Part 1 Fractures • Fracture Management • Neurovascular Assessment • Casting • External Fixation

What is a fracture?

A disruption or break in the continuity of bone.

What are common causes/risk factors for fractures?

Bending, lifting, osteoporosis, age-related sensory/CNS changes, medical conditions, history of injury, medications, depression, dementia, environmental hazards.

What is a displaced fracture?

The two ends of the bone are separated; increased risk of tissue, vessel, and nerve injury.

What fracture patterns are commonly displaced?

Comminuted and oblique fractures.

What is a non-displaced fracture?

The periosteum remains intact and the bone stays aligned.

What fracture patterns are commonly non-displaced?

Transverse, spiral, and greenstick fractures.

What is a closed (simple) fracture?

A fracture that does not break the skin.

What are assessment findings of a closed fracture?

Deformity, intact skin, swelling, assess neurovascular status.

What is the major complication of a closed fracture?

Swelling and neurovascular compromise.

What is an open (compound) fracture?

A fracture where the skin or mucous membrane extends to the fractured bone.

Why are open fractures considered emergencies?

High risk for infection.

What treatments are anticipated for an open fracture?

Sterile dressing, antibiotics, wound closure, tetanus prophylaxis.

What is a complete fracture?

The bone breaks completely into two or more pieces.

What is an incomplete fracture?

The bone cracks but does not separate completely.

What is a stress fracture?

A hairline fracture caused by repetitive overuse; may not appear on X-ray for up to 6 weeks.

What is a pathological fracture?

A fracture caused by weakened bone from diseases such as cancer or osteoporosis.

What are common signs and symptoms of a fracture?

Localized pain, muscle spasms, swelling, ecchymosis, deformity, crepitus, decreased ROM, inability to bear weight, shortening, abnormal rotation.

Why does a patient guard an extremity after a fracture?

To reduce pain and movement.

What is crepitus?

A grating sensation caused by bone fragments rubbing together.

What are the goals of fracture management?

Prevent complications, restore maximal function, achieve the best cosmetic outcome.

What are the three principles of fracture management?

Reduction, immobilization, rehabilitation.

What is the purpose of reduction?

Restore normal bone alignment and relieve pressure on nerves and blood vessels.

What is closed reduction?

Manual realignment without surgery followed by immobilization.

What is ORIF?

Open Reduction Internal Fixation using surgical hardware.

What is performed before definitive fracture repair?

Immediate neurovascular assessment.

What should be included in a neurovascular assessment?

Color, temperature, sensation, pulses, movement, capillary refill, edema.

What are the 6 P's of neurovascular assessment?

Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia.

Which of the 6 P's is usually the earliest sign of compartment syndrome?

Pain.

What type of pain is concerning after a fracture?

Relentless pain not relieved by elevation, cold, or analgesics.

What does pallor indicate?

Reduced tissue perfusion.

What does pulselessness indicate?

Loss of arterial blood flow.

What does paresthesia indicate?

Numbness or tingling caused by nerve ischemia.

What does paralysis indicate?

Loss of motor function due to severe neurovascular compromise.

What is poikilothermia?

The affected extremity becomes cool compared with the unaffected limb.

What is the NCLEX priority sequence for initial fracture care?

Assess ABCs and neurovascular status → Immobilize → Cover open wound if present → Elevate/ice (unless compartment syndrome suspected) → Prepare for reduction or surgery.

How should a fractured extremity be immobilized?

In the position found.

Should you attempt to push exposed bone back into place?

No.

How should an open fracture be covered?

With a sterile dressing.

When are tetanus prophylaxis and antibiotics anticipated?

For open fractures.

When should ice and elevation NOT be used?

If compartment syndrome is suspected.

What findings should be reported immediately after a fracture?

Absent pulse, worsening pain, numbness, pallor, paralysis, cool extremity.

What materials are commonly used for fracture immobilization?

Casts, splints, pins, wires, external fixation devices.

What are important nursing assessments for a cast?

Neurovascular status, drainage, odor, tightness, numbness, increasing pain.

How often should neurovascular checks be performed after casting?

Frequently and bilaterally.

What should never be inserted into a cast?

Objects used to scratch the skin.

What findings suggest infection under a cast?

Hot spots, drainage, foul odor.

What is cast syndrome?

Superior mesenteric artery syndrome causing abdominal or respiratory distress after body casting.

How is cast syndrome treated?

Gastric decompression.

What is the purpose of a cervical collar?

Stabilize cervical spine injuries.

What is external fixation?

Pins inserted into bone connected to an external frame.

When is external fixation commonly used?

Open fractures, severe soft tissue injury, excessive swelling, temporary stabilization.

What are advantages of external fixation?

Allows wound care while stabilizing the fracture.

What is the major complication of external fixation?

Pin-site infection.

How does internal fixation differ from external fixation?

Internal fixation places hardware inside the body using plates, screws, rods, or nails.

What should nurses focus on when caring for an external fixator?

Neurovascular status, pin-site care, infection prevention, skin assessment.

What should be assessed at pin sites?

Redness, drainage, odor, loosening.

What teaching should be given for external fixation?

Follow pin-care instructions, never adjust clamps or pins, report fever, drainage, worsening pain, numbness.

How should an extremity with external fixation be positioned?

Elevated no higher than the level of the heart.

How often should fingers or toes be moved if allowed?

Every hour.

What type of pain is expected after fracture repair?

Postoperative pain that improves with medication.

What type of pain is abnormal after fracture repair?

Increasing pain unrelieved by analgesics.

How is swelling minimized after fracture repair?

Elevation and intermittent cold application.

What is the nursing priority with casts and splints?

Tissue perfusion beneath the device.

What skin assessments should be performed with casts or braces?

Skin edges, pressure points, drainage, odor, pressure injuries.

When are antibiotics indicated after fracture repair?

Open fractures or surgery.

What mobility interventions reduce complications after fractures?

Early mobilization, assistive devices, muscle-setting exercises, DVT prophylaxis.

What is the NCLEX warning regarding pain under a cast?

Unrelieved pain under a cast is never normal.