Fracture

Fracture

à  A break in the continuity of the bone and is defined according to its type and extent

Severe mechanical Stress to bone à bone fracture

o    Direct Blows

o    Crushing forces

o    Sudden twisting motion

o    Extreme muscle contraction

TYPES OF FRACTURE

1. Complete fracture

Involves a break across the entire cross-section

2. Incomplete fracture

The break occurs through only a part of the cross-section

1. Closed fracture

The fracture that does not cause a break in the skin

2. Open fracture

The fracture that involves a break in the skin

1. Comminuted fracture

A fracture that involves production of several bone fragments

2. Simple fracture

A fracture that involves break of bone into two parts or one

ASSESSMENT FINDINGS

1. Pain or tenderness over the involved area

2. Loss of function

3. Deformity

4. Shortening

5. Crepitus

6. Swelling and discoloration

1. Pain

Continuous and increases in severity

Muscles spasm accompanies the fracture is a reaction of the body to immobilize the fractured bone

2. Loss of function

Abnormal movement and pain can result to this manifestation

3. Deformity

Displacement, angulations or rotation of the fragments Causes deformity

4. Crepitus

A grating sensation produced when the bone fragments rub each other

DIAGNOSTIC TEST

o    X-ray

EMERGENCY MANAGEMENT OF FRACTURE

1. Immobilize any suspected fracture

2. Support the extremity above and below when moving the affected part from a vehicle

3. Suggested temporary splints- hard board, stick, rolled sheets

4. Apply sling if forearm fracture is suspected or the suspected fractured arm maybe bandaged to the chest

5. Open fracture is managed by covering a clean/sterile gauze to prevent contamination

6. DO NOT attempt to reduce the facture

MEDICAL MANAGEMENT

1. Reduction of fracture either open or closed, Immobilization and Restoration of function

2. Antibiotics, Muscle relaxants and Pain medications

For CLOSED FRACTURE

1. Assist in reduction and immobilization

2. Administer pain medication and muscle relaxants

3. teach patient to care for the cast

4. Teach patient about potential complication of fracture and to report infection, poor alignment and continuous pain

For OPEN FRACTURE

1. Prevent wound and bone infection

Administer prescribed antibiotics

Administer tetanus prophylaxis

Assist in serial wound debridement

2. Elevate the extremity to prevent edema formation

3. Administer care of traction and cast

FRACTURE COMPLICATIONS

Early

1. Shock

2. Fat embolism

3. Compartment syndrome

4. Infection

5. DVT

Late

1. Delayed union

2. Avascular necrosis

3. Delayed reaction to fixation devices

4. Complex regional syndrome

FRACTURE COMPLICATIONS: Fat Embolism

Occurs usually in fractures of the long bones

Fat globules may move into the blood stream because the marrow pressure is greater than capillary pressure

Fat globules occlude the small blood vessels of the lungs, brain kidneys and other organs

Fracture

Onset is rapid, within 24-72 hours

ASSESSMENT FINDINGS

1. Sudden dyspnea and respiratory distress

2. tachycardia

3. Chest pain

4. Crackles, wheezes and cough

Nursing Management

1. Support the respiratory function

Respiratory failure is the most common cause of death

Administer O2 in high concentration

Prepare for possible intubation and ventilator support

2. Administer drugs

Corticosteroids

Dopamine

Morphine

3. Institute preventive measures

Immediate immobilization of fracture

Minimal fracture manipulation

Adequate support for fractured bone during turning and positioning

Maintain adequate hydration and electrolyte balance

Early complication: Compartment syndrome

A complication that develops when tissue perfusion in the muscles is less than required for tissue viability

ASSESSMENT FINDINGS

1. Pain- Deep, throbbing and UNRELIEVED pain by opiods

Pain is due to reduction in the size of the muscle compartment by tight cast

Pain is due to increased mass in the compartment by edema, swelling or hemorrhage

2. Paresthesia- burning or tingling sensation

3. Numbness

4. Motor weakness

5. Pulselessness, impaired capillary refill time and cyanotic skin

Medical and Nursing management

1. Assess frequently the neurovascular status of the casted extremity

2. Elevate the extremity above the level of the heart

3. Assist in cast removal and FASCIOTOMY

Strains

à  Excessive stretching of a muscle or tendon

Nursing management

1. Immobilize affected part

2. Apply cold packs initially, then heat packs

3. Limit joint activity

4. Administer NSAIDs and muscle relaxants

Sprains

à  Excessive stretching of the LIGAMENTS

Nursing management

1. Immobilize extremity and advise rest

2. Apply cold packs initially then heat packs

3. Compression bandage may be applied to relieve edema

4. Assist in cast application

5. Administer NSAIDS