B.

Compound or open
TRAUMATIC
 B o n e fragments
CONDITIONS protrude through the skin
 Fracture and it is associated with
 Herniated Nucleus Pulposus open wound.

Fracture
- A disruption or a break in the
continuity of the bone,
separating it into two or more
fragments.

Causes
1. Direct Force
2. Bone Diseases C. Incomplete or partial
3. Repeated or prolonged Stress  Only one side of the bone
breaks through the
Types periosteum
1. Broad or General Classification
2. As to appearance
3. According to direction of fracture
line.
4. According to cause.

I. Broad or General Classification

A. Closed fracture
 Skin remains intact.
 Bone does not protrude
through the skin.
D. Complete Fracture
 The break completely
disrupts the continuity of
the tissue across the
entire width of the bone
involved.

E. Complicated.
  When a bone fragment  The distal fragment is
has penetrated an forcibly pushed against
internal structure such as and int the proximal
the lungs. fragment
Post- accident chest injuries with
rib fractures, hemothorax and
pneuthorax.

D. Depressed
 Fragments are driven
inward or pressed below
the normal surface
II. Classification as to appearance
A. Simple
 The bone is broken into 2
fragments

E. Compressed
B. Comminuted
 Bone collapses under
 The bone is broken into
excessive pressure
more than 2 fragments

III. Classification according to

C. Impacted or telescoped direction of fracture line
A. Transverse
  The break is straight
across the bone

Common Types of Fractures

B. Linear
 The break runs in the
direction of the bone's
shaft

C. Oblique
 The line of the fracture is
at an oblique angle to the IV. Classification according to cause:
bone shaft A. Stress
B. Pathologic
C. Traumatic

Special types of fracture

D. Spiral
 The fracture line partially Colle's fracture
encircles the bone.
 Silver/dinner fork deformity/wrist  Fracture of the proximal 3rd
drop of ulna, associated with radial
 Fracture of the distal end of the head dislocation.
radius- ulna.
 Occurs as a result of falling onto
wrists extension

Bennett's Fracture
 Fracture of the base of the
Smith's Fracture thumb, associated with
 sometimes known as a dislocation of metacarpal joint
reverse Colles' fracture is a or thumb.
fracture of the distal radius
 caused by a direct blow to
the dorsal forearm or falling
onto flexed wrists, as opposed
to a Colles' fracture which
occurs as a result of falling
onto wrists in extension

Pilon Fracture
 a fracture of the lower end of
the tibia, bone that forms the
ankle joint by articulating with
the talus.
Pott's Fracture  occurs when the talus bone
 Fracture of the malleolus of hits the tibia with a force
fibula. directed upwards

Monteggia's Fracture
Cotton Fracture/Trimalleolar
  a fracture of the ankle involving
the medial malleolus, lateral
malleolus, and the lower part of
the tibia (the posterior
malleolus)
TRIMALLEOLAR ANKLE FRACTURE
 Cotton/Trimalleolar Fracture a
specific Injury In the ankle,
where three areas of the
malleoli break simultaneously
 vertically oriented fracture
through the posterior malleolus
 transverse fracture through the
medial malleolus
 soft tissue swelling of the ankle
and foot
 oblique fracture of the lateral
malleolus
Galleazzi's Fracture
 Fracture of the distal 3rd of
radius with associated radiu-
ulnar dislocation
Malgaigne;s Fracture
 Double fracture of the pelvic
ring causing instability in the
pelvis.
Hangman's Fracture
 Fracture of the posterior
element of the cervical
vertebra with dislocation of C1
or C2.
 a fracture of the arc in 2nd
cervical spine which also
makes the 2nd cervical spine
dislocate from the 3th cervical
spine
 Usually happens in a neck
injury.
Neer Fracture
 Fracture of the shoulders and
humerus in which the bones
are broken into 3 or more
fragments
Clinical Manifestations of Fracture
Pain
- Results from muscle
spasm, overriding of the
fractured ends of bone or
bone damage to adjacent
structure.
Loss of Normal Function
- Results from the instability of
fractured bones, muscle spasm
and nerve damage.
Obvious Deformity
- Strong muscle pull may cause
bone fragments to override,
leading to:
a. Angulation, rotation, limb
shortening
b. Bone depression
c. Altered curves in the injured
site when compared with the
opposite side.
Excessive Motion at the Site
- Due to the instability when long
bones are fractured.
Crepitus
- Grating sound heard if the
injured part is moved.
Tissue Edema
- Appears rapidly due to
extravasation of blood and
localization of tissue fluid at the
site of fracture.
Warmth over injured area
- Results from increased blood
flow to the area
Loss of Sensation or paralysis
- Results from nerve entrapment
Evidence of fracture on the X-Ray Film
Signs of shock
- Related to severe tissue injury,
blood loss or intense pain
Ecchymosis of skin surrounding
injured area
Diagnosis
 Physical examination
 History of trauma
 X-ray
 CT scan
 MRI
 Bone scan
Gustilo's classification system for
open fracture:
 Type I: with 1 cm wound or
less
 Type II: greater than 1 cm
wound; with moderate tissue
damage.
 Type III: extensive soft tissue
damage and crushing
Management of fracture
Treatment modalities:
 Reduction
  Immobilization
 Rehabilitation

