COLLES FRACTURE

1477
Group 28
PNC International College of Nursing
and Health Sciences
LEARNING OBJECTIVE
1. Define of Fracture.

2. Elaborate the statistic of Colles Fracture.

3. List the etiology of Fracture.

4. Explain the pathophysiology of Colles Fracture.

5. State the clinical manifestation of Fracture.

6. List down the early and late complication of
Fracture.

7. Explain the investigation given to patient with
Fracture.
8. Describe the medication given to patient with
Fracture.
9. Described the surgical treatment of a fractured
patient.
10. Carry out the nursing care of patient with
Fracture.

11. Provide health education to patient regarding
the care of external fixation.
PATIENTS DETAIL
Mr. K
22 years old

Male
Chinese
Buddha
42, Jalan Putra 4, Taman Tan Sri Yaacob,
Skudai, Johor.
Clerk
Single
ADMISSION
Time on admission : 2000 hours

Date of admission : 17th December 2006
Reason of admission : Involved in MVA,
complain of pain and deformity of left wrist.

Diagnosis : Closed fracture of distal end radius /
Colles Fracture.

Mode of admission : Wheel chair

Consultant : Doctor L
Continue
Surgical History : Not included (NIL)
Medical History : Not included (NIL)
Family Medical History : Hypertension (Father)
Current Medication : Not included (NIL)
Allergic : Unknown
Level of Consciousness : Conscious and alert
Mental Status : Orientated
Emotional Status : Anxious
PHYSICAL EXAMINATION
Anterior Posterior
Hair & Scalp
Eyes
Abdomen
Skin
Back
Ears
Axilla
Upper
limbs
Perineum
Lower
limbs
Pain and
deformity
Abrassion
OBSERVATION ON ADMISSON
Temperature : 37.2C

Blood pressure : 148 / 100 mmHg

Respiration : 21 breath per minute

Pulse : 80 beats per minute

Height : 175 cm

Weight : 63 kg
ACTIVITY DAILY LIVING
Respiratory :Respiration rate was 21 bpm on
admission, did not complain of difficulty in
breathing or any chest pain.
Eating and drinking : No problem with his
appetite.
Elimination : Past bowel open motion once per
day, did not take any medication.
Passing urine : No problem in passing urine.

Sleeping : No problem in sleeping pattern.

Continue
Communication : Normal, no slurred and
understand well. Able to interact.

Hobby : Listen to music.

Mobility : Rest in bed.

Spirituality : Did not required any spiritual
support.

Personal hygiene : Need assistance to go to toilet.

ANATOMY AND PHYSIOLOGY
THE BONE
Osteoblast : cells that form bone

Osteocytes : cells that function to maintain bone matrix.

Osteoclast : cells that resorb bone.

Consists of three layers ;
the perieosteum, or outside skin of the bone
the hard compact bone, supporting the weight of the
body
Spongy bone (bone marrow).
ANTERIOR POSTERIOR
THE RADIUS

The radius is situated on
the lateral side of the ulna,
which exceeds it in length
and size. Its upper end is
small, and forms only a
small part of the elbow-
joint; but its lower end is
large, and forms the chief
part of the wrist-joint. It is
a long bone, prismatic in
form and slightly curved
longitudinally. It has a
body and two extremities.
DEFINITION OF FRACTURE
To break a part, a break of continuity of bone.
By ; Christine Watson, Nurses Dictionary.

A fracture is any break in the continuity of a bone
that vary in severity according to the location and
type of fracture.
By ; Priscilla LeMone & Karen M. Burke, Medical
Surgical Nursing, 1996.
TYPE OF FRACTURE
COLLES FRACTURE
A fracture of the lower
end of the radius, the
lower fragment being
displaced backward
which affecting the
distal end of the radius
and often the ulnar
styloid.

