Fracture Notes

Fracture

Definition

  • A fracture is a disruption in the continuity of bone structure.
  • Occurs when stress exceeds the bone's ability to absorb it.
  • Caused by direct blows, crushing forces, twisting motions, or muscle contractions.

Types of Fractures

  • Closed: No break in the skin.
  • Open: Skin or mucous membrane wound extends to the fractured bone.
  • Intra-articular: Extends into the joint surface.

Specific Types of Fractures

  • Avulsion: Bone fragment pulled away by a tendon.
  • Comminuted: Bone splintered into several fragments.
  • Compression: Bone compressed (vertebral fractures).
  • Depressed: Fragments driven inward (skull and facial bones).
  • Epiphyseal: Fracture through the epiphysis.
  • Greenstick: One side broken, other side bent.
  • Impacted: Bone fragment driven into another fragment.
  • Oblique: Angle across the bone.
  • Pathologic: Occurs through diseased bone.
  • Simple: Fracture remains contained.
  • Spiral: Twists around the shaft of the bone.
  • Stress: Results from repeated loading.
  • Transverse: Straight across the bone shaft.

Clinical Manifestations

  • Pain
  • Loss of Function
  • Deformity
  • Shortening
  • Crepitus
  • Localized Edema and Ecchymosis

Emergency Management

  • Immobilize the injured part before moving.
  • Apply a splint including joints above and below.
  • Check circulation and nerve function before and after splinting.
  • For open fractures, cover with sterile dressing and immobilize.

Medical Management

  • Fracture Reduction: Realigns bone fragments and immobilizes them.
    • Closed Reduction: Manual realignment, immobilized with cast/splint.
    • Open Reduction: Surgical, uses internal fixation devices.
    • Timely Reduction: Performed early to avoid tissue damage.
  • Immobilization: Maintained in proper position until union occurs.
    • External Fixation: Bandages, casts, splints, traction.
    • Internal Fixation: Screws, plates, nails, wires.

Nursing Management

Closed Fractures
  • Educate on managing swelling and pain.
  • Exercises to keep other muscles strong
  • Strengthen muscles for transfers and assistive devices
  • Safe use of crutches, walkers, or utensils
  • Teach the patient how to monitor for possible complications
  • Emphasize the importance of continued health care follow-up
Open Fractures
  • Recognize the high risk for: Osteomyelitis (bone infection), Tetanus, Gas gangrene
  • Prevent infection in wound, soft tissue, bone
  • Help bone and tissues heal
  • Assist with planning for home modifications to enhance safety
  • Administer medications as prescribed
  • Support surgical interventions
  • Ensure fracture stabilization
  • Monitor for complications
  • Ensure treatment for damaged blood vessels, muscles, nerves, tendons
  • Inform the patient that healing typically takes 6 to 8 weeks, depending on bone health

Maintaining and Restoring Function

  • Keep injured area stable.
  • Reduce swelling by elevation and ice.
  • Check neurovascular status regularly.
  • Encourage isometric exercises to prevent muscle loss.
  • Support involvement in daily activities to promote independence.
  • Gradually increase activity as prescribed.

Factors That Inhibit Fracture Healing

  • Age >40 years
  • Avascular necrosis
  • Bone loss
  • Cigarette smoking
  • Comorbidities (e.g., diabetes, rheumatoid arthritis)
  • Corticosteroids, nonsteroidal anti-inflammatory drugs
  • Extensive local trauma
  • Inadequate immobilization
  • Infection
  • Local malignancy
  • Malalignment of the fracture fragments
  • Space or tissue between bone fragments
  • Weight bearing prior to approval

Complications

  • Early: Shock, Fat embolism syndrome, Acute compartment syndrome, VTE, DVT, and PE
  • Delayed: Delayed union, nonunion, and malunion, Osteonecrosis, Complex Regional Pain Syndrome, Heterotopic ossification