LESSON PLAN ON

FRACTURE

Submitted to:
Submitted by: Ms. Sancty Thomson
Submitted on:
Name of the Lecturer: Ms. Sancty Thomson
Subject: Medical Surgical Nursing
Unit:
Topic: Fracture
Date:
Time:
Venue: Caritas College of Nursing
Group:
No. of students:
Method of teaching: Lecture cum discussion
Teaching aids: Blackboard, Power Point
Previous Knowledge: Basic aspects of patient care in medical surgical nursing
GENERAL OBJECTIVE:
On completion of the class, the students will acquire an in-depth knowledge of Fractures and acknowledge the
importance of developing the attitude and skills in providing care to patients with Fractures.

SPECIFIC OBJECTIVE:
At the end of the teaching, the student will able to
 define fracture
 causes of fracture
 pathophysiology
 Types of fracture
 clinical manifestation
 explain in detail about medical and surgical management
 describe the nursing management
 complications of surgery

BIBLIOGRAPHY
1. Joyce M Black, Jane Hokanson Hawks’s Medical- Surgical Nursing. 7th South Asian edition. Volume 1. Elseivier: New Delhi; 2014,
2. Lewis, textbook of medical surgical nursing, volume-1, 3rd edition, Elsevier publication,
3. Brunner and Suddharth, text book of medical surgical nursing, 11" edition, Lippinciont publication,
Specific Time Content Teaching AV Aids Evaluation
Objectives Learning
Activity
I) Introduction:
Teacher
Fracture is a break or crack in the continuity of bone. introduces the
Introduce the topic
topic to the Fracture occurs due to force applied by an external
class
source.
A bone fracture is a medical condition where the
continuity of the bone is broken. Mechanical damage
produced in a bone In case of fracture tissue, joints,
muscles all are involved.
Fracture is not a fatal condition about needs emergency
care to prevent further complication.

II) Announcement of the Topic: Teacher

announces the
Fracture topic and writes
on the black
board
 III) Review:
What is a Fracture? What are its causes?

IV) Definition:
Fracture is a break in bone or cartilage. Although
at the end of Teacher defines
the session, the Fracture
student will be
usually it is a result of trauma, a fracture can be the
able to define
fracture result of an acquired disease of bone also such as
osteoporosis or of abnormal formation of bone in a
congenital discase of bone.
 V) Causes:
Causes of bone fracture it includes:
Detail the Teacher describes Slide show
possible
causes of
 Fall from a height. the causes that
will lead to
fracture fracture
 Trauma.
 Motor vehicle accidents.
 Direct blow.
 Child abuse.
 Repetitive forces, such as those caused by
running, can cause stress fractures of the foot,
ankle, tibia, or hip.
 Metabolic bone diseases like osteoporosis
VI) Types of Fractures:
There are several types of fractures:
1) Simple Fracture:
Teacher defines Slide show
The wound is non-communicating between the the types of
fractures
skin and bone and the skin will be intact over the
fracture site.
2) Open or Compound Fracture:
The wound is communicating between the skin
and bone and the skin has been penetrated by a
bone fragment from inside (compound).
3) Transverse Fracture:
The fracture line is perpendicular to the long axis
of the bone. It often occurs as a result of strong
force applied to the bone.
4) Oblique Fracture:
Fracture line occurs at an oblique angle
[45degree] to the shaft of bone.
5) Spiral Fracture:
It is a type of complete fracture which fracture
line extends in a spiral form along the shaft of the
bone. It occurs due to rotational or twisting force.
6) Linear Fracture:
In this fracture there will be one thin line of
fracture on the bone and no compression or
distortion of bones.
7) Longitudinal Fracture:
Fracture that occurs along the axis of the bone
this is most often seen in long bone fracture.
8) Avulsion Fracture:
Fracture of the bone at the site of attachment of
tendons or ligaments due to strong pulling force.
 9) Comminuted Fracture:
It is a fracture with more than two fragments. The
smaller fragments appear to be floating.
10) Pathological Fracture:
Fracture of a point in the bone weakened by a
disease.
11) Stress Fracture:
These are small or micro-fracture resulting from
repeat Stress during playing or exercise like
jogging or running
12) Depression Fracture:
Broken parts of the bone are driven inwards. An
example is skull fracture.
VII) Pathophysiology of Fracture:
Stress placed on a bone, exceeds the bone ability to Slide show
absorb it.
Teacher details
the
Injury in the bone. pathophysiology
of Fracture
Disruption in the continuity of bone.

Disruption of muscles and blood vessels attached to

the ends of the bone.

Soft tissue damage.

Bleeding.

Hematoma forms in medullary canal.

Bone tissue surrounding the fractured site dies.

Inflammatory response.
VIII)Stages of Fracture
 Hematoma Formation
Teacher mentions
 Development of Fibrocartilaginous Callus the stages of Slide show
fracture
 Development of bony calluses
 Bone re modelling
 Bone support and recovery

IX) Clinical Manifestations:

 Deformity
Teacher details Slide show
 Swelling and discoloration the clinical
manifestations of
 Pain fracture

 Loss of function.
 Numbness
 Crepitus
 Shortening
 Hypovolemic shock
X) Diagnostic Evaluations:
Teacher explains Slide show
 History and physical examination. diagnostic
evaluations of
 X-ray studies: Determines location and extent of fracture

fracture
 Computed Tomography(CT)/Magnetic
Resonance Imaging (MRI): Visualizes fractures,
bleeding, and soft-tissue damage; differentiates
between stress/trauma fractures and bone
neoplasms
 Blood chemistry, CBC: Haematocrit (Hct) may
be increased (hemoconcentration) or decreased
(haemorrhage).
 Coagulation profile: Alterations may occur
because of blood loss, multiple transfusions, or
liver injury.
 Arteriograms: May be done when occult
 vascular damage is suspected.

