A fracture, commonly known as a broken bone, occurs when there is a disruption in the continuity

of a bone due to physical trauma, stress, or pathological conditions. Fractures can be classified
based on various factors, including the type and location of the break, as well as the mechanism of
injury. Here's an overview:

Other Names for Fracture:

Broken Bone: This is the most colloquial and widely used term to describe a fracture.

Bone Fracture: Another straightforward term referring to the breakage of a bone.

Bone Crack: Used to describe minor fractures or hairline fractures where there is a partial break in
the bone.

Bone Injury: A general term encompassing any damage or trauma to a bone, including fractures.

Osseous Fracture: "Osseous" refers to bone tissue, so this term specifically denotes a fracture
involving bone.

Pathophysiology

Stress placed on a bone, exceeds the bone ability to absorb it

Injury in the bone

Distruption of continuity of bone

Distruption of muscle and blood vessels attached to the end of the bone

Bone tissue surround the fractured site dies

Inflammatory response
Clinical Manifestations of Fracture:

Pain: Fractures typically cause localized pain at the site of the injury. The intensity of pain can vary
depending on the severity and location of the fracture.

Swelling: In response to the injury, there is often swelling (edema) around the affected area due to
inflammation and fluid accumulation.

Deformity: Depending on the type and severity of the fracture, there may be visible deformity or
abnormal positioning of the affected limb or area.

Bruising: Fractures can lead to bruising (ecchymosis) around the injured site due to damage to
blood vessels and subsequent bleeding into the surrounding tissues.

Limited Range of Motion: Fractures can restrict movement in the affected area due to pain,
swelling, and instability caused by the injury.

Bone Crepitus: In some cases, there may be a grating or crackling sensation (crepitus) when the
fractured ends of the bone rub against each other or surrounding tissues.

Inability to Bear Weight: Fractures in weight-bearing bones, such as the femur or tibia, can make it
difficult or impossible to bear weight on the affected limb.

Diagnostic test

1. X-rays: An X-ray will confirm any fractures, and show how damaged your bones are.

2. Magnetic Resonance Imaging (MRI): Your provider might use an MRI to get a complete
picture of the damage to your bones and the area around them. An MRI will show tissue
like cartilage and ligaments around your bones too.

3. CT scan: A CT scan will give your provider or surgeon a more detailed picture of your bones
and the surrounding tissue than an X-ray.

4. Bone scan: Healthcare providers use a bone scan to find fractures that don’t show up on an
X-ray. This scan takes longer — usually two visits four hours apart — but it can help find
some fractures.

Laboratory test

1. Blood test

Blood tests are not typically used as a primary diagnostic tool for fractures, but they can
provide valuable information to aid in the assessment and management of fractures,
 especially in certain situations. Here are some blood tests that may be relevant in the context
of a fracture:

 Complete Blood Count (CBC): A CBC provides information about the various types of
blood cells, including red blood cells (RBCs), white blood cells (WBCs), and platelets.
Anemia (low red blood cell count) may indicate chronic blood loss from a fracture,
while elevated WBC count may suggest infection, especially in cases of open
fractures.
 C-reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR): These are
markers of inflammation in the body. Elevated levels of CRP and ESR may indicate
the presence of inflammation associated with a fracture or complications such as
infection.
 Blood Chemistry Panel: This panel includes tests such as electrolytes, liver function
tests, kidney function tests, and markers of bone metabolism (e.g., calcium,
phosphorus, alkaline phosphatase). Abnormalities in these parameters may provide
insights into the patient's overall health status and any metabolic disturbances
related to the fracture.
 Coagulation Studies: Coagulation studies, including prothrombin time (PT) and
activated partial thromboplastin time (aPTT), may be performed to assess the
patient's clotting function. This is particularly relevant in patients at risk of bleeding
complications, such as those with multiple fractures or underlying coagulopathies.
 Blood Gas Analysis: In cases of severe trauma or multiple fractures, arterial blood gas
(ABG) analysis may be performed to assess oxygenation and acid-base status. This
can help guide resuscitation efforts and monitor for complications such as
respiratory failure or metabolic acidosis.
 Blood Cultures: If there is clinical suspicion of infection, blood cultures may be
obtained to identify the causative organism and guide antibiotic therapy, especially
in cases of open fractures or suspected osteomyelitis.

Medical management
1. Immobilization
If your fracture is mild and your bones did not move far out of place (if it’s non-displaced),
you might only need a splint or cast. Splinting usually lasts for three to five weeks. If you
need a cast, it will likely be for longer, typically six to eight weeks. In both cases you’ll likely
need follow up X-rays to make sure your bones are healing correctly.
Drug study
Surgical management
1. Bone fracture surgery

Some bone fractures require surgery. Depending on which type of fracture you have — and how
badly your bones are damaged — there are few techniques your surgeon might use.

