FRACTURE
INTRODUCTION
A fracture is a break, usually in a bone. Fractures commonly happen
because of car accidents, falls, or sports injuries. Other causes are low
bone density and osteoporosis, which cause weakening of the bones.
DEFINITION
“Fracture is the break in the continuity of the bone and is
defined according to its type and extent.”
• Fracture occurs when the bone is subjected to stress grater than it can
absorb.
CAUSES
• Direct Blows ( Trauma)
• Crushing force
• Sudden Twisting motion ( Torsion )
• Extreme Muscle Contraction
• Bending force
• Compression forces.
• Shearing Forces.
• Automobile injury.
• Motor Vehicle accident.
• Falling
• Due to muscular action.
MECHANISM OF FRACTURE
• Direct force:
With direct force, the Kinetic energy is applied at or
near the site of fracture and bone cannot withstand the force.
• Indirect Force :
Kinetic energy is transmitted from the point of
impact to the site where bine is weaker and Fracture occurs at weaker
point.
CLASSIFICATION OF FRACTURE
1. COMPLETE FRACTURE
2. INCOMPLETE FRACTURE
3. CLOSED FRACTURE
4. OPEN FRACTURE
5. DISPLACED FRACTURE
6. COMMINUTED FRACTURE
1. COMPLETE FRACTURE
• It involves a break
across the entire cross
Section of the bone and
it is Frequently
Displaced.
• In a complete fracture
the bone snaps into 2 or
more Parts.
2.INCOMPLETE FRACTURE
• The break occurs
through only part of the
cross section of the
bone.
• In an incomplete
fracture the bine cracks
but does not break all
the way through.
3.CLOSED FRACTURE
• Closed fracture also
called Simple fracture.
• The bone breaks but
there is no open
wound in the skin.
• Skin is intact over
fracture site.
4.OPEN FRACTURE
• Open fracture also called
compound fracture.
• The bone breaks through
the skin.
• The skin is interrupted
over fracture site.
• Open Fracture allows
bacteria to enter injured
area and predispose the
fracture site for infection.
5.DISPLACED FRACTURE
• A fracture in which the
2 end of the broken
bone are separated from
one another fracture.
• The break seems to have
been caused by a fall.
6.COMMINUTED FRACTURE
• In this fracture bone
fragment are crushed,
Splinted ae broken into
several pieces.
• Elderly people suffer
comminuted hip fracture
during fall.
CLASSIFICATION BY FRACTURE
PATTERN
1. Linear fracture
2. Transverse fracture
3. Oblique fracture
4. Spiral fracture
5. Depressed fracture
6. Longitudinal fracture
1.LINEAR FRACTURE
• A fracture that is
parallel to the bone’s
long axis.
• Fracture line is intact.
• This occurs when
direct force applied to
bone.
2.TRANSVERSE FRACTURE
• Fracture lines is
straight across the
bone at (90) right
angle to axis f bone.
• These fracture occurs
due to bone disorders
such as Paget’s disease
and osteomalacia.
3.OBLIQUE FRACTURE
• Fracture line occurs at an
oblique angle (45 o) to
the shaft of bone.
• These fracture are caused
by twisting force.
4.SPIRAL FRACTURE
• A spiral fracture also
called torsion fracture is
a type of bone fracture
which is caused by
twisting force.
• Fracture line forms a
spiral encircling the
shaft of bone.
5.DEPRESSED FRACTURE
• A fracture in which
fragments are driven
inward ( fracture of skull
and facial bone)
6.LONGITUDINAL FRACTURE
• Longitudinal fracture
is a fracture that
normally follows the
long axis of the bone
in human in a human
body.
• Fracture extends
longitudinally.
CLASSIFICATION BY TYPE OF
FRACTURE
1. Avulsion fracture
2. Compression fracture
3. Green stick fracture
4. Impacted fracture
5. Pathologic fracture
6. Stress fracture
1.AVULSION FRACTURE
• A fracture in which a
fragment of bone has been
pulled away by a
ligaments or tendon and
its attachment.
