FRACTURE

Edfran Jed A. Serino

MSN 303

INTRODUCTIO
N

A
fracture
is the
medical
term for
a broken
bone.

INTRODUCTION
It occurs when a force
exerted against a bone
is stronger than the
bone can bear.
This disturbs the
structure and strength of
the bone, and leads to
pain, loss of function and
sometimes bleeding and
injury around the site.

ETIOLOGY
Bones are very strong and are designed to absorb shock if you fall or are in an
accident, but your bones can only absorb so much pressure before breaking.

Trauma. A fall, a motor vehicle

accident, or intentional injury
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 that
are common in athletes.

TYPES OF BONE FRACTURE

Closed/Simple
Bone breaks but
there is no open
wound.

TYPES OF BONE FRACTURE

Open/Compound
The bone breaks
through the skin.

TYPES OF BONE FRACTURE

Complete/
Displaced
The bone snaps into
two or more parts
and moves so that
the two ends are not
lined up straight.

TYPES OF BONE FRACTURE

Incomplete/
Non-Displaced
The bone cracks
either part or all of
the way through, but
does move and
maintains its proper
alignment.

Simple Fractures Based On Patterns

Common Fracture Sites

Clavicle
Humerus
Radius and Ulna
Femur (often
associated with
child abuse)
Epiphyseal plates
(potential for
growth deformity)

Signs & 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.

Intense pain
Numbness and tingling
Swelling, bruising or
bleeding
Out-of-place or deformity
of limb or joint
Limited mobility or
inability to move a limb

Anatomy & Physiology

of the Skeletal System
The adult human skeleton is a framework of 206 bones and is anatomically
divided into two parts, the axial skeleton and the appendicular skeleton.

The axial skeleton runs

along the bodys midline axis
and is made up of 80 bones
in the following regions:

Skull
Hyoid
Auditory Ossicles
Ribs
Sternum
Vertebral Column

Anatomy & Physiology

of the Skeletal System
The
appendicular
skeleton is made up of
126
bones
in
the
following regions:

Upper Limbs
Lower Limbs
Pelvic Girdle
Pectoral Girdle

Anatomy & Physiology

of the Skeletal System
Types of Bones
Long bones- are longer than they are wide
and are the major bones of the limbs.
Short bones- are about as long as they
are wide and are often cubed or round in
shape.
Flat bones- vary greatly in size and shape,
but have the common feature of being very
thin in one direction.
Irregular bones- have a shape that does
not fit the pattern of the long, short, or flat
bones.
Sesamoid bones- are formed after birth
inside of tendons that run across joints.

Anatomy & Physiology

of the Skeletal System
Support
and
ProtectionThe
skeletal systems primary function is to
form a solid framework that supports
and protects the body's organs and
anchors the skeletal muscles.
Movement- The bones of the skeletal
system act as attachment points for
the skeletal muscles of the body.
Hematopoiesis- Red bone marrow
produces red and white blood cells in a
process known as hematopoiesis.
Storage- The skeletal system stores
many different types of essential
substances to facilitate growth and
repair of the body.

Fracture Healing
Reparative process of selfhealing (union) occurs in the
following stages:

Fracture hematoma (d/t

bleeding, edema)

Granulation
tissue

osteoid (3 14 days post

injury)

Callus formation (minerals

deposited in osteoid)

Ossification (3 wks 6 mos)

Consolidation
(distance
between
fragments
decreases closes)

Remodeling
(union
completed; remodels to
original shape, strength)

Diagnosis
A doctor will carry out a physical
examination, identify signs and
symptoms and make a diagnosis.
The patient will be interviewed or friends, relatives or witnesses
if
the
patient
cannot
communicate properly - and
asked about circumstances that
clearly caused the injury or may
have caused it.
Doctors will often order an X-ray.
In some cases an MRI or CT scan
may also be ordered.

LABORATORIES & DIAGNOSTIC

TESTS
Radiographic Examination
Radiographic examination (X-RAY) 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.

Bone Scans, Tomograms, MRI & CT Scan

Visualizes fractures, bleeding, and softtissue damage.
Differentiates
between
stress/trauma
fractures and bone neoplasms.

Blood Studies
Blood studies reveal bleeding (decreased
hemoglobin and hematocrit) and muscle
damage (elevated aspartate transaminase).

TREATMENT & MANAGEMENT

Bone healing is a natural
process which in most cases
will occur automatically.

Fracture treatment is usually

aimed at making sure there is
the best possible function of
the injured part after healing.

Treatment also focuses on

providing the injured bone
with the best circumstances
for
optimum
healing
(immobilization).

