1. Prepared By
Hala Mohamed Abd El Hamed
Assistant lecturer of Adult nursing
Faculty of Nursing
Mansoura University

2. Fracture
• A fracture is a complete or incomplete
disruption in the continuity of bone structure and
is defined according to its type and extent.
• Fractures occur when the bone is subjected to
stress greater than it can absorb.
• Fractures may be caused by direct blows,
crushing forces, sudden twisting motions, and
extreme muscle contractions.

3. Types of Fractures

5. Medical Management
Reduction:
Fracture reduction refers to restoration of the
fracture fragments to anatomic alignment and
positioning.
Either: closed or open.

6. Closed Reduction
is accomplished by:
• Bringing the bone fragments into anatomic
alignment through manipulation and manual
traction.
• The extremity is held in the aligned position
while the physician applies a cast, splint, or other
device.

7. Open Reduction
• Through a surgical approach, the fracture
fragments are anatomically aligned.
• 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.

8. Nursing Management
Patients With Closed Fractures
The nurse instructs the patient regarding the proper
methods to control edema and pain.
elevate extremity to heart level; take analgesics as
prescribed.
Consume diet to promote bone healing.
Use mobility aids and assistive devices safely.
Avoid excessive use of injured extremity; observe
prescribed weight-bearing limits.
State indicators of complications to report promptly to
physician (eg, uncontrolled swelling and pain; cool, pale
fingers or toes; paresthesia; paralysis; signs of local and
systemic infection; signs of venous thromboembolism;
problems with immobilization device).

9. Fracture of the clavicle. Immobilization is accomplished with a
typical displacement in clavicular strap.
midclavicular fracture.

10. Immobilizers for proximal humeral fractures.

11. Examples of internal fixation for hip fractures.
Achieved through the use of screws and plates specifically designed for stability
and fixation.

12. cast

13. Casts
• Rigid device that immobilizes the affected
body part while allowing other body parts
to move
• Cast materials—plaster, fiberglass,
polyester-cotton
• Types of casts for various parts of the
body—arm, leg, brace, body

14. Cast Types:

15. Immobilization Device

19. • Traction is the application of a pulling
force to a part of the body.
• Traction must be applied in the correct
direction and magnitude to obtain its
therapeutic effects.

20. • Indications:
Traction is used to
– To minimize muscle spasm.
– To reduce align, and immobilize fractures
– To reduce deformity .

23. Types

25. Classification of Traction :
• Skin Traction : is maintained by direct
application of a pulling force on the client’s
skin . It is generally used as a temporary
measure.
– To reduce muscle spasms
– To maintain immobilization before surgery.
• Skeletal Traction : is attaches directly to bone
, providing a strong steady, continuous pull, and
can be used for prolonged periods .

26. Classification of Traction :
• The amount of weight used depends on
the injury, pathologic condition, body
size, and degree of muscle spasm.
• Manual Traction :
is applied with hands to temporarily
immobilize an injured part. A firm, smooth,
steady pull is maintained . Manual Traction
is used during casting, reduction of a
fracture or dislocated joint.

27. complications:
• potential complications that may develop
include the following:
– Neurovascular compromise.
– Inadequate fracture alignment..
– Skin breakdown .
– Soft tissue injury.

28. complications:
potential complications that may develop
include the following:
– Pin tract infection .
– Osteomyelitis can occur with skeletal
traction.
– In additional, complications from immobility
can be encountered , especially with long
term traction and in older adult.

29. • The nurse must be consider the psychological
and physiological impact of the musculoskeletal
problem, traction device, and immobility.
• The nurse must assess and monitor the
patient’s anxiety level and psychological
responses to traction.

30. • It is important to evaluate the body part to
be placed in traction and its neurovascular
status and compare it to the unaffected
extremity.
• As long as the client is in traction, skin
integrity must be assessed and
documented, examining especially for
redness, bruises, and lacerations.

31. • Radiological Evaluation while the client is
in traction determines the extent of injury,
maintenance of bony alignment, and the
progress of healing.

