LESSON PLAN

ON
FRACTURE
SUBJECT ---- ADULT HEALTH NURSING

PREPARED BY-

KHUSHI VERMA

NURSING TUTOR
IDENTIFICATION DATA

NAME : Khushi verma

TOPIC : FRACTURE

PLACE : Lecture Hall

DURATION : 45-50 minutes

METHODS OF TEACHING : Lecture-cum-discussion

LANGUAGE : English and Hindi

A.V AIDS : Pamphlet, Booklet, Continuous Chart, Black board and Ppt

PREVIOUS KNOWLEDGE OF GROUP : GROUP HAS PREVIOUS KNOWLEDGE ABOUT FRACTURE.

GENERAL OBJECTIVES: At the end of the presentation, the students will be able to understand and gain adequate
knowledge about FRACTURE
SPECIFIC OBJECTIVES: At the end of the presentation, students will be able to:

 Define the fracture.

 Enlist the causes of fracture.
 Explain the physiology of fracture.
 List out the types of fracture.
 Discuss the clinical manifestations of fracture.
 Enumerate the diagnostic evaluations of fracture.
 Explain the management of fracture.
 Describe the complications.
S.NO TIME SPECIFIC CONTENT TEACHING STUDENT A-V AIDS EVALUTAION
OBJECTIVE ACTIVITY ACTIVITY

1. 1min. To Define the DEFINITION Lecture cum Listening Pamphlets What is the
fracture. "A fracture is a disruption discussion definition of
or break in the continuity of fracture?
the structure of bone."

Booklet
2. 2min. To Enlist the CAUSES Lecture cum Listening What are the
causes of  Trauma - RTA, falls, discussion causes of
fracture. blunt injuries etc. fracture?
 Pathologic fracture -
Secondary to some
diseases like
 Osteoporosis
 Osteomalacia
 Cancer
 Other bone infections
 Long use of
corticosteroids
 Old age
 Occupation - steel
industries, car racer
etc.
 Continuous
3. 10 To List out the TYPES Lecture cum Listening chart How many
min. types of  Open and closed discussion types of
fracture. fracture fracture?
 Complete and
incomplete facture

Classification according
to types

COMPLETE FRACTURE

1. Simple fracture- The

wound is non-
communicating between
skin and bone.

2. Open (compound)
fracture- The wound is
Communicating between
skin and bone.

3. Complicated fracture-
Along with the fracture,
there is associated injury to
internal structure.
4. Comminuted fractures-
A fracture with more than
two fragments.

5. Linear fracture-Fracture
line is linear to the long
axis of the bone.

6. Transverse fracture-
Fracture line is
perpendicular to the long
axis of the bone.

7. Oblique fractures-
Fracture line is oblique at
45 to the long axis of the
bone.

8. Spiral fracture -Fracture

line encircles the shaft of
the bone like a spiral.

9. Impacted fracture-
Fractures fragments are
pushed into each other
i.e.one override the other
fragment.
10. Pathological fractures-
Fracture of appoint in the
bone weakened by a
disease.

12. Avulsion fracture-

Fracture of the bone at the
site of attachment of
tendons or ligaments due to
strong pulling force.

13. EXTRACAPSULAR a
fracture outside the joint
capsule and
INTRACAPSULAR a
fracture within the joint
capsule.

INCOMPLETE
FRACTURE

1. Greenstick fractures -
Break on one cortex of the
bone with splintering of
bone surface.
2. Torus fracture-Buckling
of cortex.

3. Bowing fractures- A
fracture with bending of
bone.

4. Stress fractures-These
are small or micro-fractures
resulting from repeated
stress during playing or
exercise as jogging or
running.

