FRACTURE
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.
Common Sites of Fracture in
Children
1. Clavicle fracture
2. Forearm fracture
3. Epiphyseal fracture
4. Fracture humerus
5. Femur fracture
6. Tibial fracture
7. Ankle fracture
CLASSIFICATION
1. Based on Relationship with the Environment
2. Based on Displacement
3. Based on Fracture Pattern
4. Based on Etiology
5. Miscellaneous fractures
Classification Based on Relationship
with Environment
1. CLOSED
{Simple}
2. OPEN
{Compound}
a. CLOSED FRACTURE (simple fracture) is one that
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.
Classification: Based on
displacement
NON - DISPLACED FRACTURE
The bone cracks either part or all the way
through, but does not move and maintains
proper alignment
DISPLACED FRACTURE
The bone snaps into two or more parts and
moves so that the two ends are not lined up
straight
Classification: Based on Pattern
1. Transverse
2. Oblique
3. Spiral
4. Segmental
Transverse Oblique Fracture
Fracture A fracture in which the #
A fracture in which the line is at oblique angle
# line is perpendicular (45)to the long axis of
to the long axis of the the bone
bone
Spiral Fracture
A severe form of
oblique fracture in
which the # plane
rotates along the long
axis of the bone.
Segmental
Fracture
There are two
fractures in one
bone, but at different
angles
Classification: Based on
Etiology
1. TRAUMATIC
2. PATHOLOGICAL
– Tumors
– Bone cysts
– Osteomyelitis
– Osteoporosis
– Rickets
Miscellaneous Fractures
Greenstick Buckle
fracture- one side fracture- results
of bone is broken from compression
and other side is of bone
bent.
Comminuted Impacted
Fracture - The bone is fracture- a part of
broken into many fractured bone is
fragments. driven into
another bone.
Bend fracture- Compression
when bone bends to fracture- results
a breaking point and from
is not straightened compression of
completely without bone.
intervention
Clinical Manifestations
1. Pain and tenderness
2. Loss of Function
3. Deformity
4. Shortening
5. Crepitus
6. Swelling and Discoloration
Diagnostic Evaluation
1. History and Physical examination
2. Radiologic studies (X-ray, CT, MRI, Bone
scan)
3. Decreased movement of the limb
4. Crepitation
5. Arm is usually held across the chest with
the opposite limb used to support the
weight of injured limb
MANAGEMENT
FIRST AID
1. Don't move the person except if
necessary to avoid further injury.
2. Stop any bleeding. Apply pressure to
the wound with a sterile bandage, a clean
cloth or a clean piece of clothing.
3. Immobilize the injured area. Don't try
to realign the bone or push a bone that's
sticking out back in. Apply a splint to the
area above and below the fracture sites.
Cont..
4. Apply ice packs to limit swelling and
help relieve pain. Don't apply ice
directly to the skin. Wrap the ice in a
towel, piece of cloth or some other
material.
5. Treat for shock. If the person feels faint
or breathing is short, rapid breaths, lay
the person down with the head slightly
lower than the trunk and, if possible,
elevate the legs.
PRINCIPLES OF FRACTURE
MANAGEMENT
The principles of fracture
management are,
1. Reduction,
2. Immobilization, And
3. Rehabilitation.
1.Reduction
Reduction is the process of restoring
the bone ends into their normal
anatomical positions. This is accomplished
by open or closed manipulation of the
affected area, referred to as close
reduction and open reduction.
1. Closed reduction is accomplished by
bringing the bone ends into alignment by
manipulation and manual traction. A cast
is normally applied to immobilize the
extremity and maintain the reduction.
2. In open reduction, a surgical opening is
made, allowing the bones to be reduced
manually under direct visualization.
Internal fixation devices are used to
maintain the bone fragments in reduction.
2. Immobilization - Immobilization is done
to maintain fracture reduction until healing
occurs.
Immobilization may be done by internal
fixation or external fixation.
3. Internal Fixation - Internal fixation devices
include pins, wires, screws, rods, nails, and
plates.
4. External Fixation - Methods include casts,
splints, pins and continuous traction.
Internal Fixation
External Fixation Pins &
Wires
Cast and Splints
Hip Spica Cast
Traction
Traction
is the use of weights, ropes
and pulleys to apply force to tissues
surrounding a broken bone.
Buck’s Traction
It is used when partial or temporary
immobilisation is required, and to provide
comfort following injury while awaiting
surgical fixation, especially in hip and
femur injuries.
Russell’s Traction
It is used for fractures of the tibia, and
works by supporting the flexed knee in a
sling and applying a horizontal pulling
force by use of traction tape and elastic
bandage attached to the lower leg.
Bryant’s Traction
It is mainly used in young children who
have fractures of the femur or congenital
abnormalities of the hip. Both the patient's
limbs are suspended in the air vertically at
a ninety degree angle from the hips and
knees slightly flexed.
Dunlop’s Traction
It is used for fractures of the upper
extremities. It works in the form of
horizontal traction which is applied to
the abducted humorous, while vertical
traction is applied to the flexed forearm.
Cervical Traction
It is used in cervical ailments and
injuries. It is usually used for shorter
periods.
The halter fits under the chin and around
the back of the head against the occipital
protuberance.
Rehabilitation
Rehabilitation is the regaining of strength
and normal function in the affected area.
Specific rehabilitation for each patient is
based on the type of fracture and the
methods of reduction and immobilization
used.
NURSING MANAGEMENT
Overhead Trapeze
An overhead
trapeze will facilitate
independent
movement in bed. It
also maintains range
of motion of the upper
extremities.
Complications
Early complications
1. Neurovascular impairment
2. Fat embolism
3. Compartment syndrome
4. Constipation from immobility and
analgesics
5. Deep vein thrombosis
Cont..
Delayed
complications
1. Skin breakdown
2. Joint stiffness or
contractures
3. Delayed union or no union
4. Malunion