It is often called a wrist
fracture.
0
2
4
6
8
10
12
Number of
patient
0-10 11-20 21-30 31-40 41-50 51-60 > 61
Age
STATISTIC OF COLLES FRACTURE IN PSH
2006
2005
STATISTIC
ETIOLOGY
Violence

Direct -fractures occurs at the site of applied force, near the site
of fracture.
Indirect- site of the fracture far from the site applied force or
energy transmitted from the point of impact.
E.g.: fall on out stretched hand

Pathological

Disease of the bone weaken bone structure e.g. tumor,
osteoporosis, TB of the bone and cancer bone.

Less common cause

Sudden forceful contraction of attack muscles known as
avulsion fracture.
PATHOPHYSIOLOGY
A fall or in a motor vehicle accident





Fall and land on your outstretched hands





A sudden strong force pushing the hand backwards






A break of the radius bone and flare in the shape of the bone





Comminuted fracture occur ; collapsed of radial height in regular line






Numbness and tingling in the fingertips, pain and tenderness
Deformity of the wrist ; change in the contour of the back of
the wrist
CLINICAL MANIFESTATION
Deformity : abnormal position of bones 2 to
fracture and muscles pulling from the fracture.

Swelling : edema from localization of serous
fluid and bleeding.

Pain/tenderness : muscle spasm, direct tissue
trauma, nerve pressure, movement of fractured
bone.

Numbness : nerve damage or nerve entrapment.

Decreased range of motion the fingers.

Crepitus : grating of bones or entrance of air in
an open fracture.

Hypovolumic shock : blood loss.

Ecchymosis : extravasation of blood into the
subcutaneous tissue.

Continue
COMPLICATION
EARLY COMPLICATION :

Shock
Compartment Syndrome
Fat embolism
Deep Vein Thrombosis (DVT)
Infection
Gangrene
LATE COMPLICATION :

Malunion
Delayed union
Non-union
Ulnar impaction syndrome
Joint stiffness
Continue
INVESTIGATION
X-ray :
Date ordered: 17th December 2006
Date done: 17th December 2006

Radiograph of the Left Wrist / Left Radius
/Ulnar
Fracture of the distal end of the left radius.
No dislocations.

Radiograph of the right knee
There is no fracture of the patella.
Continue
Computed Tomograph (CT) Brain
(Plain contiguous 10mm axial images from the
base of skull to the vertex)

There is no intracranial haematoma.
There is no focal brain lession.
Ventricles and basal cisterns are normal.
There is no midline shift or mass effect.
There is no skull vault fracture.

Blood test (Pre-Operation Profile)
Date ordered: 18th December 2006
Date done: 18th December 2006

HAEMATOLOGY
Haemoglobin
BIOCHEMISTERY
Glucose
Urea
Sodium
Potassium
Chloride
Result

13.1 g/dL

4.4 mmol/L
4.2 mmol/L
136 mmol/L
3.6 mmol/L
99 mmol/L
Reference range

13.0-18.0

3.9-6.1
2.0-6.8
135-155
3.5-5.5
95-111

SEROLOGY
ABO group

Rhesus group

VDRL (RPR)

HIV I / II antigen/
antibody

Hbs antigen
Result

O

Positive

Non-reactive

Non-reactive


Non-reactive
Reference range





Non-reactive

Non-reactive


Non-reactive
MEDICATION
C. Tramal 50mg, tds
Trade name : Tramadol HCl
Date on : 17
th
December 2006
Date off : 19
th
December 2006
Group : Analgesic
Indication : Moderate to severe acute & chronic pain.
Contraindication : Ac intoxication with alcohol,
hypnotics.
Adverse reaction : Sweating, dizziness, vomiting and
dry mouth.

IV Unasyn 1.5g, tds
Generic name : Ampicillin Sodium
Date on : 17
th
December 2006

Date off : 21
st
December 2006

Group : Antibiotics
Indication : Infections by susceptible microorganism ;
URTI, LRTI, UTI, bone and joint infections and
gonococcal infections.

Contraindication : Allergic to penicillins.

IM Pethidine 50mg, qid
Trade name : Pethidine HCl
Date on : 17
th
December 2006

Date off : 19
th
December 2006

Group : Analgesic

Indication : moderate to severe pain, pre-
operative medication and an analgesic adjunct in
general anaesthesia.