5. Transchondrial fracture-
Separation of articular
cartilage from main shaft of
the bone.

6. Depressed fracture-
Broken parts of the bone
are driven inwards. An
example is skull fracture.
4. 5 min. To explain the PATHOPHYSIOLOGY Lecture cum Listening Black What is the
pathophysiology discussion board pathophysiology
of fracture Due to any of fracture?
etiology(crushing
movement)

Fracture occurs, muscle

that were attached to bone
are disrupted and cause
spasm

Proximal portion of bone

remains in place, the distal
portion can become
displaced in response to
both causative force &
spasm in the associated
muscles

In addition, the periosteum

and blood vessels in the
cortex and marrow are
disrupted

Soft tissue damage occurs,

leads to bleeding and
formation of hematoma
 between the fracture
fragment and beneath the
periosteum

Bone tissue surroundings

the fracture site dies,
creating an intense
inflammatory response

release chemical mediators

(histamins, prostaglandins )

Resulting in vasodilation,
edema, pain, loss of
function, leukocytes and
infiltration of WBC

5. 5 min. To Discuss the CLINICAL Lecture cum Listening Pamphlets What are the
clinical MANIFESTATIONS discussion clinical
manifestations manifestations
of fracture.  Pain and tendernss at of fracture?
the site of a fracture-
pain is serve,
excruciating and
increased on
movement. pain is
 caused by swelling at
the site putting
pressure on the
sensory nerves,
muscle spasms and
damage to the
periosteum.

 Swelling and
oedema of the
surrounding tissue-
There is swelling and
oedema due to
disruption of soft
tissues or bleeding
into the surrounding
tissue producing the
risk of acute
compartment
syndrome.

 Increased
temperature or
warmth-Due to
fracture, there is
increased blood flow
to the part involved.
 Loss of function-
Due to disruption of
the bone, there is loss
of function of the
part involved.

 Deformity due to
alteration in the
shape and length-In a
fracture, there is
abnormally in the
shape and position of
bone because the
muscles pull or
displace the
fragments into an
abnormal position.

 Crepitus (grating
sensation)- A
crepitus or grating
sensation at the site
is produced by
grating or crunching
together of the
broken fragments.
 The crepitus is
palpable as crushing
or abnormal
sensation.

 Involvement of
surrounding tissue-
Ecchymosis of skin
surrounding the
injured area,
impairment or loss of
sensation or paralysis
distal to injury due to
entrapment of nerve
and infection occur
as associated features
of the fractures.

 Blood loss or shock-

Hypovolemic (due to
blood loss) or
neurogenic shock
due to pain can
occur.
6. 7 min. To Enumerate DIAGNOSIS Lecture cum Listening Pamphlet What are the
the diagnostic  History and physical discussion diagnostic
evaluations of examination. evaluations of
fracture.  X-Ray fracture?
 CT Scan
 MRI

FRACTURE HEALING

o Fracture hematoma:
when a fracture
occurs, bleeding
creates a hematoma,
which surrounds the
ends of the
fragments. (within 72
hours).

o Granulation tissue:
active phagocytosis
absorbs the products
of local necrosis. The
hematoma converts
to granulation tissue.
Granulation tissue
produces the basis
for new bone
 substance called
osteoid (days 3 to
14).

o Callus formation: As
minerals and new
bone matrix are
deposited in the
osteoid, an
unorganized network
of bone is formed. It
usually appears by
the end of the second
week after injury.
Evidence of callus
formation can be
verified by x-ray.

o Ossification:
Ossification of the
callus occurs from 3
weeks to 6 months
after the fracture and
continues until the
fracture has healed.
During this stage of
clinical union the
 patient may be
allowed limited
mobility or the cast
may be removed.

o Consolidation: As
callus continues to
develop, the distance
between bone
fragments diminishes
and eventually
closes. This stage is
called consolidation,
and ossification
continues. It can be
equated with
radiologic union.

o Remodeling: Excess
bone tissue is
reabsorbed in the
final stage of bone
healing, and union is
completed. Gradual
return of the injured
bone to its pre injury
structural strength
 and shape occurs.
Radiologic union
occurs when there is
x-ray evidence of
complete bony
union. This phase
can occur up to a
year following
injury.

7. 15 To Explain the MANAGEMENT Lecture cum Listening Pamphlet What are the
min. management of o Goals discussion management for
fracture. fracture?
► Anatomic
realignment of bone
► Immobilization to
maintain
► Realignment
► Restoration of
normal to near
normal function of
the injured part

Treatment Of Fracture
Phase
1: Emergency care Phase
II: Definitive care Phase
III: Rehabilitation

o Phase 1: Emergency care

o Begins at the site of the
accident.
o. It consists of 'splint them
where they lie'.

