Fracture

Presented by : Samikshya Karmacharya
BSc. Nursing 3rd year
KUSMS
2

At the end of this session the students
will be able to:
define fracture
classify fracture
list out the causes of fracture
explain the clinical features of fracture
specify the diagnostic studies for
identification of fracture
elaborate the process of fracture
healing
3

explain the management of fracture
describe various approaches of
treatment of fracture
discuss the nursing management for
fracture
enlist the complications
summarize the main points.
4

 A disruption or break in the continuity of the
structure of bone with may be either across the
cortex or through the articular surface is called
fracture.
5

On the basis of:
 Etiology.
 Displacement.
 Relationship with external
environment.
 Pattern.
6

Fracture
Traumatic Pathological
7

Fracture
displaced undisplaced
8

 Closed fracture  Open fracture
9

ATYPICAL FRACTURES
 green stick
 torus
 impacted
 stress or fatigue
 hairline or crack
11

Fall injury
Accidents(motor vehicle accidents,
RTA)
Direct blow
Repetitive forces
Pathology: inflammation, neoplasm,
generalize disease
12

Symptoms:
Complain of fall or
trauma
Pain at the site of the
fracture
Difficulty in moving the
limb
13

LOOK:
Swelling
Bruising
Skin
Deformity
Signs of shock
FEEL:
Local tenderness
Peripheral pulse
Localized edema and
echymosis
MOVE:
Crepitus
Loss of function
14

Neurovascular assessment:6Ps
Watch for compartment syndrome:
(Occurs when injured tissue swells
within the fascia and connective tissue
inside of a limb causing an increase in
the pressure in that compartment.)
15

History taking
Physical examination
Imaging: X-ray ,MRI, CT scan
Lab studies:
Complete Blood Count
Hematocrit
Renal function test
Erythrocyte sedimentation rate
C -reactive protein
18

1. Hematoma formation
occurs within 72 hours and lasts up
to 7 days.
blood leaks out through torn blood
vessels and forms hematoma between
and around the fracture.
the periosteum and local soft tissues
are stripped from the fractures ends
resulting in ischemic necrosis.
20

active phagocytosis absorbs products
of local necrosis.
granulation tissue (new blood vessels
fibroblast, osteoblast) produces the
basis for new bone substance.
occurs 3-14 days past injury.
21

as minerals are deposited, an unorganized
network of bone is formed, that is woven
around the fracture parts known as callus,
composed of cartilage, osteoblasts,
calcium and phosphorus.
begins to appear by end of 2nd week.
22

(development of bone) ossification of
the callus
sufficient to prevent movement at
fracture site
occurs from 3 weeks to 6 months.
23

as callus develops, the distance
between bone fragments diminishes
and eventually closes
6. Remodeling
excess bone tissue is reabsorbed and
union is complete.
24

AT THE SITE OF THE ACCIDENT:
apply firm pressure in bleeding site using clean
piece of cloth
Wash the wound with clean tap water or saline
and cover it with clean cloth.
 splinting
 if a piece of bone devoid of all soft tissue is
present .Wash it and cover with clean cloth.
ice therapy can be done to reduce pain and
swelling
elevate the injured part to reduce swelling
safely transport him to the hospital.
26

Wound care
Splinting
 Debridement: 3E: (Exploration,
excision and evacuation)
Prophylactic antibodies
Tetanus toxoid
Analgesics
Radiography
29

Fundamental principles of fracture treatment
Reduction
Retention / immobilization
Rehabilitation
30

a. Reduction:
technique of setting a displaced fracture to a
proper alignment.
 may be done non-operating or operatively so
called closed and open reduction respectively.
31

necessary to maintain bone in reduced
position
the main aim is to:
 prevent displacement or angulation
prevent movement which might
interfere with union and relieve pain
may be done by:
 external immobilization: plates
 internal fixation using rods, plates
screws, wires etc.
33

 begin at the time of injury and goes until
maximum possible function have been regained.
 steps of rehabilitation:
 joint mobilization
 muscle re-education exercises
 functional use of limbs
36

1. Closed reduced followed by
immobilizations:
no any incision is made for moderate size
wound.
fracture is manipulated under a type of X-
ray machine called fluoroscopy or just and a
cast is then usually applied.
37

2. Close reduction and percutaneous
fixation
done for fractures, which though can
be reduced by closed manipulation,
but are unstable and are likely to
displace subsequently.
reduced under image intensifier, and
fixed with percutaneous devices such
as K-wire, rush pins etc. which hold
fracture in position
39

the fracture fragments are surgically
exposed by dissecting the tissues and
fractured bones are put together, stabilizing
with implants such as screws, plates,
staples, rods etc.
intra-articular fractures.
also used when other methods have failed
and in fractures which are so unstable that
will redisplace in due course.
41

used to counter the forces which will not
allow reduction to happen or would cause
redisplacement.
these are the muscle forces and the force of
gravity.
 helps to bring the bone in proper
alignment after reduction
43

Replaced with metal
devices
Indicated when there
is complete
disruption of joint
Done in femoral neck
fracture, hip fracture,
finger joints etc
45

1. Assessment:
History taking
Injured extremity: Presence of fracture
and other associated complication
Vital signs
Neurological status: 6'p's
Intake and output
Laboratory reports
Routine pre operative history
47

2.Interventions:
Provide emergency care
Wash wound with antiseptic solution
Cover with sterile drape
Provide prophylactic antibiotics, tetanus
toxoid , analgesics etc as prescription.
Wound debridement
Send for radiographic imaging and tests
Administer IV fluids, oxygenation
48

Pre operative care
Consent
Removing accessories
Collection of laboratory reports
Administration of IV fluids & medications
Catheterization
Patient education: treatment, management,
complications etc
49

Post operative care
- Monitor:
Vital signs
Gaseous exchange
Fluid intakes and urine outputs
-provide IV therapy , analgesics, antibiotics
-Provide skin care
-If endoprosthetic replacement is done,
maintain adduction of the limb
-Encourage fluid and food intakes
50

Promote physical mobility
Teach using assistive aids and devices
Promote deep breathing and coughing
exercises
 Early detection and management of
complications
51

Immediate:
Hypovolemic
shock
Major vessels
injury
Injuries to
muscles, tendons,
joins, viscera etc
Early:
Shock
Respiratory distress
syndrome
Fat embolism
syndrome
Infection
Compartment
syndrome
52

Late:
Late union
Non union
Malunion
Avascular necrosis
Shortening
Joint stiffness
53

Draw a flow chart of fracture healing
process
55

 Janice L. H , Kerry H. C, Brunners and Suddarths
Textbook of Medical and Surgical Nursing , 13th ed,
Wolters Kluwer Pvt, Ltd., India,( 2014) , P: 1156-60
 Mandal G.N , Textbook of Medical Surgical
Nurisng, 4th ed, Makalu Publication House,
Dilibazzar (2015) , p: 239-46
 Jayant J., Prakash K., Essentials of Orthopedics and
applied physiotherapy, 2nd ed , Elsevier Pvt.
Ltd.,India (2000), p:83-86
 Maheswori J. , Essential or orthopedics , 4th ed,
Jaypee Brothers Medical Publishers Pvt. Ltd., New
Delhi,( 2010), P:84-134
56

 Fracture’ retrieved on 2016/2/29 available at:
 http://www.nlm.nih.gov/medicineplus/ency/p
atienteducation/com-fracture-management/
 http://www.trackbruceland.com/ck-traction-
applications/
 http://cmsrusanatory.blogspot.com/2013/4/6
Ps- of-compartment-syndrome
57

Fracture

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