NCM 116

FRACTURE
GROUP 1
 DESCRIPTION
A fracture is a broken bone. It can range from a thin
crack to a complete break. Bone can fracture crosswise,
lengthwise, in several places, or into many pieces. Most
fractures happen when a bone is impacted by more
force or pressure than it can support.
 ETIOLOGY

Sudden Twisting
Direct Blows Crushing Forces
Motions

Underlying illnesses
Extreme Muscle Repeated Stresses and
such as osteoporosis,
Contractions Strains
infection, or a tumor
 RISK FACTORS
Age
Bone density and muscle mass decreases as we age
Nutritional problems
Osteoporosis
Physical inactivity
Certain medications and chronic medical conditions
Smoking
Alcohol
Steroids
Rheumatoid Arthritis
Other chronic disorders
Diabetes
Previous fracture
Family history
 DISEASE PROCESS
Limit it only to concerns related to class

A significant percentage of bone fractures occur because of high force impact or stress.
However, a fracture may also be the result of some medical conditions which weaken the bones,
for example osteoporosis, some cancers, or osteogenesis imperfecta (also known as brittle
bone diseases). A fracture caused by a medical condition is known as a pathological fracture.
Calcium/vitamin D
defeciency
Trauma

Menopausal bone
loss

Decrease bone
FRACTURES
mass/bone quality

Age, genetics, diet

Local factors
Common types of fractures include:
Stable fracture. The broken ends of the bone line up and are
barely out of place.
Open, 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. This type of fracture has a horizontal
fracture line.
Oblique fracture. This type of fracture has an angled pattern.
Comminuted fracture. In this type of fracture, the bone
shatters into three or more pieces.
 Signs and Symptoms

Unable to bear Obvious

Sudden pain
weight deformity

Trouble using or
moving the injured Warmth, bruising,
area or nearby Swelling
or redness
joints
SURGICAL MANAGEMENT
OPEN REDUCTION AND INTERNAL FIXATION (ORIF)
EXTERNAL FIXATION
Open Reduction and Internal Fixation (ORIF)
This is a surgical procedure in which the fracture site is
adequately exposed and reduction of fracture is done. Internal
fixation is done with devices such as Kirschner wires, plates and
screws, and intramedullary nails.
 External fixation
External fixation is a procedure in which the fracture stabilization is done at a
distance from the site of fracture. It helps to maintain bone length and alignment
without casting.
External fixation is performed in the following conditions:
Open fractures with soft-tissue involvement
Burns and soft tissue injuries
Pelvic fractures
Comminuted and unstable fractures
Fractures having bony deficits
Limb-lengthening procedures
Fractures with infection or non-union
MEDICAL MANAGEMENT
REDUCTION (CLOSED AND OPEN)
IMMOBILIZATION
MAINTAINING AND RESTORING FUNCTION
 REDUCTION
Fracture reduction refers to restoration of the fracture
fragments to anatomic alignment and positioning. Either
closed reduction or open reduction may be used to reduce
a fracture.
The specific method selected depends on the nature
of the fracture.
Usually, the physician reduces a fracture as soon as
possible to prevent loss of elasticity from the tissues
through infiltration by edema or hemorrhage.
In most cases, fracture reduction becomes more
difficult as the injury begins to heal
Before fracture reduction and immobilization, the
patient is prepared for the procedure; consent for the
procedure is obtained, and an analgesic agent is
given as prescribed.
Anesthesia may be given. The injured extremity must
be handled gently to avoid additional damage.
 CLOSED REDUCTION
In most instances, closed reduction is accomplished by
bringing the bone fragments into anatomic alignment through
manipulation and manual traction. It allows the bone to grow
back together.
The doctor will push or pull the ends of the fractured bone
until they line up
Then your doctor will put a cast or splint on the affected arm
or leg to help hold the bone in place while it heals. The doctor
will take an X-ray to check that the bone is properly lined up.
 OPEN REDUCTION
Some fractures require open reduction. Through a surgical
approach, the fracture fragments are anatomically aligned.
Internal fixation devices (metallic pins, wires, screws, plates,
nails, or rods) may be used to hold the bone fragments in
position until solid bone healing occurs. These devices may be
attached to the sides of bone, or they may be inserted through
the bony fragments.
Internal fixation devices ensure firm approximation and
fixation of the bony fragments
 IMMOBILIZATION
After the fracture has been reduced, the bone fragments must be
immobilized and maintained in proper position and alignment until
union occurs. Immobilization may be accomplished by external or
internal fixation. Methods of external fixation include bandages,
casts, splints, continuous traction, and external fixators
 Maintaining and Restoring Function
Reduction and immobilization are maintained as prescribed to
promote bone and soft tissue healing.
Edema is controlled by elevating the injured extremity and applying
ice as prescribed.
Neurovascular status (circulation, motion, and sensation) is
monitored routinely, and the primary provider is notified immediately
if signs of neurovascular compromise develop.
Isometric and muscle setting exercises are encouraged to minimize
atrophy and to promote circulation.
NURSING MANAGEMENT

