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Fracture

Tony Suharsono

Definition
 A fracture is a break in the continuity of bone and is

defined according to its type and extent  A fracture is a break in a bone and can occur at any age and in any bone  Fractures occur when the bone is subjected to stress greater than it can absorb  When the bone is broken, adjacent structures are also affected, resulting in soft tissue edema, hemorrhage into the muscles and joints, joint dislocations, ruptured tendons, severed nerves, and damaged blood vessels

Types of Fracture
 A complete fracture involves a break across the entire cross-section

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of the bone and is frequently displaced (removed from normal position). Incomplete fracture (eg, greenstick fracture), the break occurs through only part of the cross-section of the bone. A comminuted fracture is one that produces several bone fragments. A closed fracture (simple fracture) is one that does not cause a break in the skin. An open fracture (compound, or complex) is one in which the skin or mucous membrane wound extends to the fractured bone

and is the most severe.Types of Fracture  Open Fracture  Open fractures are graded accordingto the following criteria:  Grade I is a clean wound less than 1 cm long  Grade II is a larger wound without extensive soft tissue damage  Grade III is highly contaminated. has extensive soft tissue damage. .

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Clinical Manifestation  Pain  The pain is continuous and increases in severity until the bone fragments are immobilized  Loss of function  Deformity  Shortening  Crepitus  Swelling and discoloration .

Patofisiology  Bone is a dynamic. As healing continues. a nonbony union called a callus develops and can be seen on x-ray examination. healthy adult bone completely heals in about 6 weeks . changing tissue  Within 48 to 72 hours after the injury a hematoma (blood clot)     forms at the fracture site because bone has a rich blood supply Various cells that begin the healing process are attracted to the damaged bone. osteoclasts (bonedestroying cells) resorb any necrotic bone Osteoblasts (bone-building cells) make new bone as a replacement. In about a week or so. Young. This process is sometimes referred to as bone remodeling.

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Diagnostic Procedure  X Ray  Menentukan lokasi/luas/jenis fraktur  Dua posisi (AP/Lat). identifikasi kerusakan jar lunak  Arteriogram  Jika terdapat kerusakan vaskuler . dua sendi terlibat  Bone Scanning  Menunjukkan tingkat keparahan fraktur.

and tight clothing from injured extremity  Immobilize extremities beyond the joint above and below the site of injury  Reevaluate neurovasculer status after reposition or imobilization  Apply ice pack to areas of swelling . other jewelry.General Management  Perform a primary assessment and initiate appropriate intervention  Evaluate the neurovasculer status  Secure any impaled object  Remove rings.

and an analgesic is administered as prescribed .Management of Fracture  Reduction  restoration of the fracture fragments to anatomic alignment and rotation  closed reduction or open reduction may be used to reduce a fracture  Usually. permission for the procedure is obtained. the patient is prepared for the procedure.the physician reduces a fracture as soon as possible to prevent loss of elasticity from the tissues through infiltration by edema or hemorrhage  Before fracture reduction and immobilization.

Management of Fracture  Closed Reduction  bringing the bone fragments into position through manipulation and manual traction  The immobilizing device maintains the reduction and stabilizes the extremity for bone healing  X-rays are obtained to verify that the bone fragments are correctlyaligned .

Management of Fracture  Open Reduction  Internal fixation devices may be used to hold the bone fragments in position until solid bone healing occurs  Internal fixation devices ensure firm approximation and fixation of the bony fragments .

Internal Fixation .

Management of Fracture  Immobilization  After the fracture has been reduced. until union occurs  Immobilization may be accomplished by external or internal fixation . or held in correct position and alignment. the bone fragments must be immobilized.

movement. sensation) is monitored. and the orthopedic surgeon is notified immediately if signs of neurovascular compromise are identified  Isometric and muscle-setting exercises are encouraged to minimize disuse atrophy and to promote circulation  Participation in activities of daily living (ADLs) is encouraged to promote independent functioning and self-esteem .Management of Fracture  Maintaining and restoring function  Swelling is controlled by elevating the injured extremity and applying ice  Neurovascular status (circulation.

vitamin D .Factors That Enhance Fracture Healing  Immobilization of fracture fragments  Maximum bone fragment contact  Sufficient blood supply  Proper nutrition  Exercise: weight bearing for long bones  Hormones: growth hormone. thyroid. calcitonin.

Factors That Inhibit Fracture Healing  Extensive local trauma  Bone loss  Inadequate immobilization  Space or tissue between bone fragments  Infection  Local malignancy  Age .

Complication of Fracture  Fat Embolism Syndrome  Fat embolism is a potentially life threatening complication of long bone trauma. and intramedularry manipulation  This syndrome manifest anywhere from 4 hours to several days after injury or orthopedic surgery. release from bone marrow. can embolize and occlude blood vessels in the brain. lungs and other tissue .  Fat globules. blunt trauma. kidnes.

most commonly a result of direct contamination from open fracture.Complication of Fracture  Osteomyelitis  Osteomyelitis is an infection of the bone. penetrating wound. or surgical procedures  it takes 10 to 14 days from the time of infection exposure before radiographs will demonstrate visible changes  The most common causative organism is staphylococcus aureus .

which lead to iskhemia and tissue necrotic  The exact pressure at which this develops is unclear.Complication of Fracture  Compartment Syndrome  Compartment syndrome develops when the presure in a muscle compartment exceeds the intraarterial hydrostatic pressure. but intracompartment pressure greater than 30 mmHg generally are considered greatly elevated  A grace periode of about 6 hours exists before irreversible soft tissue demage occurs  It is important to suspect compartment syndrome early . causing collapse of capilaries and venules.

Complication of Fracture  Bleeding  Delayed union and non union  Avascular necrosis of bone  Reaction to internal fixation devices .

sensation and motor function  Pain : a description of pain is helpful  Pallor  Pulses  Parasthesia  Paralysis .Assessment  Neurovascular assessment  Use five “P” to evaluate limb circulation.

swelling.Assessment  Inspection. deformity . alignment. or echhimosis  Range of motion  Symmetry. the injured area for the following:  Color  Disrupted skin integrity  Extremity position  Edema.

Assessment  Palpation. joint instability  Peripheral nerve function : sensory and motor . the injury to identify the following :  Skin temperature  Pain  Bony crepitus.

Nursing Diagnose  Acute pain  Impaired physical mobility  Risk for peripheral neurovaskuler dysfunction  Risk for imbalance fluid volume .

Nursing intervention  Teach patients how to control swelling and pain associated with the fracture and with soft tissue trauma and  Assess neurovascular status frequently  Encourages them to be active within the limits of the fracture immobilization .

monitoring for potential complications. medication information.Nursing intervention  Teach exercises to maintain the health of unaffected muscles and to increase the strength of muscles needed for transferring and for using assistive devices  Teach patients how to use assistive devices safely  Patient teaching includes self-care. and the need for continuing health care supervision .