Week 11: Fractures

Disruption or break in _______ of the structure of the bone 

continuity

• Open or ____

• Complete or _____

• displaced or ______

closed

incomplete

nondisplaced

skin broken and bone and soft tissue exposed 

open

skin intact

closed

Fracture occurs partly along the bone shaft, but the bone is still in one piece (non-displaced) 

incomplete

The break is completely through the bone (displaced)

complete

Significance of Edema

Unchecked bleeding, swelling, and edema in a closed space can occlude circulation and damage nerves 

Pain and tenderness

• Muscle spasm as a result of involuntary reflex action of muscle, direct tissue trauma, increased pressure on nerves, movement of fraction parts 

sign of pain and tenderness

• Pain and tenderness encourage splinting of musculature around the fracture with reduction in motion of injured ares 

muscle spasms

• Irritation of tissues and protective responses to injury and fracture 

sign of muscle spasm

• Muscle spasms may displace a nondisplaced fracture or prevent it from reducing spontaneously 

Deformity

• Abnormal position of extremity or part as a result of original forces of injury and action of muscles pulling fragment into abdominal position; seen as a loss of normal bony contours

sign of deformity

• Deformity is a cardinal sign of fracture; if uncorrected, it may result in problems with bony union and restoration of function of injured part 

Ecchymosis or contusion

• Discolouration of skin as a result of extravasation of blood in subcutaneous tissue 

sign of ecchymosis or contusion

• Ecchymosis may appear immediately after injury and may appear distal to injury 

• Reassure patient that process is normal and that discolouration will eventually resolve

Loss of function

• Disruption of bone or joint, preventing functional use of a limb/part 

sign of loss of function

• Fracture must be managed properly to ensure restoration of function to limb/part 

Crepitation

• Grating or crunching together of bony fragments, producing palpable or audible crunching or popping sensation 

sign of crepitation

• Crepitation may increase the chance for nonunion of bone ends are allowed to move excessively 

• Micromovement of bone end fragments (post-fracture) assists in osteogenesis (new bone growth)

Peripheral vascular assessment

colour, temperature, capillary refill, peripheral pulses, and edema

Peripheral neurological assessment

sensation, motor function, and pain

4 overall goals for fracture treatment

1. Anatomical realignment of bone fragments 

2. Pain management 

3. Immobilization to maintain realignment 

4. Restoration of normal or near-normal function of injured parts

Diagnostics 3

1. History and physical exam 

2. Radiographs 

3. CT, MRI

Fractture Reduction 5

1. Manipulation 

2. Closed reduction 

3. Skin traction 

4. Skeletal traction 

5. Open reduction with internal fixation

Fracture Immobilization 4

1. Casting or splinting 

2. Traction 

3. External fixation 

4. Internal fixation

Open fractures 4

1. Surgical debridement and irrigation 

2. Tetanus and diphtheria immunizations

3. Prophylactic IV antibiotics 

4. Immobilizations

Closed reduction 5

1. Non surgical 

2. Usually under conscious sedation

3. Manual realignment of bone 

4. Traction and countertraction manually applied to bone fragments 

5. After reduction, the injured part is immobilized by fraction, casts, splints

Internal fixation

1. Pins, plates, rods, and screws are surgically inserted 

2. Stainless steel, titanium and Vitallium are commonly used 

3. Proper alignment is validated by x-rays

External fixation

1. Metallic device composed of metal pins inserted into the bone and attached to external rods to stabilize the fracture 

2. Assessment for pin loosening and infection is critical 

3. Meticulous dressing changes are required

Traction is the application of a _____ force to an injured part of the body to extremity while counter traction pulls in the opposite direction 

pulling

the purpose of traction 4

1. Prevent or reduce pain and muscle spasm associated with low back pain or cervical spine 

2. Immobilize a joint or part of a body 

3. Reduce a fracture or dislocation

4. Treat pathological joint condition

Forces are usually exerted on the ____ fragment to obtain alignment with the proximal fragment 

distal

Fracture alignment depends on the correct ______ and ______ of the client while the traction forces remain constant 

positiong

alignment

For traction to be effective, countertraction or forces pulling in the opposite direction are needed to prevent the client from sliding to __ ____ __ ______ ____ ____ ______ 

to the end or side of the bed 

Counteraction is commonly supplied by client's ______ or may be augmented by _____ the head of the bed 

weight

elevating

Skin traction

• Short-term treatment until skeletal traction or surgery is available 

• tapes, boots or splits applied to skin

Skeletal Traction 

• Used to align bones and joints or treat joint contractures and congenital dysplasia 

• longer time

the physician inserts a pin or wire into the bone, either partially or completely, to align and _______ the injured body part 

immobilize

Teaching Traction:  Skeletal traction pin sites must be observed for signs of ____

Infection

Ensure that the traction weight bag is hanging _____; the bag must not rest on the bed or floor 

freely

If the rope becomes frayed,

replace them

The rope must be in the _____ tracts 

pulley

Ensure the bandages are free from _____

wrinkles

Temporary circumferential immobilization device 

casts

Cast materials are natural, synthetic ______, fiberglass ___, latex free ____, or a hybrid of materials 

Cast materials are natural, synthetic acrylic, fiberglass free, latex free polymer, or a hybrid of materials 

common treatment for closed reduction

cast

_______ reaction occurs when the cast is first applied and begins to dry 

thermochemical

Cast is not strong enough for weight bearing until about ______hours 

24-72

Fresh plaster cast should never be covered by a ____ 

blanket

During the drying process, don't , or subject the cast to any abnormal ___ that can break the cast

• During the drying process, don't wet, soil or subject the cast to any abnormal stress that can break the cast

Do not get cast ___, remove ___, insert objects to cast or bear weight for 48 hr 

1. Do not get cast wet, remove padding, insert objects to cast or bear weight for 48 hr 

1. Do not insert any ____

objects

Apply ice _____ over fracture for first 24 hours 

directly

Elevate extremity above _____ for first 48 hours

heart

Report: pain,____ with discolouration of toes, pain during movement, burning or _____ under cast, sores or ____ odours  

Report: pain, swelling with discolouration of toes, pain during movement, burning or tingling under cast, sores or foul odours  

4 Nursing Diagnoses

1. Impaired physical mobility 

2. Risk for peripheral neurovascular dysfunction 

3. Acute pain 

4. Ineffective self-health management

DVT

1. Veins are susceptible to thrombus formation 

Infection

1. High incidence of infections with open fractures 

2. Tetanus 

3. Osteomyelitis

Swelling and increased pressure can complicate the function of blood vessels, nerves and tendons 

compartment syndrome

compartmenet classes as 3

1. Classed as acute, subacute, or chronic

causes of compartment

decreased compartment size from restorative dressing, increased compartment contents from bleeding, edema

6 Ps of compartment

1. paratheiss, pain, pressure, pallor, paralysis, pulsnessnes 

pulmonary embolism symptoms 5

1. triad dysnpnea

2. hypoxia

3. cough, chest pain

4. changes in mental

5. hypotension

PE Treatment 7

1. bedrest

2. semifowelrs

3. IV line

4. o2 therapy

5. monitor labs

6. anticoag

7. cough and DB

Fat embolism syndrome 

characterized by the presence of systemic fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury 

The patient is discharged after regaining ______ skills, learning care of the ____ and ____ 

ambulation

cast

coping