The document discusses a case involving a 12-year-old boy, Ali, who suffered a closed fracture in his right arm after falling into a canal when a dog crossed his path. It provides an overview of fractures, including types, causes, clinical manifestations, complications, assessment methods, and the medical and nursing management necessary for treatment and recovery. The document emphasizes the importance of proper immobilization, assessment for infection, patient education for home care, and documentation of the care process.

1. PREPARED BY;
SEIF SAID KHALFAN
BSc.N STUDENT
November 23, 2016
TOPIC: FRACTURE
ZANZIBAR UNIVERSITY

3. Scenario: Ali, a 12-year old boy, is riding his
bicycle on the way home. Suddenly, a dog ran in
front of his path, causing him to swerve towards
the canal. Ali fell through the canal and his
bicycle landed on top of him. The emergency
room physician took his x-ray and later on
informed Ali’s parents that their son had a closed
fractured on his right arm.

4. Description
• Injury to one part of the musculoskeletal system
results in malfunction of adjacent muscles,
joints, and tendons.
• A fracture is a complete or incomplete
disruption in the continuity of the 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.

5. • When the bone is broken, adjacent structures
are affected, resulting in soft tissue edema,
hemorrhage into muscles and joints, joint
dislocations, ruptured tendons, severed nerves
and damaged blood vessels.

6. Classification of fracture
• Complete fracture. A complete fracture involves a
break across the entire cross-section of the bone and
is frequently displaced.
• Incomplete fracture. An incomplete fracture involves
a break through only part of the cross section of the
bone.
• Comminuted fracture. A comminuted fracture is one
that produces several bone fragments.
• Closed fracture. A closed fracture is one that does
not cause a break in the skin.
• Open fracture. An open fracture is one in which the
skin or mucous membrane wound extends to the
fractured bone.

8. Causes
Fractures may be caused by the following:
• Direct blows. Being hit directly by a great force
could cause fracture in the bones.
• Crushing forces. Forces that come into contact
with the bones and crush them could also result
in fractures.
• Sudden twisting motions. Twisting the joints in a
sudden motion leads to fractures.
• Extreme muscle contractions. When the muscles
have reached its limit in contraction, it could lead
to serious fractures.

9. Clinical Manifestations
The clinical signs and symptoms of a fracture may
include the following but not all are present in every
fracture:
• The pain is continuous and increases in severity until
the bone fragments are immobilized.
• Loss of function. After a fracture, the extremity
cannot function properly because normal function of
the muscles depends on the integrity of the bones to
which they are attached.

10. • Displacement, angulation, or rotation of the
fragments in a fracture of the arm or leg causes a
deformity that is detectable when the limb is
compared with the uninjured extremity.
• There is actual shortening of the extremity
because of the compression of the fractured
bone.
• When the extremity is gently palpated,
a crumbling sensation, called crepitus, can be felt.
• Localized edema and ecchymosis. Localized
edema and ecchymosis occur after a fracture as a
result of trauma and bleeding into the tissues.

11. Complications
Complications of fractures may either be acute or
chronic.
• Hypovolemic shock resulting from hemorrhage is
more frequently noted in trauma patients with pelvic
fractures and in patients with displaced or open
femoral fractures.
• Fat embolism syndrome. After fracture of long bones
and or pelvic bones, or crush injuries, fat emboli may
develop.
• Compartment syndrome. Compartment syndrome in
an extremity is a limb-threatening condition that
occurs when perfusion pressure falls below tissue
pressure within a closed anatomic compartment.

12. Assessment and Diagnostic Findings
To determine the presence of fracture, the following
diagnostic tools are used.
• X-ray examinations: Determines location and extent of
fractures/trauma, may reveal preexisting and yet
undiagnosed fracture(s).
• Bone scans, tomograms, computed tomography
(CT)/magnetic resonance imaging (MRI) scans: Visualizes
fractures, bleeding, and soft-tissue damage; differentiates
between stress/trauma fractures and bone neoplasms.

