Name: Sahani S.

Malambut
Section: H

ASSIGNED CASE: CLOSED FRACTURE

Emergency Procedure for Patient with Closed Fracture:

• In the ED, obtain a thorough history. Exclude additional injuries, and, if warranted,
provide a full trauma evaluation.

• Immobilize the injured area

o use broad bandages (where possible) to prevent movement at joints above and
below the fracture
o support the limb, carefully passing bandages under the natural hollows of the body
o place a padded splint along the injured limb
o place padding between the splint and the natural contours of the body and secure
firmly
o for leg fracture, immobilize foot and ankle
o check that bandages are not too tight (or too loose) every 15 minutes.
o Watch for signs of circulation loss to hands and feet
• Apply ice packs to limit swelling and help relieve pain. Don't apply ice directly to
the skin. Wrap the ice in a towel, piece of cloth or some other material.
• Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the
person down with the head slightly lower than the trunk and, if possible, elevate the
legs.
• The principal methods of Plaster-Of-Paris, skeletal traction, and external fixation are
viable options for many fractures and should be the first choice in disaster and conflicts.
• When a patient comes to the emergency room with wrist pain, and evidence of a
possibly broken wrist, an X-ray will be obtained of the injured area. If there is a broken
wrist, the X-rays will be carefully reviewed to determine if the fracture is in a proper
position, and to assess the stability of the bone fragments.
 • If the pain is severe, and collapse is becoming problematic, a procedure called
vertebroplasty may be considered. In this procedure, a physician injects cement into
the vertebra to stabilize the fracture and prevent further collapse. Sometimes, the height
of the bone may be restored as well.

The procedure is often painful. You will receive medicine to block the pain during the
procedure. You might receive:

• A local anesthetic or nerve block to numb the area (usually given as a shot)

• A sedative to make you relaxed but not asleep (usually given through an IV, or intravenous
line)

• General anesthesia to make you sleep during the procedure

After you receive pain medicine, your provider will set the bone in the right position by pushing
or pulling the bone. This is called traction.

After the bone is set:

• You will have an x-ray to make sure the bone is in the right position.

• A cast or splint will be put on your limb to keep the bone in the right position and protect
it while it heals.

After Your Procedure

If you do not have other injuries or problems, you will be able to go home a few hours after the
procedure.

Until your provider advises, do not:

• Place rings on your fingers or toes over your injured arm or leg

• Bear weight on the injured leg or arm

EMERGENCY TREATMENT:

Fracture treatment is highly dependent on a number of different factors. Even in two

situations of seemingly identical fracture patterns, treatment may differ based on factors such as
patient age, patient preference, or surgeon preference. Treatments are not always the same, and
often your orthopedic doctor will give you options about how to best manage your fracture.

Some of the treatments used for closed fractures include:

No Immobilization: Not every fracture requires intervention. Some broken bones are stable
injuries that can be managed without immobilization or other intervention. Sometimes a sling or
walking boot may be enough, and other times some simple reassurance that healing will occur is
fine.

Cast Immobilization: Casts are often used for the treatment of many types of fractures. Casts help
to hold bones in proper alignment and protect the healing bone.

Internal Fixation: Internal fixation is used to realign broken bones, and then hold the healing
bones in position with metal plates, pins, rods, or screws.

External Fixation: External fixation is a type of treatment that can hold bones securely without
having to operate on the surrounding soft tissue. This treatment is often used when a soft-tissue
injury makes surgery at the site of fracture unsafe.2

Many closed fractures can be treated with simple, nonsurgical treatments. However, when
the bones are not sufficiently aligned, or if the fracture cannot be supported, a surgical procedure
may be necessary to reposition and hold the bones in proper alignment. While a closed fracture
may require urgent treatment in order to restore proper alignment and prevent further damage, it
is uncommon to need for an emergency surgery as a result of a closed fracture, unlike with open
fractures. Only in rare situations would emergency surgery be required for treatment of a closed
fracture.

NURSING MANAGEMENT/NURSING INTERVENTION

1. Prevent infection
 ▪ The patient must be assessed for presence of signs and symptoms of
infection.
2. Provide care during client transfer.
▪ Immobilize a fractured extremity with splint in the position of the
deformity before moving the client; avoid strengthening the injured body
part if a joint is involved.
▪ Support the affected body part above and below fracture site when
moving the client.
3. Provide client and family teaching.
▪ Explain prescribed activity restrictions and necessary lifestyle
modification because of impaired mobility.
▪ Teach the proper use of assistive devices, as indicated.
▪ It is important to teach exercises to maintain the health of the unaffected
muscles and to increase the strength of muscles needed for transferring
and for using assistive devices.

4. Administer prescribed medications, which may include opioid or nonopioid

analgesics and prophylactic antibiotics for an open fracture.

5. Prevent and manage potential complications.

▪ Observe for symptoms of life-threatening fat embolus, which may include
personality change, restlessness, dyspnea, crackles, white sputum, and
petechiae over the chest and buccal membranes. Assist with respiratory
support, which must be instituted early.
▪ Observe for symptoms of compartment syndrome, which include deep,
unrelenting pain; hard edematous muscle; and decreased tissue perfusion
with impaired neurovascular assessment findings.
▪ Monitor closely for signs and symptoms of other complications.

6. Patient education regarding different factors that affect fracture healing.

 7. Plans are made to help the patients modify the home environment to promote safety
such as removing any obstruction in the walking paths around the house.

8. 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, vitamin D, anabolic
steroids
9. Factors that inhibit fracture healing
▪ Extensive local trauma
▪ Bone loss
▪ Inadequate immobilization
▪ Space or tissue between bone fragments
▪ Infection
▪ Local malignancy
▪ Metabolic bone disease (Paget’s disease)
▪ Irradiated bone (radiation necrosis)
▪ Avascular necrosis
▪ Intra-articular fracture (synovial fluid contains fibrolysins, which lyse the
initial clot and retard clot formation)
▪ Age (elderly persons heal more slowly)
▪ Corticosteroids (inhibit the repair rate)

NURSING DIAGNOSIS

▪ Pain related to fracture, soft tissue damage, muscle spasm, and surgery
▪ Impaired physical mobility related to fractured hip
▪ Impaired skin integrity related to surgical incision
▪ Risk for impaired urinary elimination related to immobility
 ▪ Risk for disturbed thought process related to age, stress of trauma, unfamiliar
surroundings, and drug therapy
▪ Risk for ineffective coping related to injury, anticipated surgery, and dependence
▪ Risk for impaired home maintenance related to fractured hip and impaired mobility.

REFERENCES:

• Cluent, J. (2020). Closed Fracture Treatment. Retrieved from

https://www.verywellhealth.com/closed-fracture-2548518
• Buckley, R. (2020). General Principles of Fracture Care treatment & Management.
Retrieved from https://emedicine.medscape.com/article/1270717-treatment
• Hoynak, B. (2021). Wrist Fracture in Emergency Medicine Treatment & Management.
Retrieved from https://emedicine.medscape.com/article/828746-treatment#d10