CLOSED FRACTUTRE
o Before splinting
remove any ring or
bangles worn by the
patient.
o Almost any
available object (for
eg: folded
newspaper,
magazine, rigid
cardboard, stick,
umbrella, pillow
etc.) can be used for
splinting at the site
of the accident.
OPEN FRACTURE
o The bleeding from
the wound is stopped
by applying firm
pressure using a
clean piece of cloth.
o Circular bandage can
apply proximal to the
wound in order to
stop bleeding.
o If the wound is very
dirty, it is washed
with clean tap water
and covered with a
clean cloth.
o The fracture is
splinted

IN THE EMERGENCY
DEPARTMENT
o Basic life support
o Bleeding is
recognized and
stopped by local
pressure.
o Wooden plank,
Cramer-wire splint,
 Thomas' splint,
inflatable splint are
some of the splints
used in emergency
department.
o After emergency care
is provided, suitable
radiological and
other investigations
are carried out.

FOR OPEN FRACTURE

o Wound care
o Prophylactic
antibiotics:
Cephalexin is a good
broad spectrum
antibiotic for this
purpose.
o In serious compound
fractures, a
combination of third
generation
cephalosporins and
an amino- glycoside
is preferred.
o Tetanus prophylaxis
 o Analgesics to be
given parentrally to
make the patient
comfortable.

PHASE II-
o Definitive care The
aim of treatment is
rehabilitation of the
limb to pre-injury
status.
o Anatomic
realignment of bone
fragments(reduction)
o Immobilization to
maintain realignment
o Restoration of
normal or near
normal function of
the injured part

METHODS OF
TREATMENT

 Not all fractures need

all three of these
treatment.
 Treatment by
functional use of the
limb: Some fractures
(eg: fractured ribs,
scapula) need no
reduction or
immobilization.
These fractures unite
despite functional
use of the body part.
Analgesics are
needed for the initial
few days.

 Treatment by
immobilization:
Fractures without
significant
displacement or
fractures where the
displacement is of no
concern are treated
this way.
 Treatment by
reduction followed
by immobilization: It
is required for most
 displaced fractures.
These otherwise
result in deformity,
shortening etc.
 Open reduction and
internal fixation:
Some fractures, such
as intra-articular
fractures, are best
treated by open
reduction and
internal fixation.
 Fracture reduction
Reduction of a
fracture can be
carried out by
following methods.
 Closed reduction
 Open reduction.
 Continuous traction

FRACTURE
REDUCTION

 Closed reduction
- it is the non surgical
reduction, under
 local or general
anesthesia.

 Open reduction
- surgical
- ORIF
- OREF

IMMOBILIZATION
 Casts
 Splints
 Tractions

DRUG THERAPY

* Muscle relaxants
* Analgesics
* Prophylactic antibiotics
* Tetanus immunization
* Surgical debridement and
Irrigation

NUTRITIONAL

- High protein
- Vitamins minerals
- High fluid intake
 - Small and frequent
diet
- Avoid constipation

STAGES OF BONE
HEALING

 Fracture hematoma -
72 hours of injury
 Granulation tissue - 3
to 14 days
 Callus formation -
end of 2nd week
 Ossification-3 weeks
to 6 months, clinical
munion, cast can be
removed
 Consolidation -
radiological union
 Remodeling - up to
one year
8. 5 min. To Describe the COMPLICATION Lecture cum Listening Pamphlet What are the
complications. discussion complications
► Delayed union of fracture?
► Nonunion
► Malunion
 ► Angulation
► Pseudoarthrosis
► Refracture
► Myositis ossificans
► Compartment
syndrome

NURSING CARE
1.increased risk of
hypovolemia and shock
related to trauma and
bleeding.
2. Increased risk of bone
inflammation related to
open fracture.

3. Increased risk of fat

embolism related to
fracture of the long bones.

4. Increased risk of severe

fluid, electrolyte, and
metabolic imbalances
related to injury or
inflammation.

5. Pain and immobility,

related to diagnosis of
fracture.

6. Increased risk of
respiratory, cardiovascular,
bowel, and skin
complications related to a
long period of immobility.

7. Anxiety related to the

symptoms of disease and
fear of the unknown.