ASSESSMENT
SUBJECTIVE CUES:
- Patient complains of pain
in upper right thigh.
OBJECTIVE CUES:
- Deformity in upper right
thigh with open wound
and visible pus.
- Limitation of flexion on
Right knee
Laboratory Results:
LOW
 ESR - 39 mm/hr
 Hemoglobin – 117 g/L
 Hematocrit – 0.36%
 MCV – 75.9
 MCHC – 32.5 g/dl
 MCH – 24.7
 Lymphocyte – 19%
HIGH
 RDW – 16.3 %
 WBC – 11.1 x 10^9/L
 Platelets – 579 x 10^3/
uL
Vital Signs:
BP – 120/80 mmHg
ANATOMY PHYSIOLOGY
Organ Involved: Femur is the longest, heaviest and
strongest bone of the human body that is
Normal located in the thigh. It serves as an
attachment point for all the muscles that
exert their force over the hip and knee
joints.
Proximally, the femur is composed of a
specialized metaphyseal region
consisting of the head, neck, and greater
and lesser trochanters. Distally, the
femur comprises the metaphyseal flare,
which continues into the medial and
lateral femoral condyles, separated by
the intercondylar notch. The shaft, or
diaphysis, is the segment inferior to the
lesser and ending at the metaphyseal flair
and condyles.
Aside from this, the femur also supports
all of the body’s weight in our everyday
Fractured lives, serving as pillars to allow us to
walk, run, jump and a lot of other
movements. Furthermore, the femur
supports many important muscles,
tendons, ligaments and parts of our
circulatory and lastly, just like all the
other bones of the body, has yellow and
red bone marrow on its shaft which plays
a vital role in producing blood cells and
storing fat as well.
PATHOPHYSIOLOGY ANALYSIS
Fractures of the femoral shaft often result A. CORRELATE THE PATIENT’S SIGNS AND
from high energy forces such as motor SYMPTOMS TO THE DISEASE CONDITION
vehicle collisions.
Limitation of Flexion
The incidence of femoral, particularly
diaphyseal, fractures due to severe trauma - A flexion deformity of the knee is the inability to fully
is greatest in young men. Patients younger straighten or extend the knee, also known as flexion
than 40 are more likely to sustain high contracture. This may be caused by one of the few
energy trauma (eg, motor vehicle crash) reasons: a mechanical problem within the joint,
and fracture the midshaft of the femur, swelling of tissue around the joint, spasticity of the
while those over 40 are more likely to muscles, pain or disease which may be brought about
sustain low energy trauma (eg, fall) and by the prolonged injury to the bone or the patient’s
fracture the proximal third of the femur. inability to move the affected leg fully over time.
Complications and injuries associated with
midshaft femur fractures in the adult can Pain
be life-threatening and may include
hemorrhage, internal organ injury, wound - Fracture is usually accompanied by a very severe pain.
infection, fat embolism, and adult Pain from fracture is about the worst pain so far
respiratory distress syndrome. especially in cases where the skin is being punctured
by the bone itself (because of the dermis). The kind of
pain sometimes is enough to make the patient go into a
state of shock if not controlled.
Deformity
- Deformity occurs especially with fracture of the limbs.
The part below the affected limb can be rotated
outwards or inwards. In some cases, the affected limb
is shorter than the second.
B. DISCUSS THE INDICATIONS FOR THE
LABORATORY RESULTS
LOW HGB, HCT
- Due to the break in the continuity of the bone,
PR- 67 bpm blood supply of the patient is being compromised.
This causes low levels of Rbc which then results
RR- 16 breaths/min to lower Hgb and Hct, thus also decreases the
amount of oxygen in the body system of the
Temp.- 36.4 deg C patient.

SpO2- 99% LOW MCV, MCHC, MCH

- A patient with low MCH, MCHC, AND MCV

may be experiencing anemia due to low RBC
count which may have underlying causes such as
bleeding from trauma or infection.

LOW LYMPHOCYTE

- Low lymphocyte places the patient at high risk of

infection, Lymphocyte levels can decrease when
there is undernutrition or any presence of viral
infections.

LOW ESR

- A low ESR test result means your red blood cells

sank more slowly than normal. This may be
caused by having many RBCs of smaller or
irregular shape that causes slower settling.

HIGH WBC

- High WBC may be caused by an infection which

the patient clearly manifests since he has an open
wound with visible pus formation.

HIGH RDW and PLATELETS

- High RDW is an indication of iron deficiency

which suggests macrolytic anemia, meaning the
body isn’t producing enough normal RBCs and
the cells it produces is larger than usual.
 - High platelet count is normally experienced by
patients who have experienced trauma because
platelets act up together to form clots and prevent
excessive bleeding

C. EXPLAIN THE SIGNIFICANCE OF THE

ABNORMAL RESULTS

- The patient's laboratory results and assessment

served as the foundation for understanding his
present medical situation. It enables medical
professionals to plan out the patient's care in a
way that will best encourage healing and keep
them from developing new difficulties.
PATHOGENESIS OF A FRACTURE

Osteoporosis Sports injuries Automobile accidents Falls Tumor or infection

weakening the bone

Stress placed on a bone exceeds the bone’s ability to absorb it

Injury in the bone

Disruption in the continuity of the bone

Disruption of muscle and blood vessels attached to the ends of the bone

Soft tissue damage leads to bleeding

Hematoma forms in the medullary canal SIGNS & SYMPTOMS

- Pain
Bone tissue surrounding the fractured site dies - Swelling/inflammation
- Tenderness
- Crepitus
- Loss of function
Inflammatory response - Redness
- Bleeding
LIFE THREATENING PATHWAY OF FRACTURE

Fracture not given immediate intervention

Injured site left exposed to air

Heavy bleeding
Fracture remains without
intervention

Infection

Hypovolemic shock
Compartment syndrome Fat embolism syndrome

Sepsis

Avascular necrosis Deep Vein Thrombosis

Pulmonary Embolism

DEATH