m
 

Definition:

YA break in the continuity of bone

and defined according to its type
extent.
ë
es:

Ú


 involves a
break across the entire cross-
section of the bone and it¶s
frequently displaced
Õ 

 involves a
break through only part of the
cross section of the bone


 

 a fracture
in which bone has splintered into
several fragments
Ì



fracture
that does not break/penetrate in the
skin

5. ›

 

 fracture in which the skin
or mucous membrane wound extend to
the fractured bone.
›
en fracture criteria:

÷ 
Ú a clean wound less than 1cm
long
÷ 
Õ larger wound, which without
extensive soft tissue damage
÷ 
 highly contaminated, as
extensive soft tissue damage; 


Mauses:

÷ irect blow
÷ Crushing forces
÷ Sudden twisting motions
÷ Extreme muscle contractions
÷ Accidents
Signs and s 
tos:
÷ Acute pain -
÷ Loss of function
÷ eformity
÷ Shortening of the extremities
÷ Crepitus
÷ Local swelling (edema)
÷ iscoloration
÷ ³5 P¶s´ pain, pulse, pallor,
paresthesia, paralysis
÷ Æemorrhage into the muscles and
joints
÷ Joint dislocations
÷ Ruptured tendons
÷ Severed nerves
÷ amaged blood vessels
Diagnosis:

÷ Physical examination
÷ CT scan
÷ X-ray
÷ MRI
§ergenc anageent:
" It is important to immobilize the body part
before the patient is moved.
" If an injured patient must be removed from
a vehicle before splints can be applied, the
extremity is supported distal and proximal
to the fractured site to prevent rotation as
well as angular motion.
" Adequate splinting is essential.
" With an open fracture, the wound is covered
with a sterile dressing to prevent
contamination of deeper tissues. Splints are
applied for immobilization.
Éedical anageent:

1. Surgery
>  restoration of fractured
fragments to anatomic alignment and
rotation
>
  bringing the
bone fragments to apposition through
manipulation and manual traction
>
  surgical
approach
Õ. Immobilization
3. Regaining of normal function and
strength
4. Preventing complications and
infections
Drugs:

÷ Antibiotics
÷ Analgesics
÷ Adjuvant drugs
÷ Anti-coagulants(for  T)
÷ Tetanus prophylaxis
~ursing anageent:
Patients with closed fracture
" The nurse encourages the patient to return
to their usual activities as rapidly as
possible.
" Encouraging the patient to be active within
the limits of the fracture immobilization.
" Teaching exercise to maintain the health of
unaffected muscles and to increase the
strength of muscles needed for transferring
and for using assistive devices (e.g.
crutches, walker, special utensils).
" Plans are made to help patient modify their
home environment as needed and to secure
personal assistance if necessary.
" Patient teaching includes self-care,
medication I information, monitoring for
possible complications, and the need for
continuing health care supervision.

Patient¶s with open fracture (there is a risk for

osteomyelitis, tetanus, and gas gangrene);
(the objectives of management are to
prevent infection of the wound, soft tissue,
and bone and to promote healing of soft
tissue and bone)
" The nurse administers tetanus prophylaxis if
indicated
" Serial irrigation and debridement are used
to remove anaerobic organisms.
" Intravenous antibiotics are prescribed to
prevent or treat infection.
" Æeavily contaminated wounds are left
unsutured and dressed with sterile gauze to
permit edema and wound drainage. Wound
irrigation and debridement may be
repeated, removing infected and devitalized
tissue and increasing vascularity in the
region.
"The nurse elevates the extremity to
minimize edema.
"It is important to assess the
neurovascular status frequently.
"The nurse measures the patient¶s
temperature for signs of infection.
É~§ ɛ~
MS
m ± fissure, fragmented, break, crack
may cause
R - Reduction surgery
A - Administer 4 A¶s Antibiotics,
Analgesics, Adjuvant drugs, Anti-
coagulants(for  T)
C - CT scan, MRI, X-ray, PE
T ± tetanus prophylaxis must be
administered as indicated
 - Teaching exercise to maintain the
health of unaffected muscles
U ± Unable to move(loss of function)
the damaged site, crepitus (+),
shortening of the bone, edema, 5 P¶s
R - Regaining of normal function and
strength
E - extreme muscle contractions,
direct blows, crushing forces, and
sudden twisting motions are the
cause.