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Fracture a break in the continuity of the bone.

Prevalence Annual incidence of fractures among children, adolescents, and adults was 23/1000; 29/1000; and 18/1000, respectively. Overall prevalence was 200/1000.

Types of Fracture According to soft tissue damage Closed/simple no open wound Open/compound- involve wounds that communicate with the fracture, or where fracture hematoma is exposed, and may thus expose bone to contamination. Open injuries carry a higher risk of infection.

Signs and symptoms Pain at or near the seat of fracture. Tenderness of discomfort on gentle pressure over the affected area. Swelling about the seat of fracture. Swelling frequently render it difficult to perceive other signs of fracture and care must be taken therefore not to treat the condition as a less serious injury. Loss or power; the injured part cannot be moved normally Irregularity of the bone. If the fracture is near the skin the irregularity of the bone may be felt. Crepitus (bony grating) may be heard or felt.

According to appearance Comminuted - A fracture in which the bone has broken into a number of pieces. Incomplete- A fracture in which the bone fragments are still partially joined. In such cases, there is a crack in the osseous tissue that does not completely traverse the width of the bone. Complete- A fracture in which bone fragments separate completely. Non displaced - the bone cracks with the broken pieces still in alignment. Displaced- the bone fragments on each side of the break are not aligned.

Risk Factors A bone fracture can be the result of high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, orosteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

Complications Shock FES (Fat Embolism syndrome) Compartment syndrome- limb threatening and life threatening condition, defined as the compression of nerves, blood vessels, and muscle inside a closed space (compartment) within the body. This leads to tissue death from lack of oxygenation due to the blood vessels being compressed by the raised pressure within the compartment DVT, PE Disseminated vascular coagulation Fat embolism Thromboembolism (pulmonary or venous) Exacerbation of underlying diseases such as diabetes or coronary artery disease (CAD) Pneumonia

According to general description Avulsion-pulling of bone Compression-bone is compressed Impacted-broken bones are aced into each other Green stick-bone breaks incompletely

Etiology INDIRECT VIOLENCE DIRECT VIOLENCE BENDING FORCES TORSIONAL FORCES COMPRESSION FORCES SHEARING FORCES Diagnostic Test X-Ray CT scan Medical management Reduction Open Close Casting SURGICAL THERAPY Open reduction and internal fixation (ORIF) Kirschner wires Plates and screws Intramedullary nails External fixation Nursing Responsibilities Nursing care of a patient with a fracture, whether casted or in traction, is based upon prevention of complications while healing. By performing an accurate nursing assessment on a regular basis, the nursing staff can manage the patients pain and prevent complications. When assessing a patient with a fracture, check the 5 Ps pain, pulse, pallor, paresthesia, and paralysis. Pain. Determine where the pain is located and if it is worse or better? Worsening pain may indicate increased edema, lack of adequate blood supply, or tissue damage. Pulse. Check the peripheral pulses, especially those distal to the fracture site. Compare all pulses with those on the unaffected side. Pulses should be strong and equal. Pallor. Observe the color and temperature of the skin, especially around the fracture site. Perform the capillary refill (blanching) test Bone healing is a proliferative physiological process in which the body facilitates the repair of a bone fracture.

Generally bone fracture treatment consists of a doctor reducing (pushing) dislocated bones back into place via relocation with or without anaesthetic, stabilizing their position, and then waiting for the bone's natural healing process to occur.

Phases of fracture healing There are three major phases of fracture healing, two of which can be further sub-divided to make a total of five phases;

1. Reactive Phase

i. Fracture and inflammatory phase ii. Granulation tissue formation

2. Reparative Phase iii. Cartilage Callus formation iv. Lamellar bone deposition

3. Remodeling Phase v. Remodeling to original bone contour