32. • Additional principles to follow
when caring for the patient in
traction:
1. Traction must be continuous to be effective
in reducing and immobilizing fractures.
2. Skeletal traction is never interrupted.
3. weights are not removed unless intermittent
traction is prescribed.
4. Any factor that might reduce the effective pull
or alter its resultant line of pull must be

33. 4. The factor that might reduce the
effective pull or alter its resultant line of
pull must be eliminated:
1. The patient must be in good alignment in the center
of the bed when traction is applied.
2. Ropes must be unobstructed.
3. Weights must hang free and not rest on the bed or
floor .
4. Knots in the rope or the footplate must not touch the
pulley or the foot of the bed.

34. Nursing Management:
 Alteration in Peripheral Tissue Perfusion:
 Circulatory Care: tissue perfusion is enhanced
by client exercises within the limitations of the
traction.
 Exercises, regular deep breathing and
coughing, adequate fluids, and elastic
stocking work together to prevent deep
venous thrombosis.
 Teaching the client about anti-coagulant is
essential.

35. Nursing Interventions:
 High risk for peripheral neurovascular dysfunction:
 Peripheral sensation management :
 Accurate assessment of neurovascular status
includes evaluating the client’s pain, sensation,
active and passive ROM, color, temperature,
capillary refill time, and pulses.
 Neurologic impairment specific to the location
of the traction should be assessed.
 The client must be instructed to report changes
in sensation.
 Taught the client about the appropriate
exercises.

36. • Providing pin site care:
The wound at the pin insertion site requires
attention .
• The goals to avoid infection and development
of osteomyelitis.
Initially :
1. the site is covered with sterile dressing.
2. the nurse must keep the area clean.
3. Slight serous oozing at the pin site is
expected.
4. the nurse assess the pin site and drainage
for signs of infection.

37.  Attaining maximum mobility with traction:
During traction therapy:
1. The nurse encourage the patient to exercise
muscles and joints that are not in traction to
guard against their deterioration.
During the patient exercises :
1. The nurse ensures that traction forces are
maintained and that the patient is properly
positioned to prevent complications resulting
from poor alignment.

38.  Maintaining the positioning :
1. The nurse must maintain alignment of the
patient’s body in traction as prescribed to
promote an effective line of pull.
2. The nurse positions the patient’s foot to
avoid foot drop , inward rotation, and outward
rotation.
3. The patient’s foot may be supported in a
neutral position by orthopedics devices.

39. • Monitoring and managing potential
complications:
Pressure Ulcers
• The nurse examines the patient’s skin frequently for
evidence of pressure or friction.
• It is helpful to reposition the patient frequently and to
use protective devices to relieve pressure.
• If the risk of skin breakdown is high, as in a patient
with multiple trauma or a debilitated elderly patient, use
of a specialized bed is considered to prevent skin
breakdown.
• If a pressure ulcer develops, the nurse consults with
the physician and the wound care nurse specialist.

40. Monitoring and managing potential
complications:
Pneumonia
• The nurse auscultate the patient’s lungs every 4 to 8
hours to determine respiratory status and teaches the
patient deep-breathing and coughing exercises to aid in
fully expanding the lungs and moving pulmonary
secretions.
• If the patient history and baseline assessment indicate
that the patient is at high risk for development of
respiratory complications, specific therapies may be
indicated.
• If a respiratory problem develops, prompt institution of
prescribed therapy is needed.

41. Venous Stasis and Deep Vein
Thrombosis
• Venous stasis occurs with immobility.
• The nurse teaches the patient to perform ankle
and foot exercises within the limits of the traction
therapy every 1 to 2 hours when awake to prevent
DVT, which may result from venous stasis.
• The patient is encouraged to drink fluids to
prevent dehydration.
• The nurse monitors the patient for signs of DVT,
including calf tenderness, warmth, redness,
swelling (increased calf circumference).

44. • You are a staff nurse in the emergency
department,
and a patient is brought in with an open tibia/fibula
fracture.
• He is not in respiratory distress, with an SaO2 of
99%, and is communicating appropriately with
you, but complains of pain.
• What assessments will you gather first, second,
and third on this patient? Explain your rationale
for the priority order of your assessments.