A FRACTURE is a break in the continuity of the bone.

Sometimes, excess pressure is applied to a bone that results in the breaking of the bone, also called a fracture. Fractures are common. Most people suffer from fractures at least once during their lifetime. Children's bones are relatively more flexible and less likely to break. Falls or other accidents that do not cause harm in children can cause complete fractures in older adults. Older adults suffer from fractures more than children because their bones are comparatively brittle. Bone fractures are caused by various reasons. It could be because of a fall from a height, motor accidents and repetitive forces on the bone because of physical activities like running or weightlifting.

2. Common fracture sites: Clavicle Humerus In supracondylar fractures, which occur when child falls backward on hands with elbows straight, there is a high incidence of neurovascular complications due to the anatomic relationship of the brachial artery and nerves to the fracture site. Radius and ulna Femur (often associated with child abuse) Epiphyseal plates (potential for growth deformity)

Types of Fracture

Closed or simple fracture The bone is broken, but the skin is not lacerated. Open or compound fracture -The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. The bone may or may not be visible in the wound. Transverse fracture The fracture is at right angles to the long axis of the bone. Greenstick fracture - Fracture on one side of the bone, causing a bend on the other side of the bone. Comminuted fracture - A fracture that results in three or more bone fragments. Oblique Fracture The fracture is diagonal to a bones long axis. Spiral Fracture At least one part of the bone has been twisted.

Other common fractures:

Multi-fragmentary fracture : In this the bone splits into multiple pieces. Compression Fracture : A compression fracture is a closed fracture that occurs when two or more bones are forced against each other. It commonly occurs to the bones of the spine and may be caused by falling into a standing or sitting position, or a result of advanced osteoporosis. Avulsion Fracture : An avulsion fracture is a closed fracture where a piece of bone is broken off by a sudden, forceful contraction of a muscle. This type of fracture is common in athletes and can occur when muscles are not properly stretched before activity. This fracture can also because of an injury. Impacted Fracture: An impacted fracture is similar to a compression fracture, yet it occurs within the same bone. It is a closed fracture which occurs when pressure is applied to both ends of the bone, causing it to split into two fragments that jam into each other. This type of fracture is common in car accidents and falls. Stress Fracture : It is a common overuse injury. It is most often seen in athletes who run and jump on hard surfaces such as runners, ballet dancers and basketball players. Compression fracture of the spine : It is common in individuals with osteoporosis. Often no identifiable injury causes it. This results in significant pain and disability. Rib fractures : If you experience pain while breathing you probably have a rib fracture. In this condition you also have tenderness and shallow breathing. Compacted Fracture : in this the fracture is caused when bone fragments are driven into each other.

Complications of fractures include: problems associated with immobility (muscle atrophy, joint contracture, pressure sores) growth problems ( in children) infection shock venous stasis and thromboembolism pulmonary emboli and fat emboli and bone union problems

Etiology 1. Fractures in children usually are the result of trauma from motor vehicle accidents, falls or child abuse. 2. Because of the resilience of the soft tissue of children, fractures occur more often than soft tissue injuries. 3. Fractures occur when the resistance of bone against the stress being exerted yields to the stress force. 4. Fractures most commonly seen in children: Bend Fracture is characterized by the bone bending to the breaking point and not straightening without intervention. Buckle fracture results from compression failure of the bone, with the bone telescoping on itself. Greenstick fracture is an incomplete fracture. D. Assessment Findings 1. Clinical Manifestations The five Ps pain, pulse, pallor, paresthesia, and paralysis are seen with all types of fractures. Other characteristic findings include deformity, swelling, bruising, muscle spasms, tenderness, pain, impaired sensation, loss of function, abnormality, crepitus, shock or refusal to walk (in small children). 2. Laboratory and diagnostic findings Radiographic examination reveals initial injury and subsequent healing progress. A comparison film of an opposite, unaffected extremity is often used to look for subtle changes in the affected extremity. Blood studies reveal bleeding (decreased hemoglobin and hematocrit) and muscle damage (elevated aspartate transaminase (AST) and lactic dehygrogenase (LHD). E. Nursing Management 1. Provide emergency management when situation warrants, for a new fracture. Assess the five Ps. Determine the mechanism of injury. Immobilize the part. Move injured parts as little as possible. Cover any open wounds with a sterile or clean dressing. Reassess the five Ps. Apply traction if circulatory compromise is present. Elevate the injured limb, if possible. Apply cold to the injured area. Call emergency medical services. 2. Assess for circulatory impairment (cyanosis, coldness, mottling, decreased peripheral pulses, positive blanch sign, edema not relieved by elevation, pain or cramping). 3. Assess for neurologic impairment (lack of sensation or movement, pain, or tenderness, or numbness and tingling). 4. Administer analgesic medications.

5. Explain fracture management to the child and family. Depending on the type of break and its location, repair (by realignment or reduction) may be made by closed or open reduction followed by immobilization with a splint, traction or a cast. 6. Maintain skin integrity and prevent breakdown. Institute appropriate measures for cast and appliance care. 7. Prevent Complications Prevent circulatory impairment by assessing pulses, color and temperature, and by reporting changes immediately. Prevent nerve compression syndromes by testing sensation and motor function, including subjective symptoms of pain, muscular weakness, burning sensation, limited ROM, and altered sensation. Correct alignment to alleviate pressure if appropriate, and notify the health care provider. Prevent compartment syndrome by assessing for muscle weakness and pain out of proportion to injury. Early detection is critical to prevent tissue damage. Causes of compartment syndrome include tight dressings or casts, hemorrhage. trauma, burns and surgery. Treatment entails pressure relief, which sometimes require performing a fasciotomy. 8. Prevent infection, including osteomyelitis, by using infection control measures. 9. Prevent renal calculi by encouraging fluids, monitoring I&O, and mobilizing the child as much as possible. 10. Prevent pulmonary emboli by carefully monitoring adolescents and children with multiple fractures. Emboli generally occur within the first 24 hours.