Continue
Contraindication : Respiratory depression or
where respiratory reserve is depleted. Head
injury, raised in intracranial pressure, brain
tumor. Acute bronchial asthma, chronic airway
disease. Cardiac arrhythmias. Hypersensitivity to
pethidine.

Adverse reaction : Respiratory depression, light
headedness, dizziness, sedation, nausea,
vomiting, constipation and sweating.
T. Ponstan 50mg, tds
Trade name : Mefenamic acid
Date on : 19
th
December 2006
Date off : 21
st
December 2006
Group : Analgesic
Indication : Mild to moderate pain including muscular,
traumatic & dental pain, headache, dysmenorrhea, post-
op & post-partum pain.
Contraindication : GI ulceration or inflammatory bowel
disease. Renal or hepatic impairment.

Adverse reaction : Diarrhea, skin rash, bronchospasm.

NON-SURGERY Tx
CLOSE MANIPULATION REDUCTION ( CMR )

bone fragments are brought into their pre-injury
position so that the normal shape and length of
the bone are restored and union is promoted.

the surgeon manipulates the fragments into
position by manual traction, pressure and or
rotation. There is a considerable of muscle pull.
Continue
SPLINT
Any parts which is used to provide support and to
reduce any fracture or dislocated limb from
moving.
It must be long enough to cover the fracture bone
from top to bottom and support a joint to the
other.
Purpose : -
to prevent and correct deformity
to maintain support
to reduce pain
to hasten healing process
allow a safe transfer
SURGERY
EXTERNAL FIXATOR

a device that uses pins through the skin and a
device outside the skin to pull the fragments into
position.

Purpose : to hold the fracture without a plaster
cast until union, keeps broken bones from
moving
Picture of external fixation
Skeletal pins
Connecting rods and clamps
X-ray of the post-operation
NURSING CARE PLAN
PRE-OPERATION
1. Alteration in comfort, pain related to fracture left radius and soft
tissue injury.
2. Potential neurovascular injury related to fracture left radius and
backslap.
3. Alteration in emotional status, anxiety related to operation
External Fixation.

POST-OPERATION
4. Alteration of the comfort, pain related to operation site, external
fixation of the left radius.
5. Potential infection related to external fixation on the left hand.
6. Self care deficit related to deformity and external fixation of the
left hand.

1. Alteration in comfort, pain related to fracture left
radius and soft tissue injury.

Date : 17
th
December 2006
Time : 2015 hours

Supporting data :

1. Patient verbalized that he was in pain .

2. Blood pressure was 148 / 100 mmHg .

Goal :
Patients pain will be reduced to after 2-3 hours
nursing intervention given and during
hospitalization.

Nursing intervention :

1. Assess the characteristic of pain and level of pain.
: to act as a baseline data to plan nursing intervention.
I : I checked the location of the fracture and asked patient the severity of the
pain according to pain scale, mild, moderate and severe .

2. Monitor vital sign especially blood pressure and pulse
hourly in four hours and continue two hourly if not
contraindicated.
: increase in blood pressure reading may indicate that patient in pain .
I : I checked Mr. K vital sign hourly in four hours and continue two hourly.

3. Support and immobilize the fracture site by splinting.
: splinting may prevents additional injury by immobilizing the bone
fragments.
I : I applied backslap on the patients hand and cover with bandage.
4. Elevate the left hand 2 inches above the heart.
: to promote venous return and decreased edema which decreases pain .
I : I placed the left hand on the pillow to elevate the hand.

5. Administer and serve analgesic as prescribed by doctor IM
Pethidine 50mg 6 hourly.
: to relieve pain.
I : I administer IM Pethidine 50mg to the patient with supervision by
registered nurse.

