FRACTURE

Reporters: Abrea, Hatague, Ranada

Topic Outline:
Definition
Causes of Fracture Types of
Bone Fractures
Classification of Bone Fractures
Pathophysiology
Clinical Manifestations
Diagnosis
Medical Management Nursing
Management

TODAY'S
DISCUSSION
 Learning Objectives:
 At the end of the lesson the students will be
able to:
• Define fracture
• Enlist the causes of fracture
• Describe the different types of Bone
Fractures
• Determine the different Classification of Bone
Fractures
• Discuss the Pathophysiology
• Enumerate the Clinical Manifestations
and Diagnostic test
• Explain the Medical Management and
TODAY'S
DISCUSSION
Nursing Management
FRACTURE
A complete or incomplete disruption of
the continuity of the bone structure
and is defined according to its type and
extent.
Causes of Fracture

D IR E C T C R U S H IN G
B LO W S FO R C E S

EX T R EM E
S UD D EN
M U S C LE
T W I S T IN G
C ON TRA C -
M O T IO N S
T IO N S
Types of fracture

Complete fracture
a break across the entire cross-section of
the bone.

An incomplete fracture
the break occurs through only part of the
cross- section of the bone
Types of fracture
Closed fracture
(simple fracture) is one that does not cause a brek in the skin

An open fracture
(compound, or complex, fracture) is one in which
the skin or mucous membrane wound extends to the
fractured bone.
open fracture are graded according to the
following criteria:
• Grade I is a clean wound less that 1 cm long.
• Grade II is a larger wound without extensive soft
tissue damage.
• Grade III is highly contaminated, has extensive soft
tissue danage, and is the most severe.
 CLASSIFICATION
ACCORDING TO THE
ANATOMICAL
PLACEMENT
 Avulsion
Compression
A fracture in which
A fracture in which bone has
fragments of bone has Comminuted been compressed (seen in
term-15been pulled away A fracture in which bone was several vertebral fractures)
by a tendon and its splintered into several
attachment fragments
 Depressed
A fracture in which
Greenstick
fragments are driven Epiphyseal A fracture in which other
inward (seen frequently in
A fracture through the side of the bone is broken
fractures of skull and facial epiphysis
bones) and the other side is bent
 Open
Impacted Oblique A fracture in which damage
A fracture in which a bone A fracture occuring at an angle also involves the skin or
fragment is driven into across the bone (less stable mucous membranes, also
another bone fragment then a transverse fracture) called a compound fracture
 Pathologic
A fracture that occurs through
an area of disease bone (e.g.,
osteoporosis, bone cyst, Paget
disease, bony metastasis,
tumor); can occur without
trauma or fall.
Simple Spiral
Afracture that remians
A fracture that twist around
contained, with no disruption
the shaft of the bone
of the skin integrity
 Stress Transverse
A fracture that results from repeated A fracture that is straight across the
loading of bone and muscle bone shaft
 PATHOPHYSIOLOGY
Due to any etiology (crushing movement)
I
Fracture occurs, muscle that were attached to the bone are disrupted and cause
spasm.
I
Proximal portion of the bone remains in place, the distal portion can become
displaced in response to both causative force & spasm in the associated muscles.
I
In addition, the periosteum and blood vessels in the cortex and marrow are
disrupted
I
Soft tissu damage occurs, leads to bleeding and formation of hematoma between
the fracture fragment and beneath the periosteum
 I
Bone tissue surrounding the fracture site dies, creating an intense inflammatory
response
I
Release chemical mediators histamins, prostaglandins
I
Resulting in vasodilation, edema, pain, loss of function, leukocytes and
infiltration of WBC
 CL I N I CA L
M A N I F E S T A T IO NS
• Pain
• Loss of function deformity
• Shortening crepitus
• Localized edema and ecchymosis
History collection
Physical examination
X-ray
CT scan
MRI scan
MANAGEMENT
 MEDICAL/SURGICAL
MANAGEMENT OF FRACTURES:
1.Reduction
refers to restoration of the fracture fragments to anatomic
alignment and positioning.

a.Open reduction - Its a surgical

approach, in which the fracture
fragments are reduced.
Internal fixation - Involves the use
of devices internally (under the
skin) positioned within the
patient's body. External fixation -
The devices are screwed into
fractured bones to exit the skin
and are attached to a stabilizing
structure outside the body.
 b. Closed reduction - is accomplished by bringing the bone fragments into
anatomic alignment through manipulation and manual traction. The
extremity is held in the aligned position while a cast, splint, or other device
is applied.

Traction - may be used until the patient is physiologically stable to

undergo surgical fixation.

2. Immobilization - It is done after the fracture has been reduced to

immobilized and maintained bone fragments in proper position and alignment
until union occurs. May be accomplished by external or internal fixation.
Methods used:
External fixation including bandages, casts, splints, continous traction,
and external fixators.
3. Maitaining and restoring functions
Reduction and immobilazation are mainatained
Edema is controlled
Neurovascular status is monitored
Restlessness, anxiety and discomfort are controlled
Isometric and muscle setting exercise are encouraged
Participation in activities of daily living (ADLs) Gradual
presumption of actvotirs is promoted
 Complication of fracture
Early complications
Shock
Fat embolism
Acute compartment syndrome
Deep vein thrombosis (DVT)
Pulmonary embolism
Disseminated intravascular coagulapathy (DIC)
Infection
 Complication of fracture
Late complications
Delayed union
Malunion
Nonunion
AVN of bone complex regional pain syndrome
(CRPS) Heterotropic ossification
NURSING
M A N A G E M E NT / I N T E R V E N T I O N
After a fracture confirm the patient is safe (out of harm’s way) and stable then…..
o Immobilize the fracture by using a device to splint it:
o Stop bleeding, if present, by applying pressure with a clean cloth.
o If the fracture is an opened “compound” fracture, cover with sterile dressing!
Elevate extremity to decrease swelling.
o Apply ice wrapped in towel to the injury to decrease swelling
o Keep NPO (nothing by mouth) until evaluated by surgeon…may need surgery. X-ray
will be ordered to diagnose a possible fracture and what type.
o Pain management with prescribed medications
o Monitor for fat embolism , especially if this is a long bone fracture: Assess mental
status and respiratory system: confusion, restless, increased respiration, difficulty
breathing
 Assess neurovascular status! Assess the 6 P’s
o It should be be performed every 20 minutes for 4 hours
NURSING DIAGNOSIS
Acute pain related to breakdown of continuity of the bone as evidenced
by facial expressions and verbalization of pain by patient
Impaired physical mobility related to application of traction or cast as
evidenced by loss of skeletal integrity
Self-care deficit related to fracture as evidenced by poor personal
hygiene
 REFERENCE
Ratheeshkrishnakripa. (2019) Fracture.
https://www.slideshare.net/Ratheeshkrishnakripa/fracture-153978230

Hinkle J., Cheever K., & Overbaugh K., (2022). Bunner & Suddarth's
Textbook of Medical-Surgical Nursing, fiftenth edition. Wolters Kluwers
publication, Volume 1, Page no. 1157-1169.