DEFINITION
- A FRACTURE IS A BREAK IN THE CONTINUITY OF BONE
AND IS DEFINED ACCORDING TO ITS TYPE AND EXTENT.•
-FRACTURE IS A BREAK IN ANY BONE IN THE BODY.
CLASSIFICATION OF FRACTURE
• a. CLOSED FRACTURE (simple fracture) is one t does not cause a break in the skin
• .b. AN 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:
• Grade I is a clean wound less than 1 cm long
• Grade II is a larger wound without extensive soft tissue damage
• Grade III is highly contaminated, has extensive soft tissue damage, and is the most
severe.
OTHER FRACTURE
• Avulsion: fracture which occurs when a fragment of
bone tears away from the main mass of bone
• Depressed: A fracture in which fragments are driven
inward (seen frequently in fractures of skull and
facial bones)
• Pathologic: It occurs through an area of diseased
bone (eg, osteoporosis, bone cyst, bony metastasis,
tumor);can occur without trauma or a fall
• Stress:A fracture that results from repeated loading
without bone and muscle recovery
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
• pain
• loss of function
• deformity
• shortening
• crepitus
• swelling and discoloration
DIAGNOSIS OF FRACTURE
• History collection
• Physical examination
• X ray
• CT scan
• MRI scan
MANAGEMENT
• Medical management
1. Reduction-
• Restoration of the fracture fragments to anatomic alignment and positioning.
It may be done by either closed reduction or open reduction
• a. closed reduction :- is accomplished by bringing the bone fragments into
anatomic alignment through manupulation and manual traction.
• ( cast, splint or other pinning devices is applied)
• X rays are done for confirmations
b. Open reduction:-through a surgical approach the fracture
fragments are anatomically aligned
Internal fixation devices ( metallic pins, wires, screws plates,
rods) are used to hold bone fragments in position
• 2.Immobilization
• Immobilization may be accomplished by external or internal
fixation.Methods of external fixation include bandages, casts,
splints, continuous traction, and external fixators.. Metal
implants used for internal fixation serve as internal splints to
immobilize the fracture.
• Traction:-is the use of weights, ropes which apply force to
tissues surrounding a broken bone
• splints :-common procedure for immobilizing an injured part
• Soft materials:- towels, pillows tied with bandage
• Rigid materials :- board, metal strips are user
•
• 3.maintaining and restoring function
• Restlessness , anxiety and discomfort are controlled with a variety of
approaches, such as reassurance, position changes and pain relief strategies
including use of analgesic medications
• Isometric, muscle setting exercises used to promote circulation
• Participation in ADLS is encouraged to promote self esteem
• Edema is controlled by elevating the injured extremity and applying ice.
COMPLICATIONS
• Shock
• Compartment syndrome
• Deep vein thrombosis
• Infection
• Reaction to internal fixation devices
NURSING MANAGEMENT
• Encourage pt. not to mobilize fractured site
• Exercises to maintain the health of unaffected muscles for using assistive
devices like crutches, Walker
• Teach them how to use assistive devices
• Care of cast
• Assessment of pain
• Movement of distal fingers
• Hot spots, wet spots
• Care of traction
• Care of external fixation
• Provide bed pan for evaluation
