This document describes fractures, including their classification, healing process, treatment methods, and potential complications. Fractures are breaks in bone continuity that can be open or closed. Treatment involves reduction, immobilization with casts or devices, and monitoring for complications like infection, compartment syndrome, blood clots, and fat embolism syndrome. Fracture healing is a multi-stage process of hematoma formation, new tissue growth, callus formation, bone consolidation and remodeling over several weeks or months.

1. Fractures

2. Objectives Describe the sequence of fracture healing Differentiate between open and closed reduction, cast immobilization, and traction Describe neurovascular assessment of injured extremity Explain common complications associated with fracture injury and healing

3. Description A disruption or break in the continuity of the structure of bone Traumatic injuries account for the majority of fractures

4. Description Described and classified according to: Type Communication or noncommunication with external environment Anatomic location

5. Classification by Fracture Types

6. Classification by Fracture Communication

7. Classification by Fracture Location

8. Description Described and classified according to: Appearance, position, and alignment of the fragments Classic names Stable or unstable

9. Description Closed (simple) Open (compound)

10. Description Stable fractures Occur when a piece of the periosteum is intact across the fracture External or internal fixation has rendered the fragments stationary

11. Description Stable fractures Transverse Spiral Greenstick

12. Description Unstable fractures Comminuted Oblique

13. Clinical Manifestations Patient history indicates a mechanism of injury associated with: Immediate localized pain  Function Inability to bear weight or use affected part Guarding May not be accompanied by obvious bone deformity

14. Fracture Healing Reparative process of self-healing ( union ) occurs in the following stages: Fracture hematoma Granulation tissue Callus formation Consolidation Ossification Remodeling

15. Bone Healing 1. Fracture haematoma bleeding & oedema create haematoma which surrounds the ends of the fragments Occurs within 72 hrs 2. Granulation tissue active phagocytosis absorbs products of local necrosis Granulation tissue (new blood vessels, fibroblasts & osteoblasts) produces the basis for new bone substance Occurs 3-14 days post injury

16. Bone Healing (cont.) 3. Callus formation As minerals are deposited, an unorganised network of bone is formed that is woven about the fracture parts Callus is composed of cartilage, osteoblasts, calcium & phosphorus Begins to appear by end of 2 nd week

17. Bone Healing (cont.) 4. Ossification Ossification (development of bone) of the callus Sufficient to prevent movement at fracture site Occurs from 3 weeks to 6 months

18. Bone Healing (cont.) 5. Consolidation As callus develops, the distance between bone fragments diminishes & eventually closes 6. Remodelling Excess bone tissue is reabsorbed & union is completed

19. Bone Healing

20. Collaborative Care Overall goals of treatment : Anatomic realignment of bone fragments (reduction) Immobilization to maintain alignment Restoration of normal function

21. Fracture Reduction Closed reduction Nonsurgical, manual realignment Open reduction Correction of bone alignment through a surgical incision

22. Fracture Immobilization Casts Temporary circumferential immobilization device Common treatment following closed reduction

23. Fracture Immobilization External fixation Metallic device composed of pins that are inserted into the bone and attached to external rods

24. Fracture Immobilization Internal fixation Pins, plates, intermedullary rods, and screw Surgically inserted at the time of realignment

25. Traction Application of a pulling force to an injured part of the body while counter-traction pulls in the opposite direction

26. Fracture Reduction - Traction Skin traction (short-term) Skeletal traction (longer periods)

27. Purpose of Traction Prevent or reduce muscle spasm Immobilization Reduction Treat a pathologic condition

28. Neurovascular Assessment Colour Temperature Capillary refill Peripheral pulses Oedema Sensation Motor function Pain

29. Complications of Fractures Infection Open fractures and soft tissue injuries have  incidence Osteomyelitis can become chronic

30. Complications of Fractures Infection Open fractures require aggressive surgical debridement Post-op IV antibiotics for 3 to 7 days

31. Complications of Fractures Compartment Syndrome Condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space

32. Complications of Fractures Compartment Syndrome Two basic etiologies create compartment syndrome: Decreased compartment size Restrictive dressings Splints Casts

33. Complications of Fractures Compartment Syndrome Two basic etiologies create compartment syndrome: Increased compartment content Bleeding Oedema

34. Complications of Fractures Compartment Syndrome Clinical Manifestations Six P s: Paresthesia Pain Pressure Pallor Paralysis Pulselessness

35. Complications of Fractures Venous Thrombosis Veins of the lower extremities and pelvis are highly susceptible to thrombus formation after fracture, especially hip fracture

36. Complications of Fractures Venous Thrombosis Precipitating factors: Venous stasis caused by incorrectly applied casts or traction Local pressure on a vein Immobility

37. Complications of Fractures Fat Embolism Syndrome (FES) Characterized by the presence of fat globules in tissues and organs after a traumatic skeletal injury

38. Complications of Fractures Fat Embolism Syndrome (FES) Fractures that most often cause FES: Long bones Ribs Tibia Pelvis

39. Complications of Fractures Fat Embolism Syndrome (FES) Tissues most often affected: Lungs Brain Heart Kidneys Skin

40. Complications of Fractures Fat Embolism Syndrome (FES) Clinical Manifestations Usually occur 24 to 48 hours after injury Interstitial pneumonitis Produce symptoms of ARDS

41. Complications of Fractures Fat Embolism Syndrome (FES) Clinical Manifestations Symptoms of ARDS: Chest pain Tachypnea Cyanosis  PaO 2

42. Complications of Fractures Fat Embolism Syndrome (FES) Clinical Manifestations Symptoms of ARDS: Dyspnea Apprehension Tachycardia

43. Complications of Fractures Fat Embolism Syndrome (FES) Clinical Manifestations Rapid and acute course Feeling of impending disaster Patient may become comatose in a short time