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
