introduction causes classification principle of fracture management

1. CARE OF PATIENT WITH
FRACTURE

2. INTRODUCTION
Fracture is defined as a break in the continuity of a
bone.Fractures occur when a bone is subjected to more stress
than it is able to absorb.
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3. CAUSES
Fracture may occur from several specific causes and are categorize as
follow:
1. Direct Force - In direct force fracture , a bone is subjected to more stress
than it can absorb from an impact with a solid object. for example, a direct
blow as a baseball bat or a crushing force such as some automatic
accidents.
2. Twisting - an indirect force may cause a break in a bone at a location
other than the site of the twisting force. this type of injury is common in
skinning accidents.
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4. muscle contraction - in another indirect force fracture , powerful
contraction of a muscle may cause the muscle to tear away from the
bone, often fracturing or avulsing part of the bone in the process.this type
of injury may occur during a grand mal seizure. this type fracture is seen
in soldier in an injury known as grenade throwers fracture . the humerus is
fractured as a result of the muscular contractions in throwing a hand
grenade..
Pathological fracture - bones that have become weakened from age or
diseases are easily fractured, often from just a slight movenment.
Fatigue or stress fracture - this type of injury may occur when a bone has
been subjected to reapeted stress.associated with sports enthusiasts and
soldier.

5. open /
close
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condition of
the bone
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Tissue
damage
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classification of fracture
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6. soft tissue damage
a great amount of soft tissue damage often accompanies a
fracture:
a. complicated fracture - A fracture that is associated with a large
amount of nerve, bloodvessel, and soft tissue damage is called a
complicated fracture.
b. uncomplicated fracture - A fracture without other damage
would be reffered to as an uncomplicated fracture. The nature
and extent of the damage depends upon the type and direction of
the force causing the fracture.

7. The direction of the fracture line in relation to the
bones longitudinal axis:
linear - A fracture line that runs
parallel to the bones axis.
Longitudinal - A fracture line that
runs along the length of , but not
parallel to,the bones axis.
Transverse - A fracture line that
runs across or at a right angle to ,
the bones axis.
Oblique - A fracture line that is
slant across the bones.
Spiral - that runs across the bone
at an oblique angle and coils or
spiral around the bone

8. OPEN / CLOSE
An open / compound fracture is
one in which there is an open
wound associated with the
fracture site.
In a close or simple fracture there
is no break in the skin associated
with the fracture.

9. ACCORDING TO CONDITION OF BONES
complete
Incomplete
Displaced
Impacted or Compressed
Depressed
Comminuted
Geenstick

10. SIGN AND SYMPTOMS
pain
deformity
false motion: abnormal mobility at
the fracture site
Discolouration
Edema
Crepitus
Loss of Function
Shortening of an extremity

11. PRINCIPLES OF FRACTURE MANAGEMENT
 In treating a fracture the objectives of the teatment are as follow:
a. To regain and maintain the normal alignment of the injured part.
b. To regain normal function of the injured part.
c. To achieve the above objective for the patient in the shortest time
possible.
 The principles of fracture management are reduction, immobilization and
rehabilitation:
A. Reduction - Reduction is the process of restoring the bone ends into their
normal anatomical position. This is accomplished by open or close
manipulation of the affected area, referred to as open reduction and closed
reduction.

12. B. Immobilization - Immobilization is neccasary to maintain fracture reduction until
healing occurs. Immobilization may be occomplished by external or internal
fixation.
- Method of external fixation include casts, splints, and continuous traction.
- Internal fixation devices include pins, wires, screw, rods, nails , plates.
These devices attached to the sides of the bone orinserted through the bone.
provide internal immobilization of the bone.
C. Rehabilitation - rehabilitation is the regaining of strength and normal function in
the affected area. specific rehabilitation for each patient will be based upon the
type of fracture and the methods of reduction and immobilization used. the
physician will generally consult with the physical therapist to develop an
individualized rehabilitation plan for each patient. this plan is noramally
implemented and controlled by the physical therapy department.

13. NURSING MANAGEMENT OF A PATIENT WITH A
FRACTURE
Nursing care of a patient with a fracture, whether casted or in traction, is
based upon prevention of complications while healing.By performing an
accurate nursing assessment on a regular basis,the nursing staff can
manage the patients pain and prevent complications.
ASSESSMENT
5 P's - PAIN
PULSE
PALLOR
PARESTHESIA
PARALYSIS

14. MANAGING CLOSED FRACTURES
Instruct the patient regarding the proper methods to control edema and
pain(e.g, elevate extremity to heart level , take analgesics as prescribed).
Teach excercises to maintain the health of unaffected muscle and to
strengthen muscle needed for transfering and for using assistive devices,
(e.g, crutches ,walker).
Teach patient how to use assistive devices safely.
Arrange to help patients modify their home environment as needed and to
secure personal assistance if necessary.
Provide patient teaching including self care , medication information ,
monitoring for potential complication and the need for continuing health
care supervision.

