PATHOPHYSIOLOGY OF FRACTURE

Nonmodifiable Modifiable
Personal history of fracture as an Current cigarette smoking
TRAUMA
adult Low body weight
History of fracture in first degree Estrogen Deficiency
relative Early menopause (45 years old) or
Female sex bilateral ovariectomy
Advanced age Bone Breakage Prolonged premenstrual
amenorrhea
Low Calcium Intake
Death of bone cells Alcoholism
Recurrent falls
Inadequate physical activity
Bleeding typically occurs around Poor health/Frailty
Osteoblastic activity is immediately stimulated, both the site and into the soft tissues
intraosseous and periosteal from osteoproginenitor surrounding the bone. The soft
cell tissues are usually damaged by Disruption in fracture hematoma due to
the injury. displaced and comminuted bone
Immature new bone or callus is formed
Intense Inflammatory Reaction
Fixation or proper bone alignment is
Fibrin clot is soon reabsorbed and the new needed to facilitate bone healing
bone cells are slowly remodeled to from true Vasodilation
bone
Open Reduction Internal Fixation
Increased blood flow to the area of injury Intramedullary Nailing Interlocking Femur
True bone replaces callus and is slowly
Left, Open Reduction Internal Fixation
calcified. (Several weeks to few months)
Leukocytes and mast cells accumulate Wiring Patellar Left

Phagocytosis and removal of dead cell debrisScrews, Wires, Rods, Nails or other fixation apparatuses hold both ends of broken bone together

A fibrin clot (fracture hematoma) forms at the break and acts as a new network to which new cells can adhere.

Stress on the opposed of the broken bones, which accelerates osteoblastic activity at the break leading to hastened normal bone heali
 Impaired skin and tissue integrity
related to surgical repair: Maintenance of immobilization to Impaired physical mobility related to
Skin and tissue breakage
insertion of fixation apparatuses facilitate bone healing musculoskeletal impairment

Additional inflammation aside from

response surrounding the bone Limited ROM and decreased Self care deficit related to immobility
Risk for Infection related to muscle strength
tissue trauma
Increased nociception Risk for Ineffective Tissue Perfusion related
Risk for Deficient Fluid Volume related to Blood vessel damage secondary to multiple fracture to Immobility
Increased Vital Signs, Moaning, Irritable, Guarding Behavior

Risk for Peripheral Neurovascular

Dysfunction
Acute Pain related to physical trauma

Asks questions about

operation and post operative
activities

Deficient Knowledge regarding fracture and

surgical treatment and care related to lack of
exposure

References:

Hall, J.E., Guyton A. C. Guyton and Hall Textbook of Medical Physiology 12 th edition (2011) Elsevier (Singapore) Pte Ltd. Pp 960

Black J, Hawks J.H. Medical Surgical Nursing Clinical Management for Positive Outcomes 7 th edition (2005) Elsevier (Singapore) Pte Ltd. Pp 619-648