Fractures

Fracture
Break in the continuity
of the bone.
When force is applied that exceeds the
tensile strength
or compressive strength
of the bone.
Types of Fracture
Closed (simple)
The bone is broken, but the skin is not lacerated.
Open (compound)
If the skin is open. The bone may or may not be
visible in the wound.
COMPRESSION SIMPLE
GREENSTICK COMPOUND
OCCULT SPIRAL
COMMINUTED TRANSVERSE
OBLIQUE
RISK FACTORS
Risk factor

Toddler
Risk factor
Risk factor
Paget’s Disease
Risk factor
Risk factor
Pathophysiolgy of
Fracture
 Moderate to
severe energy
transmitted

Bone impact
exceed tensile Swelling
strength Pain

Fat embolus
Deformity
Break in the
Loss of function
continuity of the
Myoglobinurea Impaired
bone
sensation
Compartment Decrease
syndrome Bleeding mobility
 Hematoma
formation

Stimulates
Bone tissue dies
inflammatory response

Decalcify fracture
bone ends

Bone tissue
revascularization
Osteoblast

Procallus

Callus

Remodeling

New bones
 Clinical Manifestations
• Local Swelling
• Loss of function or abnormal movement of affected
part
• Deformities such as shortening, rotation
• Crepitation
• Pain/ local tenderness
• Anesthesia and flaccidity (few minute to hrs)
- This is due to a temporary loss of nerve function at
the site associated vascular injury.
Complication
Osteomyelitis
The open area is a rich
culture medium for infection.
It retards healing by
destroying newly formed
bone and interrupting it’s
blood supply.
S. aureus is the usual cause.
Complications
Embolism
 Fat & Pulmonary Embolism
Fractures of long bones may
release enough fat to travel
through the veins, they attract
platelets which become part
of the microembolus and
deplete circulating platelets
Disseminated Intravascular Coagulation
Precipitating mechanism
Treat the
underlying
problem
Tissue damage Endothelial damage

Increased tissue Intrinsic pathway of

thromboplastin coagulation

Extrinsic pathway
of coagulation
Heparin to prevent
microclotting
(controversial)
Intravascular coagulation (production of
microthrombi)
Cryoprecipitate factor
VIII
Occlusion of small blood Production of thrombi
vessels Fresh frozen plasma
Activation of fibrinolytic
Tissue necrosis system Platelets
Consumption of clotting
Digestion of fibrin clots factors

Decreased clotting Thrombocytopenia

Inhibition of platelet
factors
function

Blood Bleeding

Key: = treatment
Complications
incorrect

Delayed union Failure

Complications
Nerve Damage
- Bone fragments may
rupture and compress
nerves that may also
be damaged by
dislocation or direct
trauma
Complications

Dislocation
Subluxation temporary displacement of
if the contact bone one or more bones in a joint
between the opposing bone in which the opposing bone
surface is partially lost. surface loss contact entirely.
 Complication
Myoglobinuria
(Rrabdomyolysis)

Severe muscle trauma.

An excess myoglobin
(intracellular muscle protein)
in the urine.
Muscles damage, with
disruption of sarcolemma,
releases myoglobin which
would lead to renal failure
Complication
COMPARTMENT SYNDROME
- Pressure build within the
compartment due to bleeding.
- swelling reaches the point at which
the fascia permits no outward
enlargement
- increasing pressure is directed
inward and compresses
components in the compartments.
 Nursing Diagnosis
1. Acute pain r/t stimulation of free nerve endings 2
to soft tissue injury.
2. Risks for peripheral neurovascular dysfunction r/t
reduction/interruption of blood flow.
3. Impaired Gas Exchange r/t altered blood flow/fat
emboli.
4. Impaired physical mobility r/t skeletal instability 2
to physical trauma.
 Nursing Diagnosis
5. Impaired Tissue integrity r/t insertion of traction
pins wires and screw/ physical immobilization
6. Situational low Self –Esteem r/t loss of body
parts/ change in functional abilities.
7. Ineffective peripheral tissue perfusion r/t
reduced arterial venous blood flow; tissue edema;
hematoma formation.
Diagnostic Tests
 RADIOLOGIC EXAM
Radiologic exam- to determine location extent of
fracture/trauma; may reveal preexisting undiagnosed
fracture.
Bone scan, tomograms, CT, MRI scan
- Visualized fractures, bleeding and soft tissue damage.
May be prepared for diagnostic tool because of superior
ability to image some types of injuries.
Arteriogram
- May be done when occult vascular damage is suspected.
 URINE ANALYSIS
Urine creatinine clearance

- Muscle trauma increases load of Cr for renal clearance.

- Creatinine level and urea nitrogen level should be analyzed when renal function is
elevated.
- NORMAL VALUE
- .6-1.3 mg/dL
 URINE ANALYSIS
Blood Urea Nitrogen
- Urea normally freely filtered through renal
glomeruli, small amount reabsorbed in the
tubule and the remainder excreted in the
urine.

-NORMAL VALUE
8-25 mg/dl
 BLOOD ANALYSIS
Hemoglobin
- main component of erythrocyte & serve
as the vehicle for transportation of O2 and CO2.
- NORMAL VALUES
Male: 14-16.5 g/dL Female: 12-15 g/dL
Hematocrit
- Determinations are important in identifying anemia.
- Fasting is not required.
- NORMAL VALUES
- Male: 42%-52% Female: 35%-47%
 BLOOD ANALYSIS
WBC
- Immune defense system of the body.
- Cell count assess each leukocytes distribution.
- increase WBC, normal response to trauma.

NORMAL VALUE
4,500 – 11, 000 cells/L
 Coagulation profile
activated Partial Thromboplastin Time (aPTT)
- Test screens
deficiencies & inhibitors of all factors
except factor VII & XIII.
- Screen for coagulation disorders.
- NORMAL VALUE
20-36 seconds
 Coagulation profile
Prothrombin Time (PT)
- Measures the amount of time it takes for clot
formation
- within 2 sec (+ or - ) of the control is considered
normal.
NORMAL VALUES
- Male: 9.6 -11.8 seconds Female: 9.5 -11.3 seconds

-
PT > 30 seconds at risk for HEMORRHAGE
The end….