FRACTURES

Mary Grace B. Gutierrez

Resti Mariano
Ma. Cindy O. Bautista
Fracture
Is a medical condition in which there is a
break in continuity of bone and is define
according to its type and extent.
Types of Fractures
Complete Fracture Incomplete Fracture

 A break across the entire Involves a break through only

cross-section of the bone and part of the cross-section of
is frequently displaced. the bone.
 SIMPLE/CLOSED FRACTURE
“The fracture occurs along one line, splitting the bone into two
pieces and muscles and vessels injury may occurs by sharp edges
of bone”
 COMPOUND/OPEN FRACTURE
“An open fracture is a fracture where the broken bone is exposed.
That is dangerous because of increased chances of infection.”
Specific Types of Fracture
Oblique
A fracture occurring at an angle across the bone.
Comminuted
Fracture in which the bone has splintered into several
fragments
Spiral
Fracture that twist around the shaft of the bone.
Compound
A fracture in which the damage also involves the skin
and mucous membrane, also called open fracture.
Greenstick
A fracture in which one side of the bone is broken and
the other side is bent.
Transverse
A fracture that is straight across the bone shaft.
Compression
A fracture in which the bone has been compressed.
Causes/etiology
Most often caused by some type of trauma to a bone.
This trauma might occur as a result of a
Fall from height
Physical Abuse
Motor Vehicle Accident
Or disease
Everyday activities can cause bone fracture in people with
diseases that weaken the bones.
Signs and symptoms
Pain
Loss of function
Deformity
Shortening
Crepitus
Swelling and Discoloration
Bruising around the injured area
Medical management
Reduction
Refers to restoration of the fracture fragments to
anatomic alignment and rotation. Either closed
reduction or open reduction may be used to reduce a
fracture.
Considerations
Permission for the procedure is obtained
Analgesic is administered as prescribed
The injured extremity must be handled getly to avoid
additional damage
Closed Reduction

It is accomplished by bringing the bone fragments into

apposition (placing the end in contact) through
manipulation and manual traction. The extremity is
held in the desired position while physician applies cast,
splint or other devices. The immobilizing device
maintains the reduction and stabilizes the extremity for
bone healing. X-rays are obtained to verify that the bone
fragments are correctly aligned.
NURSING MANGEMENT
Teaches how to control the edema and pain associated
with fracture.
Nurse and physical therapies teach patients how to
use assistive devices safely.
Pt. teaching include self-care, medication
information, monitoring for potential complications
Open reduction
Internal fixation devices (metallic, pins, wires, screws,
plates, nails) may be used to hold the bone fragments
into position until the solid bone healing occurs. These
device may be inserted through the bony fragments.
Nursing management
Prevent infection of the wound, soft tissue, and bone
and to promote healing soft tissue and bone.
nurse elevate extremity to minimize edema.
Monitors the patients signs of infection.
 Early complication
Shock
Fat embolism syndrome
Compartment syndrome
Femur fracture
It is more prone on elderly people especially in women
who have brittle bones from osteoporosis and who
tend to fall frequently have a high risk of hip fracture.
2 types of hip fractures:
 Intracapsular fractures- fracture of the neck of the femur.
 Extracapsular fractues-fractures of the trochanteric
region.
Clinical manifestations
Pain in the hip and groin or in the medial side of the
knee.
The patient is more comfortable with the leg slightly
flexed in external rotation.
 Gerontologic manifestations
Hip fractures are a frequent contributor to death after 75
years of age.
Exhibit delirium as a result of the stress of the trauma,
unfamiliar surroundinds, sleep deprivation and
medications.
Medical management:
Buck’s extension traction
A temporary type of skin traction, may be applied to
reduce muscle spasm, to immobilize the extremity and
to relieve pain.

 Goal: To obtain a satisfactory fixation so that the client can be

mobilize quickly and avoid secondary medical complications.
hip hemiarthraoplasty
is the word used to describe a
half of a hip replacement. In this
procedure, the ball of the ball-
and-socket joint is removed, and
a metal prosthesis is implanted
into the joint.
It is favored in patients with
displaced fractures because of
the complications described
above with trying to repair these
fractures.
Nursing management:
Repositioning the patient
The nurse may turn the patient onto the affected or
unaffected extremity as prescribed by the physician.
Placing a pillow between the affected leg in the
abducted position.
Promoting exercise
Encourage to exercise by means of trapeze.
-this helps the clients strengthen the arms and shoulder in
preparation for protected ambulation.

 Hip flexion and internal rotation

 Apply only if the client has had a hemiartroplasty

 PT work with the patient to transfers, ambulation and in the

safe use of walker and crutches

Monitoring and managing potential complications
Neurovascular complications may occur from direct
injury to nerves and blood vessels or an increase tissue
pressure.
DVT is common complications.
 Increase fluid intake
 Ankle and foot exercises
 Elastic compression stockings

Pulmonary complications
 Deep breathing exercises
 Change in position after 2 hrs.
 Use of incentive spirometer
Skin breakdown
Use of elastic hip spica wrap dressing or elastic tape
applied on a vertical fashion may reduce the incidence of
tape blisters.
Loss of bladder control
use of indwelling catheter is avioded because of the high
risk for urinary tract infection.
Health promotion
Osteoporosis screening of patient who have
experienced hip fracture is important for prevention of
future fracture.
Dual-energy x-ray absorptiometry(DEXA)Scan testing
risk for additional fracture can be predicted.
Education regarding dietary requirements, Lifestyle
changes And weight-bearing exercises to promote
bone health is needed.
Femoral Shaft Fractures
A femoral shaft fracture is a severe injury that
generally occurs in high-speed motor vehicle collisions
and significant falls. These injuries are often one of
several major injuries experienced by a patient.
Medical management
Intramedullary rod
The most common procedure is to
insert a metal rod down the center
of the thigh bone.
This procedure reconnects the two
ends of the bone, and the rod is
secured in place with screws both
above and below the fracture. The
intrameduallary rod generally
remains in the bone for the life of
the patient, but can be removed if
it causes pain or other problems.
External fixation
is a method of immobilizing
bones to allow a fracture to heal.
It is accomplished by placing pins
or screws into the bone on both
sides of the fracture. The pins are
then secured together outside the
skin with clamps and rods. The
clamps and rods are known as the
"external frame."
Knee fracture
A knee fracture can be a break of any of the bones
around the knee-
-Femur (thigh bone), Patella (kneecap), Tibia (shin
bone)