XI) Medical Management:

Teacher explains Slide show
 Management of a patient with fracture can be medical
management of
either under emergency care or under non- fracture

emergency care.
 Immediately after injury, if a fracture is
suspected, it is important to immobilize the body
part before the patient is moved.
 Adequate splinting is essential to prevent
movement of fracture fragments.
 The bleeding from the wound is stopped by
applying firm pressure using a clean piece of
cloth.
TREATMENT OF FRACTURE (Emergency Care)
 Begins at the site of the accident.
 It consists of ‘splint them where they lie’.
Closed Fracture
 Before splinting remove any ring or bangles worn by
the patient.
 Almost any available object( for eg: folded news
paper, magazine, rigid cardboard, stick, umbrella,
pillow etc.) can be used for splinting at the site of the
accident.
Open Fracture
 The bleeding from the wound is stopped by applying
firm pressure using a clean piece of cloth.
 Circular bandage can apply proximal to the wound in
order to stop bleeding.
 If the wound is very dirty, it is washed with clean
 tap water and covered with a clean cloth.
 The fracture is splinted
In the emergency department
 Basic life support
 Bleeding is recognized and stopped by local
pressure.
 Wooden plank, Cramer-wire splint, Thomas’ splint,
inflatable splint are some of the splints used in
emergency department.
 After emergency care is provided, suitable
radiological and other investigations are carried out.

Reduction: Reduction of a fracture (setting the bone)

refers to restoration of the fracture fragments to
anatomic alignment and rotation. Reduction of a
fracture can be carried out by following methods
Closed Reduction:
 Nonsurgical, manual realignment of bone
 fragments to their previous anatomic position.
 Traction and counter traction are manually
applied to the bone fragments
 This is usually performed under local or general
anaesthesia.
Open reduction:
 It is a surgical approach by which the fracture
fragments are reduced.
 It usually includes internal fixation of the fracture
with the use of wires, screws, pins, plates, intra
medullary rods or nails.
Splint and Braces
Splints are used for immobilizing fractures; either
temporary during transportation or for definitive
treatment.
 Splint: Splints are often used for simple and stable
fractures., sprains, tendon injuries, and other soft
tissue injuries. They offer many advantages over
casts in that they are faster and easier to apply.
 Splints are easily removed, facilitating inspection of
injury site.
 Braces: Braces are used to provide support, control
movement and prevent additional injury. They are
custom fitted to various parts of the body; thus, they
tend to be indicated for longer term use than splints

Continuous Traction:
 It is the application of a pulling force to an injured or
diseased part of the body or an extremity while
counter traction pulls in the opposite direction.
 Prevent or reduce muscle spasm
 Immobilize a joint or part of the body
 Reduce a fracture or dislocation
 Treat a pathologic condition
 The two most common types of traction are Skin
traction and Skeletal traction
Principles Of Effective Traction
 Traction must be continuous to be effective in
reducing and immobilizing fractures.
 Skeletal traction is never interrupted
 Weights are not removed unless intermittent traction
is prescribed
 Any factor that might reduce the effective pull must
be eliminated
 The patient must be in good body alignment should
be in the centre of the bed when traction is applied

Skin Traction
 It is generally used for short term treatment (48 to 72
hours) until skeletal traction or surgery is possible.
 An adhesive strap is applied on the skin and traction
applied.
 The traction weights are usually limited to 2.3 to 4.5
 kg.
 Pelvic or cervical skin traction may require heavier
weights applied intermittently.
 The traction force is transmitted from the skin
through the deep fascia and inter muscular septae to
the bone

Skeletal Traction
 Provides long term pull that keeps the injured bones
and joints aligned.
 Applied directly on the bone by inserting K-wire or
Steinmann pin through the bone to align and
immobilize the injured body part.
 Used to align injured bones and joints or to treat
joint contractures and congenital hip dysplasia.
 Weight for skeletal traction ranges from 2.3 to 20.4
kg. The use of too much weight can result in delayed
union or non-union.
XII) Nursing Management: Teacher details Slide show
nursing
 Administer drug therapy as ordered by health care management of
fracture
provider
 Report the diagnosis to the local health
department
 Focus on preventing the spread of the infection
 Discuss pain management, handling fatigue,
importance of good nutrition
 Ensuring effective skin traction
 Monitoring and managing potential complication
 Maintaining positioning
 Promoting exercises
Teacher details
nursing diagnosis
of possible
XIII)Nursing Diagnosis: fracture

 Acute Pain is a primary concern post- fracture,

often due to tissue injury and muscle spasms.
  Impaired Physical Mobility
 Risk for Infection
 Risk for Compartment Syndrome
Teacher explains Slide show
the various
possible
XIV)Complications complications

Local Complications:
 Infection
 Vascular injury
 Nerve injury
 Visceral injury
 Hemarthrosis (bleeding inside a joint)
 Compartment syndrome
General Complications:
 Haemorrhage and shock
 Fat embolism
 Venous thrombosis and pulmonary embolism
 Crush syndrome
 Complications of prolonged bed rest and
 recumbency especially in elderly and aged
patients. Eg., DVT, bedsores, etc

XV) Summary:
During this class we have discussed about the
definition, causes, types, pathophysiology, clinical
manifestations, diagnostic measures, treatment medical
and nursing management of Fracture.