FRACTURE

S
Catherine M. Ebajan
◦ Is a complete or incomplete disruption in the continuity of bone
structure.
◦ It occurs when the bone is subjected to stress greater than it can absorb
(Porth, 2015).
◦ Fractures may be caused by direct blows, crushing forces, sudden
twisting motions, and extreme muscle contractions.
◦ When the bone is broken, adjacent structures are also affected, which
may result in soft tissue edema, hemorrhage into the muscles and joints,
joint dislocations, ruptured tendons, severed nerves and damaged blood
vessels.
◦ Body organs may be injured by the force that caused the fracture.
 Types of Fractures
◦ Fractures types are classified by location (e.g., proximal, midshaft, distal)
and type (Porth, 2015).
◦ According to degree of break (e.g., greenstick fracture refers to a partial
break).
◦ Character of any fractured bone fragments (e.g., a comminuted fracture
has more than two fragments).
◦ Closed fracture (simple fracture) is one that does not cause a break in the
skin.
◦ Open fracture (compound , or complex fracture) is one in which the skin
or mucous membrane wound extends to the fractured bone.
◦ Open fractures are graded according to the following criteria (Halawi &
Morwood, 2015)
◦ Type I is a clean wound less than 1cm long
◦ Type II is a larger wound without extensive soft tissue damage or
avulsions
◦ Type III ( A, B, C) is highly contaminated and has extensive soft tissue
damage.
◦ It may be accompanied by traumatic amputation and is the most severe.
◦ An intra-articular fracture extends into the joint surface of a bone.
Types of fractures
Clinical manifestations
◦ Pain
◦ Loss of function
◦ Deformity
◦ Shortening
◦ Crepitus
◦ Localized edema and ecchymosis
Emergency management
Immediately after injury, if a fracture is suspected
◦ The body part must be immobilized before moving the patient
◦ Adequate splinting is essential
◦ Joint proximal and distal to the fracture also must be immobilized
Open fracture
◦ The wound is covered with sterile dressing
◦ No attempt is made to reduce the fracture
◦ Splints are applied for immobilization(Schaller, 2016)
Medical management
◦ Fracture reduction refers to restoration of the fracture fragments to anatomic
alignment and positioning.
Closed reduction - bringing the bone fragments into anatomic alignment
through manipulation and manual traction.
Open reduction - fracture fragments are anatomically aligned through a surgical
approach.
◦ Immobilization - the bone fragments must be immobilized and maintained in
proper position and alignment until union occurs.
◦ Maintaining and restoring function
Nursing management
Patients with closed fractures
◦ Educate the patient regarding proper methods to control edema and pain.
◦ Educate about exercises to maintain the health of unaffected muscle
◦ Educate on how to use assistive devices safely.
◦ Patient education includes self-care, medication information, monitoring for
potential complications, and the need for continuing health care supervion.
◦ Fracture healing and restoration of strength and mobility may take an average
of 6 to 8 weeks depending on the quality of the patient’s bone tissue.
Nursing management
Patients with open fractures
The objectives of management are to prevent infection of the wound, soft
tissue and bone, and to promote healing of bone and soft tissue.
◦ Intravenous (IV) antibiotics are given along with intramuscular (IM) tetanus
toxoid if needed (Schaller, 2016).
◦ Wound irrigation and debridement (removal of tissues and foreign material)
are initiated in the OR as soon as possible.
◦ The fracture is reduced and stabilized by external fixation and the wound is
usually left open.
◦ The extremity is elevated to minimize edema.
◦ Temperature is monitored at regular intervals and the patient is monitored for
signs of infection.