FRACTURES

A. Description 1. A fracture is a break in the continuity of the bone. 2. Common fracturesites:
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Clavicle Humerus – In subpracondylar fractures, which occur when child falls backward on hands with elbows straight, there is a high incidence of neurovascular complications due to the anatomic relationship of the brachial artery and nerves to the fracture site.

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Radius and ulna Femur (often associated with child abuse) Epiphyseal plates (potential for growth deformity)

3. Types of Fracture

Closed or simple fracture – The bone is broken, butthe skin is not lacerated.

Open or compound fracture - The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. The bone may or may not be visible in the wound.

Transverse fracture – The fracture is at right angles to the long axis of the bone.

Greenstick fracture - Fracture on one side of the bone, causing a bend on the other side of the bone.

Comminuted fracture - A fracture that results in three or more bone fragments.

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Oblique Fracture – The fracture is diagonal to a bone’s long axis. Spiral Fracture – At least one part of the bone has been twisted.

4. Complications of fractures include:

problems associated with immobility (muscle atrophy, joint contracture, pressure sores)

 Buckle fracture – results from compression failure of the bone. Fractures in children usually are the result of trauma from motor vehicle accidents. pulse. paresthesia. Clinical Manifestations  The five “Ps” – pain.      growth problems ( in children) infection shock venous stasis and thromboembolism pulmonary emboli and fat emboli and bone union problems B. pallor. Because of the resilience of the soft tissue of children. Fractures occur when the resistance of bone against the stress being exerted yields to the stress force. . Fractures most commonly seen in children:  Bend Fracture – is characterized by the bone bending to the breaking point and not straightening without intervention. C. Assessment Findings 1. with the bone telescoping on itself.  Greenstick fracture – is an incomplete fracture. D. 2. Etiology 1. falls or child abuse. 2. fractures occur more often than soft tissue injuries. and paralysis are seen with all types of fractures. Pathopysiology 1.

4. edema not relieved by elevation. positive blanch sign. or clean dressing. 2. or numbness and tingling). Assess for circulatory impairment (cyanosis. Determine the mechanism of injury. mottling. shock or refusal to walk (in small children). unaffected extremity is often used to look for subtle changes in the affected extremity. pain. Immobilize the part. pain or cramping). Apply traction if circulatory compromise ispresent. Reassess the five “Ps”. 3. impaired sensation. tenderness. Laboratory and diagnostic findings  Radiographic examination reveals initial injury and subsequent healing progress. swelling. or tenderness. Nursing Management 1. Assess for neurologic impairment (lack of sensation or movement. Cover any open wounds with a sterile. Other characteristic findings include deformity. . pain. Administer analgesic medications. 2. if possible. coldness. A comparison film of an opposite. crepitus. E. abnormality. bruising. Provide emergency management when situation warrants.  Blood studies reveal bleeding (decreased hemoglobin and hematocrit) and muscle damage (elevated aspartate transaminase (AST) and lactic dehygrogenase (LHD). Move injured parts as little as possible. Elevate the injured limb. muscle spasms.          Assess the five “Ps”. decreased peripheral pulses. Call emergency medical services. for a new fracture. Apply cold to the injured area. loss of function.

limited ROM. monitoring I&O.  Prevent nerve compression syndromes by testing sensation and motor function. 10. . which sometimes require performing a fasciotomy.  Treatment entails pressure relief. Early detection is critical to prevent tissue damage. Explain fracture management to the child and family. repair (by realignment or reduction) may be made by closed or open reduction followed by immobilization with a splint. burning sensation. Institute appropriate measures for cast and appliance care. 9. including subjective symptoms of pain. trauma.5. Depending on the type of break and its location. 8. and by reporting changes immediately. and altered sensation.  Prevent compartment syndrome by assessing for muscle weakness and pain out of proportion to injury. Emboli generally occur within the first 24 hours. 6. Maintain skin integrity and prevent breakdown. Prevent infection. burns and surgery. Prevent pulmonary emboli by carefully monitoring adolescents and children with multiple fractures. Prevent Complications  Prevent circulatory impairment by assessing pulses. Prevent renal calculi by encouraging fluids. hemorrhage. Correct alignment to alleviate pressure if appropriate. color and temperature. 7. traction or a cast. bys usinginfection control measures. and notify the health care provider. muscular weakness. including osteomyelitits. and mobilizing the child as much as possible.  Causes of compartment syndrome include tight dressings or casts.

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