6. Demonstrate and encourage patient to do deep breathing
exercise.
: to divert mind and act as a relaxation exercise. .
I : I demonstrated to the patient to take a deep breathe through nose and blow
out slowly through mouth and encouraged him to do it when in pain.
7. Provide a condusive environment such a quiet
environment.
: to allow patient have a good rest.. .
I : I slowed the volume of the television an advised all the relative to not
make a noise and disturb patient .

8. Inform doctor if pain still persist
: to plan further management .
I : I did not inform doctor because patient did not complain of pain
again.

Evaluation :
Patients pain was reduced after 2 hours nursing
interventions given.
Supporting data :
Patient verbalized that the pain was tolerable.
Blood pressure was 120 / 80 mmHg.

Date: 17th December 2006
Time : 2215 hours
Signature : STN 1477

Re-evaluation:
Patient was having bearable pain during hospitalization
and refuse for IM Pethidine.
Date : 18th December 2006
Time : 0800 hours.
2. Potential neurovascular injury related to fracture
left radius and backslap.

Date : 17
th
December 2006
Time : 2130 hours

Supporting data :

1. Patient used backslap after the CMR procedure at 2130
hours.
2. Patient was fractured his left distal radius.

Goal :
Patient will be not experienced sign and symptom
of neurovascular decompression within 24 hours
before operation after nursing interventions were
given and during hospitalization.
Nursing intervention :


1. Assess the affected limb for colour, warmth, sensation,
capillary refill, and presence of pulse.
: pale and cool may indicate decreased tissue perfusion and cyanosis may
indicate venous congestion.
I : I assess for the skin condition whether pale or normal, and check for the
warmth by touch the fingers, check for sensation, I use pen and touch at the
fracture hand and found the finger automatics react show the nerve still
function, check for capillary refill by pressing nail bed and observe the changes
the color when I leave it, I check also for the radial pulse and I can find the
pulse but the beat is weak and I ask Mr. I to move his both fingers and he
able to do so. Finding is normal.

2. Assess the extremity for edema and swelling.
: excessive swelling and haematoma formation can compromised circulation.
I : I looked for edema and excessive swelling of the affected hand.
3. Assess the patient for deep, throbbing,
unrelenting pain.
: pain that is not relieved by analgesic may indicate
neurovascular compromise.
I : I assess the level of pain of the affected limb by asking patient
the characteristic of the pain.

4. Monitor circulation chart strictly especially hourly
: : applying of backslap may cause damage of blood vessels
and other tissue at the fracture site because it can increase
internal pressure that form of swelling.
I : I checked of circulation chart by feel the skin warmth of
fracture site, capillary refill, sensation, and movement same as I
monitor neurovascular status. The finding is normal.
5. Position patient in appropriate position e.g. supine
: Flat position may help in blood supply to the whole body so
the pressure using is not consumptions and patient might feel pain
less.
I : I position patient in supine and told the purpose to the patient
and ensure he comfort with his position supine.

6. Elevate the fracture site and ensure the hand
maintain 2 inches above the heart level.
: : to promote blood circulation and supply to affected hand
I : I placed the left hand on a firm pillow and advised patient to
use armsling to move around.
7. Ensure the backslap is not too tight or loose and
fix to the hand.
: Tight splint apply might cause discorrupted blood flow and
if prolong may lead to pain and spasm.
I : I ensure that the bandage is not too tight on the left hand .

8. Advise patient to do some passive exercise
especially at the fingers.
: : to increase blood circulation and can reduce muscle
spasm by doing some passive movement.
I : : I advised patient to move the fingers frequently .
9. Inform staff nurse regarding my patient
condition and noted the abnormalities
found.
: : to plan further management.
I : : I told staff nurse that the patient was in the good
condition.

Evaluation :
Patient not experienced any sign and symptom of
neurovascular decompression within 24 hours before
operation after nursing interventions were given.
Supporting data :
The circulation chart was normal.
Date: 18th December 2006
Time : 0800 hours
Signature : STN 1477

Re-evaluation :
No abnormal detected from the assessment of the
neurovascular. The data patient taken is normal; no
complain of numbness or loss of sensation from the
patient and from the assessment.
Date: 19th December 2006
Time : 1415 hours
3. Potential neurovascular injury related to fracture
left radius and backslap.