2. COMPRESSION FRACTURE
• A compression fracture
is also called as crush
fracture.
• Which happens when
bone is compressed by
force greater than the
bone can withstand
• Mostly vertebral
fracture.
3. GREEN STICK FRACTURE
• A fracture in which one
side of a bone is broken
and the other side is
bent.
• Like a stick of green
wood.
4. IMPACTED FRACTURE
• An impacted fracture is
a loss in continuity in
the structure of bones.
5. PATHOLOGIC FRACTURE
• A fracture that occurs
through an area of
diseased bones.
• Example: osteoporosis,
bone cyst
6. STRESS FRACTURE
• A fracture that result
from repeated loading
without bone and
muscle recovery.
• Mostly occurs in
marathon runners.
CLASSIFICATION BY EPONYM
1. COLLES’S FRACTURE
2. POTT’S FRACTURE
1. COLLES’S FRACTURE
• A Colles’s fracture is
often called a broken wrist
is a fracture of the distal
radius in the forearm with
dorsal and radial
displacement of the wrist
and hand.
• Radius is fractured within
1 inch of articular surface.
2. POTT’S FRACTURE
• This fracture occurs at
medial malleolus of the
tibia and fibula.
• It is also called associated
with rupture of the internal
lateral ligaments.
CLASSIFICATION BY ANATOMIC
LOCATION
1. ARTICULAR FRACTURE
2. EXTRA CAPSULAR FRACTURE
3. INTRA CAPSULAR FRACTURE
4. EPIPHYSEAL FRACTURE
1.ARTICULAR FRACTURE
• A fracture involving the
articulating surfaces of
a joint.
• These fracture can
damage the articular
cartilage and
subchondral bone and
lead to articular
incongruity.
2. EXTRA CAPSULAR
FRACTURE
• Any fracture that occurs
near a joint but does not
directly involve the
joint capsule.
• This type of fracture is
extremely common in
the hip.
3. INTRA CAPSULAR
FRACTURE
• These fracture occurs at
the level of the neck
and the head of the
femur and are generally
with in the capsule.
4. EPIPHYSEAL FRACTURE
• A fracture involving the
epiphyseal plate of a long
bone, which causes
separation or
fragmentation of the
plate.
• It is also called salter
fracture.
PATHOPHYSIOLOGY
Stress on bone
Injury in the bone
Disruption in the continuity of bone
PATHOPHYSIOLOGY
Disruption of muscle and blood vessels
Soft tissue damage
Bleeding and hematoma forms in
medullary canal
PATHOPHYSIOLOGY
Bone tissue surrounds the fractured site
dies
Inflammatory response
Vasodilation, edema, pain, loss of
function
CLINICAL MANIFESTATION
• Continuous pain
• Pain become severe with movement
• Discomfort, irritability and restlessness
• Localized swelling
• Discoloration of skin
• Tenderness over fracture site
• Weakness
• Lethargy
• Loss of function in fracture extremity
CLINICAL MANIFESTATION
• Numbness
• Deformity
• Edema and ecchymosis
• Crepitus
• Hypovolemic shock – blood loss
DIAGNOSTIC EVALUATION
• HISTORY COLLECTION • PHYSICAL EXAMINATION
DIAGNOSTIC EVALUATION
• X-RAY • CT SCAN
DIAGNOSTIC EVALUATION
• BLOOD CHEMISTRY, CBC.
COAGULATION STUDIES
EMERGENCY CARE OF FRACTURE
• Immobilization of body parts.
• In case of severe trauma, Normal Body alignment must maintained.
• Open fracture require the protruding bone be covered with clean
dressing.
• Bleeding can be controlled by application of pressure dressing.
• Asses color, Warmth, Circulation movement and sensation of the limb.
• Adequate Splinting should be applied.
• Complete Physical assessment of patient to rule out any other injury.
MEDICAL MANAGEMENT
1. REDUCTION :
• Reduction ( Setting of Bone ) is the process of Manipulation of
fractured bone to restore alignment and alleviate compression and
stretching of nerves and Vessels.
