiphyseal fracture
•Impacted fracture
•Oblique fracture
•Transverse fracture
•Spiral fracture
•Pathologic fracture
•Stress fracture

9. Bone Fracture
Types of bone fractures
 Closed (simple) fracture –break that does not
penetrate the skin
 Open (compound) fracture –broken bone penetrates
through the skin
 Complete fracture –it involves a break across the entire
cross section of the bone and is frequently displaced.
 Incomplete fracture –it involves a break through only
part of the cross section of the bone.

10. Types of bone fractures

11. TYPES OF BONE FRACTURES

12. Types of bone fractures

13. Common Types of Fractures

14. FRACTURES (TYPES)
 Open or compound: Bone is exposed to the air
through break in the skin. Can be associated with soft
tissue injury.
 Closed or simple: Skin remains intact. Chances are
greatly decreased for infection.
 Greenstick: A crack; bending of a bone within
complete fracture. Only affects one side of the
periosteum. Common in skull fractures or in young
children when bones are pliable.

15. FRACTURES (TYPES) (Contd)
 Comminuted: Bone completely broken in a transverse,
spiral or oblique direction. Bone broken into several
fragments.
 Compression: Eg.vertebral fractures. Bone has been
compressed by other bones.
 Complete: Bone is broken with disruption of both sides
of the periosteum.
 Impacted: one part of fractured bone is driven into
another.
 Depressed: Usually seen in skull or facial fractures.
Bone or fragments of bone are driven in ward.
 Pathological: break caused by disease process.

16. FRACTURES (TYPES) (Contd)
 Intracapsular: Bone broken inside the joint.
 Extracapsular: Fracture outside the joint.
 Compound Fracture:
Complete fracture in which bone breaks through
skin

17. Fractures (signs & symptoms)
Pain or tenderness
Loss of function of the
extremity
Crepitation
Ecchymosis or erythema
Edema
Muscle spasm
Deformity:

18. DIAGNOSTIC EVALUATION
X –ray will confirm the diagnosis
History collection
Physical examination

19. Stages in the Healing of a Bone Fracture

20. Fractures(stages of bone healing)
• Occurs over several weeks
 New bone tissue occurs in region of break
 •Repair is initiated by migration of blood vessels and
connective tissue from periosteumin break area.
 Dense fibrous tissue fills from periosteumin break
area. Osteoblastnear the broken area.
Chondroblastfurther away from broken area.
 Cells deposit cartilage between broken surfaces
 Cartilage is slowly replaced by mineralized bone tissue,
which completes repair.

21. Fractures (Emergency Management)
• Immobilize affected extremity to prevent further
damage to soft tissue or nerve.
 •If compound fracture is evident don’t attempt to
reduce it. Apply splint.
 •Cover open wound with sterile dressing.
 •Use splint: External support is applied around a
fracture area to immobilize the broken ends..

22. Factors affecting Bone Healing
 Unfavorable factors
 Impairment of blood supply
 Infection
 Excessive movement
 Presence of tumor
 Synovial fluid in intra articular Fx.
 Interposition of soft tissue
 Any form of Nicotine

23. FRACTURE MANAGEMENT
PRINCIPLES OF TREATMENT
 Treat the Patient, not only the fracture
 Restriction of movement
 Prevention of displacement
 Alleviation of pain
 Promote soft‐tissue healing
 Try to allow free movement of the unaffected parts
 Splint the fracture, not the entire limb

34. SURGICAL MANAGEMENt
 ORIF(openreductioninternalfixation.)
 Externalfixation

45. ABSOLUTE INDICATIONS OF ORIF
• Unable to obtain an adequate reduction
 Displaced intra‐articularfractures
 Certain types of displaced epiphysealfractures
 Major avulsion fractures where there is loss of function
of a joint or muscle group
 Non‐unions
 Re‐implantations of limbs or extremities

46. NURSING MANAGEMENT

49. Review Questions
 List the causes for fracture
 List the classification of fracture
 Write the clinical manifestations fracture
 List the diagnostic measures used in fracture
 Write about the management of fracture

50. •
REFERENCES
 Black,J.M.&Jacobs,E.(1998).Medical and surgical
nursing Clinical management for continuity of
care(5thed) Philadelphia: W.B Saunders.
 Lewis,S.L.Heitkemper,M.Dirksen,S.R.et
al.(2007).Medical surgical nursing assessment and
management of clinical problems(7thed).Missouri.
Mosby elsevier publishers.
 Smeltzer,S.C.(2004).Brunner & suddarth’s textbook of
medical surgical nursing(10 th ed) Philadelphia :
Lippincott Williams & Wilkins publishers.