Definition types causes sign and symptoms treatment nursing care

1. FRACTURE
DEPT. OF MEDICAL SURGICAL
NURSING

2. LEARNING OBJECTIVES
 At the end of the class the students will be able to;
 Define fracture
 Enlist the causes
 List out the types
 Discuss the clinical manifestations
 Enumerate the diagnostic measures
 Explain the management
 Describe the complications

3. DEFINITION
“A fracture is a disruption or break in the
continuity of the structure of bone.”

4. CAUSES
Trauma – RTA , falls, blunt injuries etc.
Pathologic fracture - Secondary to some
diseases like
Osteoporosis
Osteomalacia
Cancer
Other bone infections
Long use of corticosteroids

5.  Old age
 Occupation – steel industries, car racer etc.

6. CLASSIFICATION
Open and closed fracture
Complete and incomplete facture
Classification according to types

7. COMPLETE FRACTURE
1. Simple fracture- The wound is non communicating
between skin and bone.
2. Open (compound) fracture- The wound is
communicating between skin and bone.
3. Complicated fracture-Along with the fracture, there is
associated injury to internal structure.
4. Comminuted fractures- A fracture with more than two
fragments.

8. 1. Linear fracture-Fracture line is linear to the long axis of
the bone.
2. Transverse fracture-Fracture line is perpendicular to the
long axis of the bone.
3. Oblique fractures-Fracture line is oblique at 45 to the
long axis of the bone.
4. Spiral fracture -Fracture line encircles the shaft of the
bone like a spiral.
5. Impacted fracture-Fractures fragments are pushed into
each other i.e.one overrides the other fragment.

9. 1. Pathological fractures-Fracture of appoint in the bone
weakened by a disease.
2. Avulsion fracture-Fracture of the bone at the site of
attachment of tendons or ligaments due to strong
pulling force.
3. EXTRACAPSULAR a fracture outside the joint capsule
and INTRACAPSULAR a fracture within the joint capsule.

10. INCOMPLETE FRACTURE
1. Greenstick fractures – Break on one cortex of the bone
with splintering of bone surface.
2. Torus fracture –Buckling of cortex.
3. Bowing fractures- A fracture with bending of bone.

11. 1. Stress fractures-These are small or micro-fractures
resulting from repeated stress during playing or exercise
as jogging or running.
2. Transchondrial fracture-Separation of articular cartilage
from main shaft of the bone.
3. Depressed fracture- Broken parts of the bone are driven
inwards. An example is skull fracture.

12. TYPES

13. TYPES

14. PATHOPHYSIOLOGY
 Due to any etiology(crushing movement)
 Fracture occurs , muscle that were attached to
bone are disrupted and cause spasm
 Proximal portion of bone remains in place, the
distal portion can become displaced in response to
both causative force & spasm in the associated
muscles

15.  In addition, the periosteum and blood vessels in the
cortex and marrow are disrupted
 Soft tissue damage occurs, leads to bleeding and
formation of hematoma between the fracture
fragment and beneath the periosteum
 Bone tissue surroundings the fracture site dies,
creating an intense inflammatory response

16.  release chemical mediators (histamins,
prostaglandins )
 Resulting in vasodilation, edema, pain, loss of
function, leukocytes and infiltration of WBC

17. CLINICAL MANIFESTATIONS
1. Pain and tendernss at the site of a fracture-
pain is serve, excruciating and increased on
movement . pain is caused by swelling at the
site putting pressure on the sensory nerves,
muscle spasms and damage to the periosteum
2. Swelling and oedema of the surrounding tissue-
There is swelling and oedema due to disruption
of soft tissues or bleeding into the surrounding
tissue producing the risk of acute compartment
syndrome.

18.  Increased temperature or warmth-Due to fracture, there
is increased blood flow to the part involved.
 Loss of function-Due to disruption of the bone, there is
loss of function of the part involved.
 Deformity due to alteration in the shape and length-In a
fracture, there is abnormally in the shape and position
of bone because the muscles pull or displace the
fragments into an abnormal position

19.  Crepitus (grating sensation)- A crepitus or grating
sensation at the site is produced by grating or
crunching together of the broken fragments. The
crepitus is palpable as crushing or abnormal sensation
 Involvement of surrounding tissue-Ecchymosis of skin
surrounding the injured area , impairment or loss of
sensation or paralysis distal to injury due to entrapment
of nerve and infection occur as associated features of
the fractures.
 Blood loss or shock-Hypovolemic (due to blood loss) or
neurogenic shock due to pain can occur.

20. DIAGNOSIS
History and physical examination
X – Ray
CT Scan
MRI

21. FRACTURE HEALING
 Fracture hematoma: when a fracture occurs, bleeding
creates a hematoma, which surrounds the ends of the
fragments. (within 72 hours)
 Granulation tissue: active phagocytosis absorbs the
products of local necrosis. The hematoma converts to
granulation tissue. Granulation tissue produces the basis
for new bone substance called osteoid ( days 3 to 14 )
 Callus formation: As minerals and new bone matrix are
deposited in the osteoid, an unorganized network of bone
is formed. It usually appears by the end of the second
week after injury. Evidence of callus formation can be
verified by x-ray.