Date : 18
th
December 2006
Time : 1100 hours

Supporting data :

1. Patient verbalized that he anxious to proceed with the
surgical treatment.
2. Patient looked worried and kept asking about the
surgery.

Goal :
Patients anxiety will be reduced to after 4-6
hours nursing intervention given and before
operation (External Fixation).
Nursing Intervention :

1. Assess the level of anxiety.
: to act as a baseline data to plan nursing intervention.
I :I observe the non-verbal and verbal expression of the patient.

2. Assess the level of the knowledge by asking him
about the fracture and external fixation.
: : to identify the level of the understanding of the fracture.
I : I asked patient what he understand about after doctor
explained to him regarding the fracture in advantage of the
external fixation.
3. Reinforce doctor explanation to the patient.
: for better understanding .
I : I explained to the patient that he should proceed with the
surgery to prevent from complication such as mal-union or
shortening of the bone beside patient was still young.

4. Introduce patient to the other patient that had
gone for external fixation.
: : to allow patient to share their experience.
I : I introduced Mr. K to a patient that had gone for external
fixation of the tibia before.

5. Encourage family members especially his
parents to give moral support.
: to increase confident of patient
I : I advised family members to give support to Mr. K to
proceed with the surgical treatment .

6. Show the empathy when patient expressed his
feelings.
: : to increase patients self-esteem.
I : I tried to be a good listener when the patient expressed his
feeling.

7. Inform staff nurse incharge regarding patients
condition.
: To detect any abnormalities changes.
I : I informed what the treatment Im doing to Mr. K to ensure
doctor know what were doing to his patient and the care plan
we did.

Evaluation :
Patients anxiety was reduced to after 6 hours nursing
intervention given and before operation (External
Fixation).

Supporting data :
Patient verbalized that he wanted to go for external
fixation.
Date: 18th December 2006
Time : 1600 hours
Signature : STN 1477

Re-evaluation:
Patient was ready to go for operation and looked calm.
Date : 19th December 2006
Time :1445 hours.
4. Alteration in comfort, pain related to operation
site, external fixation of the left radius.

Date : 19
th
December 2006
Time : 1730 hours

Supporting data :

1. Patient verbalized that he was in pain after return to
ward.
2. Blood pressure was 140 / 98 mmHg.

Goal :
Patients pain will be reduced to after 1-2 hours
nursing intervention given and during
hospitalization.
Nursing Intervention :
1. Assess the characteristic of pain and level of pain.
: to act as a baseline data to plan nursing intervention.
I : I checked the operation site and asked patient the severity of
the pain according to pain scale, mild, moderate and severe.

2. Monitor vital sign especially blood pressure and
pulse hourly in four hours and continue two hourly
if not contraindicated.
:increase in blood pressure reading may indicate that patient
in pain.
I : I checked Mr. K vital sign hourly in four hours and continue
two hourly.
3. Elevate the left hand 2 inches above the heart with
pillow.
: to promote venous return and blood supply which decreases
pain.
I : I placed the left hand on the firm pillow to elevate the hand.

4. Administer and serve analgesic as prescribed by
doctor IM Pethidine 50mg 6 hourly.
: :to relieve pain.
I : I administer IM Pethidine 50mg to the patient with
supervision by registered nurse.
7. Hold the rods of the external fixation when
moving patients hand to support the hand.
: to prevent the moving of the bone fragments.
I :I hold the rods to raise he hand and I advised patient to do
so.

8. Provide a condusive environment such a quiet
environment.
: to allow patient have a good rest
I :I slowed the volume of the television an advised all the
relative to allow patient to have an adequate rest.

9. Inform doctor if pain still persist.
: to plan further management.
I : I did not inform doctor because patient
did not complain of pain again.

Evaluation :
Patients pain was reduced after 2 hours nursing
interventions given.
5. Potential infection related to external fixation on
the left hand.