15. MANAGING OPEN FRACTURES
the objectives of the management are to prevent infection of the wound,
soft tissue and bone and to promote healing of bone and soft tissue . In an
open fracture, there is the risk of osteomylitis , tetanus and gas gangrene.
Administer IV antibiotics immediately upon the patients arrival in the
hospital along with tetanus toxoid if needed.
perform wound irrigation and debridement.
Elevate the extremity to minimize edema
Assess neurovascular status frequently.
Take the patients temperature at regular intervals and monitor for signs of
infection.

16. RELIEVE PAIN
Provide analgesics and anti inflammatories as ordered to
relieve pain and swelling.
Ensure proper positioning and alignment to minimize
discomfort and promote pain relief.
Assess for compartment syndrome if patient has a cast in
place to prevent neurovascular complications
Apply ice as ordered to decrease swelling and pain.
Teach alternative measure of pain relief to maximize means to
relieve pain.

17. PROPER POSITIONING
Position the affected limb properly to prevent dislocation,use
abduction if a prosthesis was inserted , but use a neutral position if
another internal fixation device was inserted.
Turn the patient on the nonoperative side as prescribed to facilitate
circulation and recovery while easing tired muscle and relieving
pressure; prop the operative limb with an abduction pillow if the
patient has a prosthesis or with pillows if the patient has another
internal fixation device

18. MAINTAIN PHYSICAL MOBILITY
Encourage independence to promote mobility.
Utilize other discipline such as occupational and physiotherapy to
encourage and promote patient mobility.
Provide equipment and resources such as crutches and wheelchairs to
improve mobility.

19. MAINTAIN NEUROVASCULAR HEALTH
Assess and monitor frequently for compartment syndrom.
Assess for swelling of affected limb.
keep limb elevated above heart level to minimize edema
administer anti inflammatory agents as ordered
monitor for increasing pain even after analgesic administration.

20. MAINTAIN NUTRITIONAL STATUS
Provide regular diet as prescribed and monitor bowel sounds,a
patient with good bowel sounds who is passing flatus can receive
regular foods.
 Monitor fluid intake and output and iv infusions intake should be
3000ml daily output should include 2300 ml of urine and 300 to
700 ml of insensible water loss and perspiration.
MAINTAIN FLUID INTAKE AND OUTPUT STATUS

21. PREVENT COMPLICATION
Encourage deep breathing and coughing every 2 hours and use an
incentive spirometer every 1 to 2 hours to prevent complications.
assess skin and provide skin care to pressure area
(heal,back,sacrum,shoulders,elbows)
encourage the patient to perform foot and ankle exercises,including
dorsiflexion and plantar flexion to increase venous return and prevent
thrombophebitis.

22. PREVENT INFECTION
cover any breaks in the skin with clean or sterile dressing.
PROVIDE CARE DURING CLIENT TRANSFER
immobilize a fractured extremity with splint in the position of the deformity
before moving the client, avoid strengthening the injured body part if a joint
is involved.
support the affected body part above and below fracture site when moving
the client.

23. PROVIDE CLIENT AND FAMILY TEACHING
Explain prescribed activity restrictions and neccessary lifestyle modification
because of impaired mobility.
Teach the proper use of assistive devices , as indicated.
Administer prescribed medications,which may include opiod or nonopiod
analgesics and prophylactics atibiotics for an open fracture.

24. PATIENT EDUCATION REGARDING DIFFERENT
FACTORS THAT AFFECT FRACTURE HEALING
FACTOR THAT ENHANCE
FRACTURE HEALING :
immobilize of fracture fragement
maximum bone fragment contact
sufficient blood supply
proper nutrition
excersise - weight bearing for
long bones
hormones - growth
,thyroid,calcitonin,vitamin
D,anabolic steroids.
FACTOR THAT INHIBIT
FRACTURE HEALING :
extensive local trauma
bone loss
inadequate immobilization
space or tissue between bone
fragement
infection
local malignancy
age (elderly person heel more
slowly)

25. THANK YOU
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