NILOFAR LOLADIYA MSN: OBGY This Presentation has on types, pathophysiology and management of fracture.

1. FRACTURE

2. Fracture is a break or disruption in the
continuity of bone.
• A bone gets fracture when the force
applied to it exceeds the amount, the bone
can absorb.
• In children: due to fall or direct trauma.
• Pathological cause or due to severe
muscular contraction.
• Child abuse may result bony injury in
children

3. In children, bones
are having thick
periosteum. Long
bones are more
resilient than those
of adults, so they are
able to withstand
greater deflection
without fracturing.

4. • Damage of growth plate may result in
cessation of or disturbance in bone
growth
• There is often acceleration in bone growth
after fracture in the long bones in
children.
• Fracture bone heals more rapidly in young
children and remodel more completely
and actively with less disability and
deformity

5. Common Sites of Fracture
1. Forearm fractures 50%: 3/4th of forearm
fractures involve distal third of radius and
ulna.
2. Epiphyseal fractures involve the physis
(growth plate) and accounts for about 15 to 30
percent of all fracture cases in children.
The mechanism of injury is usually fall on an
outstretched hand involving physeal injury of the
distal radius and ulna.

6. 3. Fracture humerus:
It occurs due to fall onto an
out stretched arm or hand
involving proximal part of
the shaft of the humerus.
Direct trauma.
Supracondylar fracture: 60%
Lateral condylar 2nd most
common in distal humeral
injuries.
Medial epicondylar 3rd most
common

7. 4. Femur fractures:
It is common in children involving mid shaft
of the femur.
motor vehicle accidents.
5. Tibial fracture and ankle fracture:
Most common lower extremity fracture in
children occurs in the tibial and fibular shaft
due to motor vehicle accidents and sports
injury.
Ankle fracture in adolescents: direct trauma.

10. Common types of fractures
A. Open/Compound fracture:
The wound through the adjacent or overlaying
soft tissues communicates with the site of the
break.
B. Closed:
Does not produce on open wounds.

11. 3. Plastic deformation (bending):
A bending of the bone occurs in such a manner as
to cause a microscope fracture line that does not
cross the bone.
It is unique to children and commonly found in the
ulna.

12. 4. Buckle (torus) fracture: A
fracture occurring on the
tension side of the bone
near the softer
metaphyseal bone.
crosses the bone and
buckles the harder
diaphyseal bone on the
opposite site causing a
bulge. The bone cortex not
broken but is buckled.

13. 5. Greenstick fracture:
A fracture in which the bone partially bent and
partially broken, as a green stick breaks.
The bone is bent and the fracture begins but does
not entirely cross through the bone.
Other types of fractures which may found in
children are pathological fracture due to
weakening of the bone structure by
pathological processes such as neoplasm,
osteomyelitis, etc

18. A. IMMOBILIZATION
B. CLOSED REDUCTION: f/b immobilization in
cast or splint
C. CLOSED REDUCTION and PERCUTANEOUS
PINNING:
D. CLOSED OR OPEN REDUCTION and
application of external fixators
E. OPEN REDUCTION with or w/o internal
fixation f/b immobilization in cast or splint
F. TRACTION

26. • RUSSELL’S TRACTION

29. BRYANT’S TRACTION DUNLOP TRACTION

30. 90 degree-90 degree

42. NURSING ASSESSMENT
• Initial: ABC
• Bleeding
• LOC
• V/S
• Neurological
• Head to foot
• Detailed history of trauma

43. When assessing for neurovascular integrity,
remember the five Ps:

45. NURSING INTERVENTION
PAIN

46. • ANTIBIOTIC THERAPY

49. • FREQUENT POSITION CHANGE

50. MOBILITY
• Exercise of uninvolved limbs
• Progressive ambulation
• Ambulatory aid

51. • WOUND CARE