Fractures occur when bones break due to stresses that exceed the bone's strength. The causes of fractures include direct injuries, repetitive stresses, and pathological fractures caused by weakened bones from conditions like osteoporosis. Fractures are classified based on features like location, communication with the skin (open vs closed), and the direction of the break. Clinical signs include pain, swelling, deformity. Diagnosis involves history, exam, and imaging like x-rays. Treatment focuses on saving life by addressing vital organ injuries, saving the limb by splinting and assessing circulation, and saving function by properly immobilizing and rehabilitating the injury. Nursing care involves splinting, wound management, exercises, pain control, and

1. FRACTURE
Dr Ninad S Patil
MBBS,MD Pediatrics
Department of Pediatrics
NKP Salve & LMH ,Nagpur

2. Definition
 It is break/disruptions in the continuity of
bone
Fractures occurs when bone is subjected to
the stress greater than it can absorb

3. Causes
• Injury
• Repetitive stress
• Pathological fracture

4. Injury
• Direct force - the bone breaks at the point of
impact
• Indirect Force - the bone breaks at the point of
away from point of impact

5. Fatigue/stress Fracture
• Occurs in normal bone, subject to repeated
heavy loading like athletes, military people

6. Pathologic fracture
• Occurs in a bone that is made weak bye some
disease
• Causes
- inflammation eg osteomyelitis
- neoplastic- Ewing's sarcoma
- hereditary – osteogenesis imperfecta
- acquired- rickets ,osteomalacia

7. classification
• Type
• Communicating OR non-communication to
external environment
• Anatomical location

8. • Closed fracture - fracture hematoma does not
communicate with the outside surface(skin)
• Open fracture/compound/complex - fracture
hematoma communicate with the outside
surface(skin)

9. Anatomical classification
1) Impacted # - vertical force drives the distal
fragment of the # into the proximal fragment
2) Depressed # - type of skull fracture, segment
of the bone get depressed into the cranium

10. # type based upon “path of fracture line”
1) Transverse #
2) Oblique #
3) Longitudinal #
4) Spiral /torsion #

13. CLINICAL MANIFESTATION
• Pain
• Local swelling/tenderness/painful movement
• Discoloration of limb
• Deformity/shortening
• Loss of function of limb

14. Diagnosis of fracture
• History
• Physical examination- General and local
• X-ray- two view imaging
• CT scan- vertebral /joint /hairline #
• MRI scan- vertebral fracture compressing SC

15. Fracture Complication

16. STAGES OF FRACTURE HEALING
1) Inflammatory stage (A & B) –
A – stage of hematoma formation
B - Stage of granulation tissue (more fibrin to
hematoma & increased blood flow)
2) Reparative phase (A & B) –
A- stage of fibrocartilaginous callus
B- stage of bony callus (woven bone become calcified)
3) Remodeling Phase –excess material inside bone shaft
get replaced by more compact bone

18. Immediate
Damage to Vessel Hemorrhage/shock
Damage to Organ Brain/Liver/spleen etc
Damage to Nerve Power/sensation loss
Damage to Muscle compartment syndrome
Fat embolism

19. DIAGNOSIS
• History collection
• Physical examination
• X ray- 2 views
• CT scan
• MRI scan

20. PRINCIPLE OF MANAGEMENT
1st save life
2nd save limb
3rd save function of limb

21. SAVE THE LIFE
• Check for the Vitals and Injury to vital organs
act accordingly
A-airway
B-breathing
C-circulation

22. SAVE THE LIMB
• Early splinting
• Assess the fracture site and involved limb
• Look for the color and perfusion of limb
• Look for the injury to blood vessels and
Nerves
• Wound contamination

23. Splinting
• It is the most common procedure for
immobilizing an injury
• It stabilizes the limb and reduces the area
• Any material available can be used like towel,
paper etc

24. Any material can be used for splinting

25. Guideline for splinting
• Support the injured area
• Splint injury in the position that you find it
• Don’t try to realign the bones
• Check color, warmth and sensation
• Immobilize above and below the injury

26. SAVE THE LIMB FUNCTION
• Fracture reduction
• Wound/limb care
• Immobilization
• Early physiotherapy and rehabilitation
• Help to hasten recovery
• Look for complications

27. Reduction of fracture
(correction of displacement of fragments)
- Closed or Open reduction
CLOSED REDUCTION
Non-surgical procedure
plaster applied

28. OPEN REDUCTION
• Surgical correction of fractured bone alignment
• Internal Fixator used for stabilization

29. NURSING MANAGMENT
Closed Fracture
• Encourage patient to not to mobilize fracture
site
• Exercise to maintain the health of the
unaffected muscle for using assisted devices
like crutches /walker
• Patient education about – self care,
medication information, monitoring for
potential complication and need for
continuous supervision

30. Open fracture
• Injection TT
• Wound irrigation and debridement
• Heavily contaminated wounds – left
unsutured and dressed with sterile gauze to
permit swelling & wound drainage
• Administering IV antibiotics/painkiller

31. Nursing diagnosis
• Acute pain related breakdown of continuity of
the bone as evidenced by facial expression
and verbalization of patient
• Goal- patient should be pain free
• Interventions-
- asses the onset,duration,location,severity & intensity
of pain
- administer the analgesic as per prescription
- provide the comfort devices like sand bag for
immobilization of affected parts

32. Thank You