22.  Ossification : Ossification of the callus occurs from 3
weeks to 6 months after the fracture and continues until
the fracture has healed. During this stage of clinical
union the patient may be allowed limited mobility or the
cast may be removed.
 Consolidation : As callus continues to develop, the
distance between bone fragments diminishes and
eventually closes. This stage is called consolidation, and
ossification continues. It can be equated with radiologic
union.

23.  Remodeling : Excess bone tissue is reabsorbed in the
final stage of bone healing, and union is completed.
Gradual return of the injured bone to its pre injury
structural strength and shape occurs. Radiologic union
occurs when there is x-ray evidence of complete bony
union. This phase can occur up to a year following
injury.

26. MANAGEMENT
 Goals
 Anatomic realignment of bone
 Immobilization to maintain
realignment
 Restoration of normal to near normal function of
the injured part

27.  Treatment Of Fracture Phase
 I: Emergency care Phase
 II: Definitive care Phase
 III: Rehabilitation

28.  Phase I: Emergency care
 • Begins at the site of the accident.
 • It consists of ‘splint them where they lie’.

29.  Closed fracture
 • Before splinting remove any ring or bangles worn
by the patient.
 • Almost any available object( for eg: folded news
paper, magazine, rigid cardboard, stick, umbrella,
pillow etc.) can be used for splinting at the site of
the accident.

30. OPEN FRACTURE
 • The bleeding from the wound is stopped by
applying firm pressure using a clean piece of cloth.
 • Circular bandage can apply proximal to the wound
in order to stop bleeding.
 • If the wound is very dirty, it is washed with clean
tap water and covered with a clean cloth.
 • The fracture is splinted

31. IN THE EMERGENCY DEPARTMENT
 • Basic life support
 • Bleeding is recognized and stopped by local
pressure.
 • Wooden plank, Cramer-wire splint, Thomas’
splint, inflatable splint are some of the splints used
in emergency department.
 • After emergency care is provided , suitable
radiological and other investigations are carried out.

32. FOR OPEN FRACTURE
 • Wound care
 • Prophylactic antibiotics: Cephalexin is a good
broad spectrum antibiotic for this purpose.
 • In serious compound fractures, a combination of
third generation cephalosporins and an amino-
glycoside is preferred.
 • Tetanus prophylaxis
 • Analgesics to be given parentrally to make the
patient comfortable.

33. PHASE II-
 Definitive care The aim of treatment is rehabilitation
of the limb to pre-injury status.
 • Anatomic realignment of bone
fragments(reduction)
 • Immobilization to maintain realignment
 • Restoration of normal or near normal function of
the injured part

34. METHODS OF TREATMENT
 Not all fractures need all three of these treatment.
 • Treatment by functional use of the limb: Some
fractures (eg: fractured ribs, scapula) need no
reduction or immobilization. These fractures unite
despite functional use of the body part. Analgesics
are needed for the initial few days.
 • Treatment by immobilization : Fractures without
significant displacement or fractures where the
displacement is of no concern are treated this way.

35.  Treatment by reduction followed by immobilization:
It is required for most displaced fractures. These
otherwise result in deformity, shortening etc.
 • Open reduction and internal fixation: Some
fractures , such as intra- articular fractures, are best
treated by open reduction and internal fixation.

36.  Fracture reduction Reduction of a fracture can be
carried out by following methods
 Closed reduction
 Open reduction •
 Continuous traction

37. FRACTURE REDUCTION
 Closed reduction
it is the non surgical reduction.
under local or general anesthesia.
 Open reduction
surgical
ORIF
OREF

38. OREF

39. IMMOBILIZATION
Casts
Splints
tractions

40. ORIF

41. DRUG THERAPY
Muscle relaxants
Analgesics
Prophylactic antibiotics
Tetanus immunization
Surgical debridement and irrigation

42. NUTRITIONAL
 High protein
 Vitamins minerals
 High fluid intake
 Small and frequent diet
 Avoid constipation

43. STAGES OF BONE HEALING
Fracture hematoma – 72 hours of injury
Granulation tissue – 3 to 14 days
Callus formation – end of 2nd week
Ossification – 3 weeks to 6 months, clinical
union, cast can be removed
Consolidation – radiological union
Remodeling – up to one year

45. COMPLICATION
Delayed union
Nonunion
Malunion
Angulation
Pseudoarthrosis
Refracture
Myositis ossificans
Compartment syndrome

47. NURSING CARE
1.increased risk of hypovolemia and shock related to trauma and
bleeding.
2. Increased risk of bone inflammation related to open fracture.
3. Increased risk of fat embolism related to fracture of the long
bones.
4. Increased risk of severe fluid, electrolyte, and metabolic
imbalances related to injury or inflammation.
5. Pain and immobility , related to diagnosis of fracture.
6. Increased risk of respiratory, cardiovascular, bowel, and skin
complications related to a long period of immobility.
7. Anxiety related to the symptoms of disease and fear of the
unknown.

48. SUMMARY
In this class we discussed the :-
 Definition of fracture
 Causes of fracture
 Types of fracture
 Clinical manifestations of fracture
 Diagnostic measures of fracture
 Management of fracture
 Complications of fracture

49. BIBLIOGRAPHY
Lippincott “Medical surgical nursing” 10th
edition
Joyce M Black ” Medical surgical nursing”
Brunner And Suddharth “Medical surgical
nursing”

50. THANK YOU!!!