FRACTURE

What is Fracture?
• A fracture is a broken bone. It can
range from a thin crack to a
complete break. Bone can fracture
crosswise, lengthwise, in several
places, or into many pieces.
Most fractures happen when a
bone is impacted by more force or
pressure than it can support.

• Fractures can be classified as

closed or open.
 Closed vs. open
• A closed fracture is also called a
simple fracture. In a closed fracture,
the broken bone doesn’t break your
skin.
• An open fracture is also called a
compound fracture. In an open
fracture, the ends of the broken bone
tear your skin. When your bone and
other internal tissues are exposed, it
puts you at higher risk of infection.
 Types of Fracture
• Avulsion fracture - a muscle or ligament
pulls on the bone, fracturing it.
• Transverse fracture - a straight break right
across a bone.
• Stable fracture-The broken ends of the bone
line up and are barely out of place.
• Open, 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.
• Oblique fracture- This type of fracture has an
angled pattern.
• Comminuted fracture - the bone is shattered into many
pieces.
• Symptoms
• The signs and symptoms of a fracture vary according
to which bone is affected, the patient's age and
general health, as well as the severity of the injury.
However, they often include some of the following:
•
• pain
• swelling
• bruising
• discolored skin around the affected area
• angulation - the affected area may be bent at an
unusual angle
• the patient is unable to put weight on the injured area
• the patient cannot move the affected area
• the affected bone or joint may have a
grating sensation
• if it is an open fracture, there may be
bleeding
• When a large bone is affected, such as the
pelvis or femur:
• the sufferer may look pale and clammy
• there may be dizziness (feeling faint)
• feelings of sickness and nausea.
Causes
• The most common causes of fractures are:

• Trauma. A fall, a motor vehicle accident, or a

tackle during a football game can all result in
fractures.
• Osteoporosis. This disorder weakens bones
and makes them more likely to break.
• Overuse. Repetitive motion can tire muscles
and place more force on bone. This can result in
stress fractures. Stress fractures are more
common in athletes.
• Pathophysiology
• The natural process of healing
a fracture starts when the injured
bone and surrounding tissues bleed,
forming a fracture hematoma. The
blood coagulates to form a blood clot
situated between the broken
fragments. Within a few days, blood
vessels grow into the jelly-like matrix
of the blood clot.
 Bone Fractures: Diagnosis and Tests

How is a fracture diagnosed?

• X-ray: X-ray imaging produces a picture of

internal tissues, bones, and organs. Most
fractures are diagnosed by using an X-ray.
• Other tests (usually not needed if the fracture is
obvious on X-ray)
• Magnetic resonance imaging (MRI): An MRI is
a procedure that produces a more detailed
image. It is usually used for smaller fractures or
stress fractures.
• Bone scan: An agent is injected that binds in the area of the
fracture where bone turnover is higher than normal.
• Computed tomography scan (CT, or CAT scan): a three-
dimensional imaging procedure that uses a combination of X-
rays and computer technology to produce slices, (cross-
sectional images), horizontally and vertically, of the body.
Bone Fractures: Management and Treatment
• How is a bone fracture treated?
• A bone fracture is usually treated with a cast and/or
splint. A cast or splint will immobilize the bone (keep it
from moving) in order to encourage the bones to align
(straighten) and to prevent use of the bone. In some
cases when the bone is small (toes or fingers), no cast is
needed and the fracture is immobilized by wrapping.
Medication may also be prescribed to ease the pain of
the fracture.
Possible complications of Bone Fracture:
• Compartment syndrome: raised pressure within a
closed part of the body (compartment) that cuts off blood
supply to muscles and nerves.
• Haemarthrosis: bleeding into a joint space that causes
the joint to swell
• Shock
• Blood clot in a blood vessel: blockage of a blood
vessel that can break off and move through the body
• Complications from casting such as pressure ulcers
and joint stiffness
• Delayed bone healing
• Damage to surrounding tissue, nerves, skin, blood
vessels, or nearby organs
• Wound infection
Medical Management
• Management of a patient with fracture can belong to
either emergent or post-emergent.
• Immediately after injury, if a fracture is suspected, it is
important to immobilize the body part before the patient
is moved.
• Adequate splinting is essential to prevent movement of
fracture fragments.
• In an open fracture, the wound should be covered
with sterile dressing to prevent contamination of the
deeper tissues.
• Fracture reduction refers to restoration of the fracture
fragments to anatomic alignment and positioning and
can be open or closed depending on the type of fracture.
Nursing Management
• Prevent infection
– Cover any breaks in the skin with clean or
sterile dressing.
• Provide care during client transfer.
– Immobilize a fractured extremity with splint in
the position of the deformity before moving
the client; avoid strengthening the injured
body part if a joint is involved.
– Support the affected body part above and
below fracture site when moving the client.
• Provide client and family teaching.
– Explain prescribed activity restrictions and
necessary lifestyle modification because of
impaired mobility.
– Teach the proper use of assistive devices, as
indicated.
• Administer prescribed medications, which may
include opioid or nonopioid analgesics and
prophylactic antibiotics for an open fracture.
• Patient education regarding different factors that
affect fracture healing
• Factors that enhance fracture healing
– Immobilization of fracture fragments
– Maximum bone fragment contact
– Sufficient blood supply
– Proper nutrition
– Exercise: weight bearing for long bones
– Hormones: growth hormone, thyroid,
calcitonin, vitamin D, anabolic steroids

THE END :D