Rehabilitation
 To begin normal strength and
function of the affected part
Members of the rehab team
 Physician
 Nurse
 Physical therapist
 Occupational therapist
 Psychiatrist
 Orthotist/prosthetist
 Vocational counselor
 Social worker
 Speech therapist

Reduction
 putting the bone back to its
proper alignment.
 Types:
 Closed
 Open
A. Closed Reduction
 involves manipulation of the
fragments by manual traction,
pressure or rotation to lock the
ends of a fragment together
and restore normal bone
alignment.
 done under local anesthesia.
After reduction, immobilization
is done by casting.
B. Open Reduction
 with intramedullary fixator
 involves the insertion of
screws, pins, nails, wires, rods
or plates. Fracture is aligned
through surgery.
Note: Treatment of choice for
comminuted fracture or widely
separated fracture is not pins or wires
(internal fixators). They just initially
help to immobilize a fracture but not a
substitute for bone healing.
Left distal radius ORIF surgery

Nursing Management following

reduction:
1. Positioning, which include ILAZAROV FRAME
elevation of the affected area to
reduce swelling. Maintain
alignment and must be free from
pressure.
2. Monitor V/S.
3. Assessment of increasing pain,
pallor, pulselessness, paralysis
and paresthesia (5 P's)
4. Relief of discomforts.
5. Prevent Complication.
Roger anderson external fixator
Immobilization - Screws are placed into the bone
 To hold the bone fragments in above and below the fracture,
contact with each other until and a device is attached to the
healing takes place. screws from outside the skin,
 Methods: where it may be adjusted to
 Splinting realign the bone
 External fixation
 Casting

External fixation
- A method of fracture
immobilization in which a
system of percutaneous pins or
wires is connected to a rigid
external frame.
Hoffman’s External Fixator

DRYING A CAST
Synthetic cast
 about 20 minutes to set
Delta Frame External Fixator completely.
 dry with thermal reaction and
may feel hot
 surface is sticky and should be
handled only when wearing a
gloves.

Plaster of Paris
Tower’s External fixator
 it takes several hours to dry
completely
 large cast may dry for several
days.

Ways to Promote Drying of Cast

1. Promote the circulation of
Casting Warm dry air to enhance
- Synthetic (fiber glass) evaporation to speed the
drying process.
2. Cast dryer or a hair dryer
3. Fanning

Comparison of Wet Cast and Dry Cast

WET CAST DRY CAST
1. Musty 1. Odorless
smelling 2. Shiny white
2. Gray/white in
in appearance
appearance 3. Feels similar
3. Feels cold to the room
Plaster of Paris to touch temperature
- A form of support made of 4. Dull on
gypsum which comes in a dry percussion
roll. When mixed with water, it
forms a hard cement.
Complications
1. Impaired blood flow
producing soft tissue ischemia
2. Nerve damage from pressure
where a nerve passes over a
bony prominence.
3. Infection and tissue necrosis
4. Compartment syndrome
5. Cast syndrome
6. Joint stiffness

Nursing responsibilities to patients Long arm Circular Cast: for fractured

with cast radius or ulna without open wound or
 Neuro-vascular checks (check inflammation
color, pulse, temperature,
sensation, motion)
 Preservation of the efficiency
of the cast
 Maintenance/promotion of the
integrity of the systems of the
body
 Maintenance of the cleanliness
of the cast
 Maintenance or promotion of
patient's morale
Hanging Cast: for fractured shaft of the
- Signs of neurovascular impairment humerus
5P’s
 PAIN
 PULSELESSNESS
 PALLOR
 PARALYSIS
 PARESTHESIA
 compression of messenteric
arteries (arteries supplying
the GIT)

Munster Cast/Fuenster’s Cast: for

Short Arm Circular Cast: for affection fractured radius ulna with callus
of wrist and fingers without open formation
wound, inflammation or infection
 Patellar Tendon Bearing Cast: for
fractured tibia-fibula with callus
Short Arm Posterior Mold: wrist and formation
fingers with compound affection.

Long Arm Posterior Mold: for fractured Long Leg Circular Cast: for fractured
radius or ulna with compound tibia fibula
affection

Short Leg Circular Cast: ankle and foot

fracture
Quadrilateral (Ischial Weight Bearing) Long Leg Posterior Mold: for fractured
Cast: for fractured shaft of the femur tibia- fibula with compound affection
with callus formation

Shoulder Spica: humerus and shoulder

Cylinder Cast: for Fractured patella
joint

Short Leg Posterior Mold: ankle and

foot with compound affection Collar cast: for cervical affection
Minerva Cast: for upper dorsal / Single Hip Spica: fracture of hip and
cervical spine affection femur

Airplane cast: for humerus and

shoulder joint with compound
Rizzer’s Jacket: for scoliosis
fracture.

Body Cast: for lower dorsolumbar

spine affection Pantalon Cast: for pelvic bone fracture
Frog Cast: for congenital hip Internal Rotator Splint: for post hip
dislocation operation

For hip and femur with compound Delvet / Delbit Cast: fracture of tibia or
affection fibula

Cocked-Up Splint: for wrist drop Cast Brace: for fracture of the femur
which allows flexion and extension.
Basket Cast: for severe leg trauma with Bivalving a cast
open wound or inflammation.

Functional Cast: for fractured humerus

with abduction and adduction

Windowing a cast