FRACTURE

A fracture is a complete or incomplete distruption in the continuity of bone. Fracture occurs

when stress placed on the bone is greater than the bone can absorb.

Muscle, blood ,vessels, nerve, tendon’s , joints and other organs may be
injured when fracture occurs.

Risk Factors

IN BOOK IN PATIENT
Direct blows Present
Crushing Forces Absent

Sudden twisting motion Present

Osteoporosis Present

Osteomalasia Absent

Metastatic bone defect Present

Biological condition such as ospeopenia Present

Types of fracture :

 Complete fracture :
It involves or break across the entire cross section of the bone and it
is frequently displaced from normal position.

 Incomplete fracture
It involves portion of the cross-section of the bone. E.g. in this
fracture one side of the bone is breaken and the other side is bent.
  Closed fracture :
This is also known as simple fracture. Closed fracture is the fracture
that does not produce break in the skin.

 Open fracture :
It is also known as complex fracture ,in this break in which the skin or
mucus membrane ,wound extends to the fractural bone open fracture are graded as
follows :

 Grade 1 :
A clean wound less than 1 cm long.

 Gradnee II :
A large wound without extension ,soft tissue damage.

 Grade III :
Wound is highly contaminated and has extensive soft tissue damage is
most severe type.

Pathological Fracture :
It is fracture that occurs at area of diseased bone , e.g. osteomalasia bony metastasis
and it can occur due to trauma and fall.

 Depressed fracture :
It is a fracture in which fragment can occur. E.g. fracture of skull and
facial bone.
 Compression fracture :
It is a fracture in which bone has been compressed.

 Comminuted fracture :
In this fracture ,the bone has slintered into several fragment.

 Epiphysed fracture :
A fracture through the epiphysis.

 Impact fracture :
A fracture in which a bone fragment is driven in another bone fragment.
  Oblique fracture :
A fracture occurring at the angle across the bone.

 Spiral fracture :
A fracture that lines around the shaft of the bone.

 Stress fracture :
The fracture that result from repeated loading of bones and muscles.

 Transverse fracture :
A fracture that is straight across the bone shaft.

Etiological Factors :

 Primary factors :
 People involves who have no history of joint disease and systemic illness.
 It involves large weight bearing joint.
 It is most prevalent in adults of 65 years older.

 Secondary factors :
 It results from trauma ,inflammation , joint disease and vascular necrosis.
 Over weight people have high rate of osteoarthritis of knee.

Complication of fracture :

 Immediate complication
 Delayed complication
 Nerve injury
 Joint stiffness
 Complication of fixation device
Pathophysiology of fracture :

Stress placed on a bone ,exceeds the bone ability to absorb it

Injury in the bone

Disruption of the continuity of bone

Disruption in the muscles and blood vessels attached to the ends of the bone

Soft tissue damage

Bleeding

Hematoma form in medullary canal

Bone tissue surround the fractured site dies

Inflammatory Response

Pain clinical manifestation appears.

Mechanism of Injury :

Book Picture Patient Picture

Direct violence :
Due to road traffic accident most common Present
of injury fall etc. open fracture are common in
this mode of injury.

Indirect injury : Absent

Due to falls , twisting force , usually cause
spiral fracture.

Clinical Features :

Book picture Patient picture

Pain Present

Loss of function Present

Edema Present

Deformity Present

Bruising Enphymosis Present

Shortening Absent

Discolouration Present
Complications :

 Shock :
Hypovolemic resulting from haemmorhage and from loss of intravenous with
volume to the interstitial spaces in the damaged tissue may occur in fracture’s of the
extremities pelvis , spine.

 Fat embolism syndrome :

After fracture of long bone or pelvic bones multiple fracture of cross injuries fat
embolism may defuse into the development at the development at the time of fracture
fat globules may defuse into the vascular compartment .

Diagnostic findings :

Book Picture Patient Picture

Collect the history regarding parasthesia Done

numbness which are early signs of nerve
involvement
Peripheral circulation is to be evaluated by Done
assessing color capillary refill time e.g. pulse

X-ray Done

Blood test Done

Radiography Done

Arthroscopy Done
Management

Book Picture Patient Picture

Analgesics Given

Non steroid anti inflammatory Given

Antibiotics Given

Closed Reduction: Done

It refers to restraction into anatomic
alignment to rotation
Immobilization : Done
The bone fragment must be immobilized
and stabilize the extremity for bone healing

Surgical Management :

Book Picture Patient Picture

Internal Fixation Device :

Screw Fixation is done.
Such as metallic pins plates , or rod may
used to hold the bone fragment in position
until the bone healing occur. These devices
may be attached to the site of the bone, they
may be inserted through the bony fragment or
directly into the medullary cavity of the bone
internal fixation devices ensure fixation of the
bony fragment.
 Nursing Management :

 Assess neurovascular status of the extremity especially circulatory perfusion of the

lower leg and foot.
 Note signs of dislocation of the hip and knee effusion which may be suggest ligament
damage and possible instability of the knee joint.
 Assist patient in minimal weight bearing when indicated and progress to full weight
bearing as tolerated .
 Reinforce that cast trace is warm for 12-14 weeks.
Plan for Discharge :

 Now the condition of the patient is progressive , the vitals of the patient is stable as
compared to before and medicines are removed from the first day.
 Dr. Rajesh Pasricha have given permission to discharge the patient.

Summarization :

 18 year old young girl ,patient name Sunita Rani , comes to the civil hospital with chief
complaints of fever , pain in left leg , immobility ,bachache, edema ,weakness .
 Doctor advice X-Ray and Radiography and to determine the integrity of bone and doing
to surgical procedure and taking some medicine.
 Pantaprazole , Diclofenac, Ceftiaxone , Frusamide , Paracetamol.
 Now the patient condition is progressive and doctor discharge the patient.
 Bibliography

 Wilkins and Lippincott William ,medical surgical nursing wolters kluwers, page no- 1234-
1248.
 Brunners and Suddarth medical and surgical nursing ,10th edition ,wolters kluwers page
no- 1288
 Thon Ebnezar medical and surgical nursing 2nd edition ,page no -126-130
 Ross and Wilson anatomy and physiology 10th edition ,page no- 384-404