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Aquino, Bianca Denisse C.
Aquino, Paula Nichaelle E.
BSN III-1 RLE2
The Skeletal System
The Skeletal System is composed of 206 bones and
associated cartilages, tendons ,and ligaments.
It gives the body a framework, maintains its shape,
and protects vital organs.
It provides a place for attachment of muscles and
supporting structures.
It produces body movements through a system of
levers.
A site for mineral storage and blood cell formation.
Two Parts of the Skeletal System
AXIAL SKELETON– composed of the skull, the hyoid
bone, the vertebral column (spine, sacrum, and
coccyx), the sternum, and the ribs. Its components are
aligned along the long axis of the body.
APPENDICULAR SKELETON- includes the bones of
the upper extremities (arms, forearms, and hands), the
pectoral (shoulder) girdle, the pelvic (hip) girdle, and
the bones of the lower extremities (thigh, knee, leg,
and foot). Its components are outside the body main
axis.
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Definition
Break in the continuity of the margins of a bone
Occurs whenever a force exceeds the tensile strength
of the bone
Maybe caused by stress, trauma, overuse, repeated
wear
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Risk Factors
Falls
Vehicular accidents
Sports
Use of drugs that impair judgement
Tumors
Infection
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Signs and Symptoms
Deformity
Edema
Ecchymosis
Redness
Muscle Spasms
Loss of function (affected part)
Crepitus
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Types of Fractures
AVULSION- fracture that pulls bones and other
tissues from their usual attachments
Ring Finger Avulsion
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Types of Fractures
CLOSED- skin closed but bone is fractured
Closed Fracture (Right Forearm)
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Types of Fractures
COMPRESSION- bone is squeezed or wedged
together at one side
Thoracic Compression Fracture
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Types of Fractures
GREENSTICK- break in only one cortex of the bone
Forearm Greenstick Fracture
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Types of Fractures
IMPACTED- one end wedged into the opposite end or
into the fractured fragment
Impacted Fracture
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Types of Fractures
OBLIQUE- fracture at an oblique angle across
bothecortices
Metatarsal Oblique Fracture
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Types of Fractures
OPEN- skin is open, bone is fratured; soft tissue
trauma may occur
Open Fracture
(Radius and Ulna)
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Types of Fractures
PATHOLOGIC- transverse, oblique or spinal fracture
of a bone weakened by tumor
Pathologic Fracture of the Spine
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Types of Fractures
STRESS- crack in one cortex of a bone
Stress Fracture
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Types of Fractures
TRANSVERSE- Horizontal break through the bone
Left Humerus Transverse Fracture
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Stages of Bone Healing
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Emergency Management
Assess for signs of respiratory distress, bleeding and head
injuries
Provide lifesaving care before focusing on the fracture itself
Assess fracture injury
Cut clothing from affected side
Apply direct pressure on the area
Apply digital pressure over proximal artery
Immobilize fractured area by splinting
Prevent further damage, reduce pain, and increase circulation
Splints are used to support, immobilize, and protect parts with
known or suspected fractures, dislocations or severe pain
Cover open fractures with a clean or sterile dressing
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Nursing Management
Assess vital signs and monitor signs of shock
Significant blood loss may occur, especially with fractures involving
long bones
Apply ice bags to fracture site
Vasoconstirction: decreases bleeding, edema, and pain
Help client sit in a chair with legs elevated
Upright positions increase peripheral circulation: decrease edema
Administer analgesics and antibiotics as prescribed
Change dressing as needed using strict aspectic technique
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Medical and Surgical Management
Reduction – restores proper bone alignment
• Closed reduction: manual manipulation under local or
general anesthesia
• Open reduction: for fractures that cannot be managed
with closed reduction
Closed Reduction
• Manual manipulation of extremities to align the fractured
fragments
• Traction – exertion of a pulling force applied in 2 directions
to reduce muscle spasm and immobilize a fracture
– Skin traction: uses elastic bandages and coverings attached to
the patient’s skin
– Skeletal traction: use of pins or wires inserted through the
distal bone and attached to a weight, allowing a more prolonged
traction
• Casting
– Application of plaster of paris or fiberglass for the purpose of
stabilizing a fracture while bony union occurs
Cast
Balanced Skeletal Traction
Nursing care for patients with casts
Keep cast and extremity elevated
Allow wet cast to dry within 24-48 hours; handle with
palms of the hands
Monitor extremity for circulatory impairment
Inspect cast edges and underlying skin for irritation
Monitor for any signs of infection: “hot spots”
Instruct not to inset anything in the cast
Instruct to do isometric exercises
Help patient in using an ambulatory aid
Weight bearing is restricted until some bone union occurs
Open Reduction
Surgical intervention used to treat fractures with the use of
internal fixation devices
Either placed on a traction or a cast
Internal Fixation
Involves application of screws, plates, pins, or nails to hold
fragments in alignment
Provides immediate bone strength
External Fixation
An external frame is used with multiple pins applied through the
bone
Provides more freedom of movement than with a traction
Open Reduction Internal Fixation
(ORIF)
Open Reduction External Fixation
(OREF)
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Rehabilitative Use Assistive Devices
• Crutch Walking
– Used for aiding the client in ambulation
– Accurate measurement to avoid damage to the brachial plexus
– Distance between the axial and the arm pieces should be 2
finger widths in the axilla space
– Elbows should be slightly flexed, 20-30 degrees when walking
– Instruct never to rest the axilla on the bars
– Stop ambulation if numbness or tingling occurs
– Stand on the affected side
– Instruct to look upward and outward when ambulating
– Place crutches 6-10 inches diagonally in front of the foot
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Rehabilitative Use Assistive Devices
Crutch Gaits
• One leg can bear weight
– Swing to gait
– Swing thru gait
– 3 point gait
• Both legs can move separately and bear some weight
– 4 point gait
– 2 point gait
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Rehabilitative Use Assistive Devices
Going up and down the stairs
Up the stairs: unaffected leg first then moves the
affected leg and crutches up
Going down the stairs: affected leg and crutches down
first then unaffected leg