• It is 2 types closed reduction and open reduction.
• For these procedure the patient is Prepared, Permission for the
procedure is obtained and an analgesic is administered.
A) CLOSED REDUCTION
In most Instances closed Reduction is accomplished by
bringing the into fragment into apposition through manipulation and
manual Traction.
Steps :-
• Longitudinal Pull on distal end of fracture or extremity should be
applied. This Maneuver overcomes the initial muscle spasm, Limb
shortening and Overriding of Bone fragment.
• Disengagement of the bony ends of fracture which is bone by rotating
the distal portion.
• Realignment of the end of the bone done. Alignment of the bone
maintained.
• The Extremity is held in the Desired position while the physician
applies a cast, Splint.
• Reduction under anesthesia with percutaneous pinning may be used.
• X ray is done to verify the correct alignment of the bone.
• Traction or Cast may be used effect fracture reduction and
immobilization.
B) OPEN REDUCTION
• Some fracture requires Open reduction through a surgical approach.
• In Open reduction and incision is made and fracture is aligned during
surgery.
• Open reduction and Internal fixation done while using metallic device
Like pins, Wires, Screws, Plates, Nails and Rods.
• These device hold the bone fragments in Position until solid bone
healing occurs.
• These device can be attached to Sides of the bone, Maybe inserted
through bony fragment or Direct in to the Medullary cavity of the bone.
• These device ensure the fixation of the bony fragment.
2. IMMOBILZATION
• After the Fracture has been reduces the bone fragment must be
immobilized.
• Immobilization may be accomplished by external or internal fixation.
• External Fixation includes bandages, Cast, splints, Continuous traction
and external fixation.
• Internal Fixation Includes metal implants, It functions as Internal
Splints.
• Immobilizing device maintain the Reduction and Stabilize the
extremity of the bone healing.
3. MAINTAING AND RESTORING FUNCTION
• Reduction and Immobilization Promotes and soft Tissue healing.
• Elevate the affected Extremity and apply cold to reduce swelling.
• Neuro Muscular status ( Circulation, Movement, Sensation ) Elevated and any
deviation should be notified to Physician.
• Assist the client to change position to relieve pressure and use pillow for
support.
• Teach client to use alternative methods of pain management, Relaxation and
guided Imagery.
• Isometric Muscle setting exercise should be thought to Patient to promote
Circulation.
• Motivate the client to carry out ADLs to promote independent Functioning
and self esteem.
4. PHARMACOLOGICAL MANAGEMENT
• Narcotic are administered initially.
• As healing started oral analgesic ( NSAIDS ) can be given, This Focus
on Relieving pain.
• Antibiotics may be administered to client with open or complex
fracture to Prevent infection.
• Anticoagulants may be administered to prevent DVT.
• Stool softeners may be administered to Decrease the Risk of
constipation.
5. NURSING MANAGEMENT
• HEALTH HISTORY : Age, History of trauma / Accident, History of
chronic Illness and History of previous musculoskeletal illness/ surgery
should be collected.
• PHYSICAL ASSESSMENT: Pain with movement, pulse, edema, skin
color, temperature, deformity, range of motion, sensation should be
assessed.
• NEUROMUSCULAR ASSESSMENT: Pain, pulse, pallor, paralysis and
paresthesia should be assessed.
COMPLICATION
Complication of fracture fall into two categories:
I. EARLY COMPLICATION
II. DELAYED COMPLICATION
I. EARLY COMPLICATION
1. Shock – hypovolemic shock
2. Thromboembolitic complication
3. Fat embolism syndrome
4. Compartment syndrome
• Acute Compartment syndrome
• Chronic Compartment syndrome
• Crush Compartment syndrome
5. Volkmann’s contracture
6. Infection
II. DELAYED COMPLICATION
1. Delayed union, malunion and non union
2. Avascular necrosis of bone
3. Reflex sympathetic dystrophy
4. Heterotrophic ossification