First Aid
Don't move the person except if necessary to avoid further injury.
Take these actions immediately while waiting for medical help:

Stop any bleeding.

Immobilize
the
injured area.
Apply ice packs to
limit swelling and
help relieve pain.
Treat for shock.

Medical & Surgical

Management of Fracture
Doctors use a variety of treatments to treat
fractures.
All forms of treatment of
broken bones follow one
basic rule:
The broken pieces
must be put back into
position and
prevented from
moving out of place
until they are
healed.

Medical & Surgical

Management of Fracture
Cast

Temporary
circumferential
immobilization
device.
(Plaster or Fiberglass)

Functional Cast or Brace

The cast or brace allows

limited
or
"controlled"
movement of nearby joints.

Traction

Traction is usually used to

align a bone or bones by a
gentle, steady pulling action.

Medical & Surgical

Management of Fracture
Close Reduction
Fragments
aligned
manipulation
casted.

are
with
and

Open Reduction
Surgical
Exposure
and
repair
with
plates and screws.

Expected outcomes
Usually curable with skillful first
aid and aftercare.
The broken bone should be
manipulated,
realigned
and
immobilized as soon as possible.
Realignment
is
much
difficult after 6 hours.

more

Healing time varies.

Recovery is complete when there
is no bone motion at the fracture
site, and X-rays show complete
healing.

Possible Complications
Problems associated with
immobility
Venous stasis and
thromboembolism
Pulmonary emboli and fat emboli
Failure to heal (non-union)
Growth problems
Nerve damage
Infection
Shock

NURSING DIAGNOSIS
Acute pain related breakdown of continuity of the bone as
evidenced by facial expressions and verbalization of patient.

Goal: Patient will not feel

pain
Intervention:

Assess the onset, duration,

location,
severity
and
intensity of pain.
Administer
the
analgesic
according to physician order.
Provide comfort devices like
sand bags for immobilization
of affected parts.

NURSING DIAGNOSIS
Impaired physical mobility related to application of traction or
cast as evidenced by assessment.

Goal: Patient will able to move

unaffected area.
Intervention:

Provide
range
of
motion
exercises to the patient.
Assist the patient in ambulation
after recovery of fracture.
Provide assistance while using
walker or crutches if required.
Prevent
from
complication
which usually occurs due to
immobility.

NURSING DIAGNOSIS
Self-care deficit related to fracture as evidenced by poor
personal hygiene.

Goal: Patient will maintain

the personal hygiene
Intervention:

Assess the need of self-care

Encourage the patient or
relatives
to
do
self-care
activity
Head to foot care to be
provided to the patient.
Educate about importance of
maintaining personal hygiene.

NURSING DIAGNOSIS
Imbalanced nutrition less than body requirement relate to increase
demand of nutrient for bone healing as evidenced by observation.

Goal: Maintain the nutritional

status of the patient
Intervention:

Assess the nutritional status by

intake/output chart, biochemical
measures, body mass.
Maintain intake output chart daily.
Encourage the patient to take
protein rich diet.
Plenty of fluids and frequent
intake of meal is necessary.
Try to assess the daily weight of
the client.

NURSING MANAGEMENT
Patients with Closed Fractures
Encourage patient not to mobilize
fracture site.
Exercise to maintain the health of
unaffected muscles for using assistive
devices (e.g., crutches, walker).
Teach patients how to use assistive
devices safely.
Patient teaching includes self-care,
medication information, monitoring
for potential complications, and the
need for continuing health care
supervision.

NURSING MANAGEMENT
Patients with Open Fractures
Administers tetanus prophylaxis if indicated.
Wound irrigation and debridement in the
operating room are necessary.
Intravenous antibiotics are
prevent or treat infection.

prescribed

to

Fracture is carefully reduced and stabilized by

external fixation or intramedullary nails.
Any damage to blood vessels, soft tissue,
muscles, nerves, and tendons is treated.
Heavily contaminated wounds are left
unsutured and dressed with sterile gauze to
permit swelling and wound drainage.

NURSING MANAGEMENT
General Preventive Measures
A diet rich in calcium and Vitamin D will
promote bone strength.
Weight bearing exercise also helps keep
bones strong.
Maintain a safe home environment.
Wear protective gear for sports.
Don't drink alcohol or use mind-altering
drugs and drive. Use your auto seat belt.
If you have osteoporosis, adhere to your
treatment program, and avoid situations
in which injury is likely.

QUESTIONS?
THANK YOU FOR LISTENING & GOD BLESS US
ALL