Date : 19
th
December 2006
Time : 1730 hours

Supporting data :

Patient return to ward with external fixation on the left
hand

Goal :
Patient will be free from infection after nursing
intervention given and during hospitalization.

Nursing Intervention :

1. Assess the patients wound site especially at the pin sites.
: to detect early sign and symptoms of infection.
I : I assess for an discharge, redness, swelling and itchiness which are the
sign and symptom of infection.

2. Monitor vital sign four hourly especially body
temperature.
: hyperthermia ma indicate that patient having infection.
I : I checked the vital signs 4 hourly to detect any signs of infection.


3. Perform dressing daily as ordered by doctor with
septic technique.
: to prevent growth of the microorganism.
I : I performed aseptic dressing daily in the morning shift to the
patient.

4. Encourage patient to call nurses to change
dressing if oozing or wet.
: wet environment may promoting the growth of the
microorganism.
I : I told patient to inform nurses t change the dressing if wet
and dirty.
5. Advised patient not to touch the pins site
unnecessary.
: touching with dirty hand may promote transmission of the
microorganism.
I : I explain to the patient not to touch or scratch the pins site
unnecessary.

6. Advised patient o cover the external fixation with
plastic when bathing.
: to prevent the external fixation site wet and dirty.
I : I provide plastic and plaster to cover the external fixation
when e waned to have bath.



7. Administer and serve antibiotic IV Unasyn 1.5 g,
tds as ordered by doctor.
: to act as prophylactic agent o prevent infections.
I : I diluted the IV Unasyn and observe staff nurse administer
he IV drug.

8. Inform doctor if patient has sign ad symptom of
infections.
: to plan further management.
I : I did not inform doctor because patient free from infection.


Evaluation :
Patient was free from infection after nursing
intervention given and during hospitalization.

Supporting data :
Patient was not having fever during hospitalization.
The pins site were intact during hospitalization.
Date: 21st December 2006
Time : 0800 hours
Signature : STN 1477
6. Self care deficit related to deformity and external
fixation of the left hand.

Date : 19
th
December 2006
Time : 1730 hours

Supporting data :

Patient was dominant in the left hand.
Patient need assistance in performing Activity Daily
Living (ADL).

Goal :
Patient will be able to participate in ADL within
level of own ability after nursing intervention
given.


Nursing Intervention :

1. Assess level of participating in own self care.
: to act as baseline data to plan further interventions.
I : I assess the maximum ability of the patient in performing ADL such
as eating and maintaining hygiene by using one hand only.


2. Encourage self care with supervise by nurses or family
members.
: to increase the independence of the patient.
I : I let the patient to survive independently to do self care like bathing and
wear clothes but with supervision of nurse or family members.


3. Assist and encourage patient to participate in
social activity with family such as watching TV.
: to prevent feeling of isolated.
I : I encouraged patient to get involve in family activities.

4. Praise and motivate patient to perform ADL
independently.
: to increase self esteem in patient himself.
I : I praised the patient if he able to do by himself and motivate
him to do better.

5. Provide and promote rest and privacy.
: to prevent exhausted and give up in patient.
I : I did not push patient to do activity, but I explain to him,
he may have his own time to do it.

6. Encourage patient to do passive exercise such as
moving the fingers.
: to prevent joint stiffness and to strengthen the muscles.
I : encouraged patient to use squeeze ball to exercise.


Evaluation :
Patient was able to maintain self care within
level of own ability and less assistance needed.

Supporting data :
Patient able to be independent in self care.
Date: 21st December 2006
Time : 0800 hours
Signature : STN 1477
HEALT H EDUCATION
DIET
Calcium and vitamin D supplements
E.g.: Non-fat yogurt, tofu, soy bean, spinach, kidney
bean, and broccoli.

Protein supplement
E.g. : chicken, fish, soy bean, tohu

Vitamin C (ascorbic acid slow-release)
E.g. : fruits (orange, grape, guava)

Omega-3 Fatty Acids (found in fish oil and
flaxseed oil)

Continue
Other vitamin supplements such as folic
acid
E.g. : sangobion

Vitamin K (Menadione)
E.g. :dark leafy vegetables

Avoid taking of bone robbers.
E.g. : sugar, salt, alcohol, caffeine, red meats


CARE OF THE EXTERNAL FIXATION

Elevate the hand.

