Fracture

-is a break in the continuity of the bone.

Common fracture sites:

1. 2. 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 3. 4. 5. 1. 2. fracture site. Radius and ulna Femur (often associated with child abuse) Epiphyseal plates (potential for growth deformity) Closed or simple fracture The bone is broken, but the 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 3. 4. 5. 6. 7. 8. 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. Oblique Fracture The fracture is diagonal to a bones long axis. Spiral Fracture At least one part of the bone has been twisted. Avulsion fragment of bone pulled off by ligament or tendon and its attached.

Clinical Manifestation
The 6Ps pain, pulse, pallor, paresthesia, paralysis and poikilothermia are seen with all types of fractures. Others: deformity, swelling, bruising, muscle spasms, tenderness, pain, impaired sensation, loss of function, abnormality, crepitus, shock or refusal to walk (in small

children).

Diagnostic test
1. Radiographic examination reveals initial injury and subsequent healing progress. A comparison film of an opposite, unaffected extremity is often used to look for subtle changes in the affected extremity. 2. Blood studies reveal bleeding (decreased hemoglobin and hematocrit) and muscle damage (elevated aspartate transaminase (AST) and lactic dehygrogenase (LHD).

Types of Fracture

Nursing Management
1. Reduction(setting the bone) - Restoration to anatomical alignment. Closed Reduction a. Bringing the body into opposition by manipulation and manual traction. b. Cast and traction used for fractures of long bones. c. Skin Traction: Tape, sponge, rubber or plastic mat d. Skeletal traction- wires, pins, or tongs. Open Reduction Operative intervention to achieve fracture reduction. Application of internal fixation devices. 2. Immobilization maintains reduction in placeuntil healing. Methods: a. External Flexion- bandages, plaster cast fixation splint, continuous traction. b. Internal fixation nails, plates, screws, wires, rods. 3. Rehabilitation Regaining normal function of affected part. Exercise joints above and below the cast. Isometric exercise as soon as possible after cast application. Instruct methods of ambulation like walkers, crutches and canes. ROM and ADL.

Prepared by : Demetrio Ferrer III BSN 4a