13. • Arteriograms: May be done when occult vascular damage is
suspected.
• Complete blood count (CBC): Hematocrit (Hct) may be
increased (hemoconcentration) or decreased (signifying
hemorrhage at the fracture site or at distant organs in multiple
trauma). Increased white blood cell (WBC) count is a
normal stress response after trauma.
• Urine creatinine (Cr) clearance: Muscle trauma increases load
of Cr for renal clearance.
• Coagulation profile: Alterations may occur because of blood
loss, multiple transfusions, or liver injury.

14. Medical Management
• Management of a patient with fracture can
belong to either emergent or post-emergent.
• Immediately after injury, if a fracture is
suspected, it is important to immobilize the body
part before the patient is moved.
• Adequate splinting is essential to prevent
movement of fracture fragments.

15. • In an open fracture, the wound should be
covered with sterile dressing to prevent
contamination of the deeper tissues.
• Fracture reduction refers to restoration of the
fracture fragments to anatomic alignment and
positioning and can be open or closed
depending on the type of fracture.

16. Nursing Management
Nursing management for close and open fractures
should be differentiated.
Nursing Assessment: Assessment of the fractured
area includes the following:
• Close fracture. The patient with close fracture is
assessed for absence of opening in the skin at
the fracture site.
• Open fracture. The patient with open fracture is
assessed for risk for osteomyelitis, tetanus, and
gas gangrene.
The fractured site is assessed for signs and
symptoms of infection.

17. Nursing Diagnosis
Based on the assessment data gathered, the
nursing diagnoses developed include:
• Acute pain related to fracture, soft tissue injury,
and muscle spasm.
• Impaired physical mobility related to fracture.
• Risk for infection related to opening in the skin in
an open fracture.

18. Planning & Goals
Planning and goals developed for a patient with
fracture are:
• Relief of pain.
• Achieve a pain-free, functional, and stable body
part.
• Maintain asepsis.
• Maintain vital signs within normal range.
• Exhibit no evidence of complications.

19. Nursing Interventions
• Nursing care of a patient with fracture include:
• The nurse should instruct the patient regarding
proper methods to control edema and pain.
• It is important to teach exercises to maintain the
health of the unaffected muscles and to increase
the strength of muscles needed for transferring
and for using assistive devices.

20. • Plans are made to help the patients modify the
home environment to promote safety such as
removing any obstruction in the walking paths
around the house.
• Wound management. Wound irrigation and
debridement are initiated as soon as possible.
• Elevate extremity. The affected extremity is
elevated to minimize edema.
• Signs of infection. The patient must be assessed
for presence of signs and symptoms of infection.

21. Evaluation
• The following should be evaluated for a successful
implementation of the care plan.
• Pain was relieved.
• Achieved a pain-free, functional, and stable body
part.
• Maintained asepsis.
• Maintained vital signs within normal range.
• Exhibited no evidence of complications.

22. Discharge and Home Care Guidelines
After completion of the home care instructions, the patient
or caregiver will be able to:
• Control swelling and pain. Describe approaches to
reduce swelling and pain such as elevating the extremity
and taking analgesics as prescribed.
• Care of the affected area. Describe management of
immobilization devices or care of the incision.
• Consume diet to promote bone healing.
• Mobility aids. Demonstrate use of mobility aids and
assistive devices safely.
• Avoid excessive use of injured extremity and observe
weight-bearing limits.

23. Documentation Guidelines
The focus of documentation should include:
• Client’s description of response to pain and
acceptable level of pain.
• Prior medication use.
• Level of function.
• Ability to participate in specific or desired activities.
• Signs and symptoms of infectious process.
• Wound/ incision site, Plan of care and Teaching plan.
• Response to interventions, teaching, and actions
performed.
• Attainment or progress toward desired outcomes.
• Modifications to plan of care.
• Long term needs.