Perform pin care to keep pin sites clean.
Technique of dressing.
Do not wet the external fixation area.
Do not to touch the pins site unnecessary
or scratch the pins site.
Continue
Extra careful, do not hit or bang external
fixation hit or bang other things.
Observe for swollen, redness, itchiness,
presence of pus or pain or loosening of the
pins and clamps.

EXERCISE
Regular exercise of fingers; use squeeze ball.

MEDICATION
Finish the course of antibiotic
Continue
DISCHARGE
21
st
December 2006 @ 0900 hours.
Doctor had prescribed TTA for 1 week:
T. Ponstan 50mg, tds
T. Unasyn 375mg, bd
T. Gelusil Antacid 250mg, tds

Vital sign before discharge :
Temperature : 36.2C
Blood pressure : 115/94 mmHg
Pulse rate : 87 bpm
Respiration rate : 20 bpm
FOLLOW UP
27
th
December 2006 @ 1000 hours.

Mr. K looked healthy and verbalized that he able
to cope with his new alteration in his activity
daily living due to immobility of the left hand.

Doctor L had examined Mr. K, no infection
detected. External fixation in-situ.

Next follow up : 20
th
January 2007
SUMMARY
Mr. K was admitted on 17
th
December 2006 @ 2000
hours, c/o complain of pain and deformity of left wrist.

Involved in MVA

Dr. A diagnosed him as Colles Fracture.

External Fixation was done at the left hand on 19
th

December 2006.

Discharged on 21
st
December 2006 @ 0900 hours with
TTA :
T. Ponstan 50mg, tds
T. Unasyn 375mg, bd
T. Gelusil Antacid 250mg, tds
REFERENCE
BOOKS
Lemone P., Burke K., (2004) Medical-Surgical Nursing, 3rd Edition,
Nursing Care of Client with Musculoskeletal Trauma, page 1555-1600
.

Smeltzer S.C, Bare B., (2004) Textbook of Medical-Surgical Nursing,
Tenth Edition, Care A Patient with Musculoskeletal Disorder, page
189-199.

Smeltzer S.C, Bare B., (2004) Textbook of Medical-Surgical Nursing,
Tenth Edition, Nursing Process, page 76-85.

Waugh A., Grant A., (2001) Anatomy and Physiology in Health and
Illness, Ninth Edition, Section 2, No. 5, The Musculoskeletal System,
page 77-78.

Walsh M, (1997) Watsons Clinical Nursing and Related Sciences,
Fifth Edition, Caring for the Patient with Musculoskeletal Trauma,
page 836-860.
Continue
ELECTRONIC MATERIALS

orthopedics.about.com/cs/brokenbones/g/orif.htm :
External fixator at 20tth December 2006, 1600 hours.

www.eatonhand.com/hw/hw020.htm : Wrist fracture
Colles at 20th December 2006, 1600 hours.

orthopedics.about.com/cs/upperfx/g/colles.htm, Colles
Frracture at 20th Decenber 2006, 1600 hours.

www.physioroom.com/injuries/arm/colles_fracture_fu
ll.php, Colles Fracture at 20th December 2006, 1600
hours.
Continue
www.nlm.nih.gov/medlineplus/ency/article/000201.htm,
Medline Plus Medical Encyclopedia :- Colles Fracture at 23rd
December 2006, 1500 hours.

www.nlm.nih.gov/medlineplus/ency/article/003876.htm,
Medline Plus Medical : Closed Fracture at 23rd December 2006,
1500 hours.

www.healthscout.com/ency/1/000201.html Definition of
Comminuted Fracture at 23rd December 2006, 1500 hours.

www.emedicine.com/radio/topic822.htm, eMedecine-Radius,
Distal Fractures, 23rd December 2006, 1600 hours.