Causes: A very common cause is a car accident. A blow

to the knee during almost any contact sport can also
result in a fracture. Falls from heights or even sudden
indirect forces, such as stumbling down stairs, can cause
a fracture.
Assessment:
On physical examination, there will be moderate to
severe swelling and usually an inability to bear weight
on the affected leg. X-rays will usually confirm the
fracture but sometimes a MRI (Magnetic Resonance
Image) or CT (Computed Tomography) scan may be
needed to further assess the damage.
Treatment:
Treatment for knee fractures is based on the severity of the
fracture and the bone involved.
Usually fractures of the femur require some form of
surgical stabilization.
Mild fractures of the patella can sometimes be treated with
immobilization.
Displaced patellar fractures, however, require surgery.
Finally, tibia fractures are highly variable and need
individual assessment prior to developing a treatment plan.
Most surgery involves the placement of screws, plates, wires
or rods.
Lateral Tibial Plateau Fracture Lateral Tibial Plateau Fracture
with Screw Fixation
Prevention
Prevention of knee fractures requires excellent strength
and stability of the joint.
Agility and flexibility may also help athletes avoid these
broken bones.
Usually, however, a knee fracture is the result of an
unfortunate sports related collision or accident that was
hard to avoid.
Tibia and fibulla fractures:
This fracture can occur
anywhere between the knee
and ankle. The tibia is the
most commonly fractured long
bone. Only the tibia bears
weight, but fracture of the tibia
is often associated with
fracture of the fibula because
force is transmitted via the
interosseous membrane that
connects the two bones.
Assessment:
The exam may reveal swelling (edema), bruising
(ecchymosis), and tenderness at the fracture site.
There may be swelling and decreased range of motion
at the knee or ankle, depending on the location of the
fracture.
Risk:
Individuals at risk of tibia and/or fibula fractures are
those who work at heights or participate in high-risk
sports.
Participants in repetitive impact sports, such as
jogging, are at higher risk of stress fractures than the
general population.
Individuals afflicted with thinning of the bone
(osteoporosis) are also at a higher risk of tibia and/or
fibula fractures.
Treatment:
Compound or displaced fractures may require pins
placed externally (external fixation devices), or surgery
for open reduction, internal fixation (ORIF) with pins,
plates, screws, or intramedullary rods placed
longitudinally within the shaft of the bone.
Rib fracture
A rib fracture is a break or fracture
in one or more of the bones making
up the rib cage.
The first rib is rarely fractured
because of its protected position
behind the clavicle (collarbone).
The middle ribs are the ones most
commonly fractured. Fractures
usually occur from direct blows or
from indirect crushing injuries.
A lower rib fracture has the
complication of potentially injuring
the diaphragm, which could result
in a diaphragmatic hernia.
Assessment:
Pain when breathing or with movement
 A portion of the chest wall moving separately from the
rest of the chest (flail chest)
 A grating sound with breathing or movement
At risk:
The most common mechanism of injury for rib
fractures in elderly persons is a fall from height or from
standing.
In adults, motor vehicle accident is the most common
mechanism.
Youths sustain rib fractures most often secondary to
recreational and athletic activities.
Surgery:
Acute Innovations RibLoc is a
titanium U-Shaped plate that is sized
to match rib thickness and uses screws
that fixate to anterior and posterior of
plate and provide fixation without
needing bone purchase for screws and
without risking damage to the
neurovascular bundle. These plates
can be contoured to match the rib
segment being plated and come in
various lengths.
Synthes MatrixRIB Fixation
System has two options: a
precontoured metal plate
that uses screws to secure the
plate to the rib; and/or a
intramedullary splint which
is tunneled into the rib and
secured with a set screw.
Amputation is the removal of a
body extremity by trauma or surgery.
As a surgical measure, it is used to
control pain or a disease process in
the affected limb, such as
malignancy or gangrene. In some
cases, it is carried out on individuals
as a preventative surgery for such
problems. A special case is the
congenital amputation, a congenital
disorder, where foetal limbs have
been cut off by constrictive bands
Nursing Diagnosis
Acute pain r/t Fracture, soft tissue damage, muscle
spasm and surgery
Outcome
Will be able to relief pain
Intervention
Asses type and location of patient’s pain whenever vital
signs are obtained and as needed.
Handle the affected extremity gently, supporting it with
hand or pillow.
Administered prescribed analgesics as needed.
Assist with frequent changes position.
Nursing Diagnosis
Impaired Physical Mobility R/T fractured Hip
Outcome
Achieves pain free, functional, stable hip
Interventions
Maintain neutral positioning of hip.
Place pillow between legs when turning.
Instruct and assist in position changes and transfer.
Offer encouragement and support exercise regimen.
Nursing Diagnosis
Impaired Skin Integrity R/T Surgical Incision
Outcome
Will be able to achieves wound healing
Interventions
Monitor vital signs.
Perform aseptic dressing changes.
Assess wound appearance and character of drainage.