CLOSED FRACTURES
OPEN FRACTURES
 NURSING MANAGEMENT

PATIENTS WITH CLOSED FRACTURES

Instruct the patient regarding the proper methods to control the edema

and pain.

Teach patients exercises to maintain the health of unaffected muscles

and to increase the strenght of muscles needed for transferring and for

using assistive devices (e.g. crutches, walkers, etc.)

Patients also taught how to use assistive devices safely.

Help patients modify the environment as needed to ensure safety.

Educate patients includes self-care, medication, information, monitoring

for potential complication, and the need for continuing health care

pervision.
PATIENTS WITH OPEN FRACTURES

WOUND MANAGEMENT. Wound irrigation and debridement are initiated

as soon possible. The wound is cultured and bone grafting may be

performed to fill in the areas of bone defects. Heavily cotaminated

wonds are left unsutured and dressed with sterile gauze to permit edema

and wound drainage. Wound irrigation and debridement may be

repeated, removing infected and devitalized tissue and increasing

vascularity in the region.

ELEVATED EXTREMITY. The affected extremity is elevated to minimize

edema. it is impotant to assess the neurovascular status frequently.

SIGNS OF INFECTION. The patient must be assessed for presence for

signs and symptoms of infection. Temperature is monitored at regular

intervals.
Early complications
 Life-threatening complications

·These include vascular damage such as disruption to the femoral

artery or its major branches by femoral fracture, or damage to the
pelvic arteries by pelvic fracture.

·Patients with multiple rib fractures may develop

pneumothorax, flail chest and respiratory compromise.

·Hip fractures, particularly in elderly patients, lead to loss of mobility

which may result in pneumonia, thromboembolic disease or
rhabdomyolysis.
 Local

··Vascular injury.
·Visceral injury causing damage to structures such as the brain, lung
or bladder.
·Damage to surrounding tissue, nerves or skin.
·Haemarthrosis.
·Compartment syndrome (or Volkmann's ischaemia)
·Wound Infection - more common for open fractures.
·Fracture blisters
 Systemic

Fat embolism
Shock
Thromboembolism (pulmonary or venous)
Exacerbation of underlying diseases such as diabetes or coronary
artery disease (CAD)
Pneumonia
 Late
complications
of fractures
 Local

·Delayed union (fracture takes longer than normal to heal)

·Malunion (fracture does not heal in normal alignment)
·Non-union (fracture does not heal)
·Joint stiffness
·Contractures
·Myositis ossificans
·Avascular necrosis
·Algodystrophy (or Sudeck's atrophy)
·Osteomyelitis
Growth disturbance or deformity
 Systemic

·Gangrene, tetanus, septicaemia.

·Fear of mobilizing
References:
Brunner & Suddarth's Textbook of
Medical-Surgical Nursing 14th
Edition.pdf
https://patient.info/doctor/complica
tions-from-fractures