2. Internal fixation

Your surgeon will realign (set) your bones to their correct position and then secure them in place so
they can heal and grow back together. They usually perform what’s called an internal fixation, which
means your surgeon inserts pieces of metal into your bone to hold it in place while it heals. You’ll
need to limit how much you use that part of your body to make sure your bone can fully heal.

Internal fixation techniques include:

 Rods: A rod inserted through the center of your bone that runs from top-to-bottom.

 Plates and screws: Metal plates screwed into your bone to hold the pieces together in place.

 Pins and wires: Pins and wires hold pieces of bone in place that are too small for other
fasteners. They’re typically used at the same time as either rods or plates.
Some people live with these pieces inserted in them forever. You might need follow-up surgeries to
remove them.

3. External fixation

You might need an external fixation. Your surgeon will put screws in your bone on either side of the
fracture inside your body then connect them to a brace or bracket around the bone outside your
body. This is usually a temporary way to stabilize your fracture and give it time to begin healing
before you have an internal fixation.

4. Arthroplasty

If you fracture a joint (like your shoulder, elbow or knee) you might need an arthroplasty (joint
replacement). Your surgeon will remove the damaged joint and replace it with an artificial joint. The
artificial joint (prosthesis) can be metal, ceramic or heavy-duty plastic. The new joint will look like
your natural joint and move in a similar way.

5. Bone grafting

You might need bone grafting if your fracture is severely displaced or if your bone isn’t healing back
together as well as it should. Your surgeon will insert additional bone tissue to rejoin your fractured
bone. After that, they’ll usually perform an internal fixation to hold the pieces together while your
bone regrows. Bone grafts can come from a few sources:

 Internally from somewhere else in your body — usually the top of your hip bone.

 An external donor.

 An artificial replacement piece.

After your surgery, your bone will be immobilized. You’ll need some combination of a splint, cast,
brace or sling before you can start using it like you did before your fracture.

Complications fracture
1. Acute compartment syndrome (ACS): A build-up of pressure in your muscles may stop blood
from getting to tissue, which can cause permanent muscle and nerve damage.
2. Malunion: This happens when your broken bones don’t line up correctly while they heal.
3. Nonunion: Your bones may not grow back together fully or at all.
4. Bone infection (osteomyelitis): If you have an open fracture (the bone breaks through your
skin) you have an increased risk of bacterial infection.
5. Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE): Immobilization following a
fracture can increase the risk of blood clots forming in the deep veins of the legs (DVT). If a
clot dislodges and travels to the lungs, it can cause a life-threatening pulmonary embolism
(PE). Prophylactic measures such as early mobilization, compression stockings, and
anticoagulant medications may be used to prevent DVT and PE.
6. Joint Stiffness and Contractures: Prolonged immobilization or inadequate rehabilitation can
lead to joint stiffness and contractures, limiting range of motion and function. Physical
therapy and early mobilization are important for preventing and managing joint stiffness.
7. Nerve and Blood Vessel Injury: Fractures, particularly those involving long bones or in
proximity to major nerves and blood vessels, can cause injury to surrounding structures.
Nerve damage may result in sensory or motor deficits, while vascular injury can lead to
impaired blood flow and tissue necrosis.
Nursing diagnosis

1. Impaired Physical Mobility related to fracture immobilization

 Fractures often require immobilization, which can lead to decreased mobility.

Nursing interventions may involve assisting with activities of daily living, providing
mobility aids, and encouraging active range of motion exercises as appropriate.

2. Risk for Impaired Skin Integrity related to immobilization and impaired circulation

 Prolonged immobilization can increase the risk of pressure ulcers and skin
breakdown. Nursing interventions may include regular skin assessments,
repositioning the patient frequently, and providing skin care to prevent pressure
injuries.

3. Anxiety related to uncertainty about recovery and changes in lifestyle

 A fracture can cause anxiety due to concerns about recovery, pain, and changes in
daily activities. Nursing interventions may include providing emotional support,
educating the patient about the healing process, and teaching coping strategies to
manage anxiety.

4. Risk for Infection related to disruption of skin integrity and invasive procedures

 Fractures can increase the risk of infection, especially if there is an open wound or
surgical intervention. Nursing interventions may include monitoring for signs of
infection, promoting hand hygiene, and providing wound care as appropriate.

5. Impaired Social Interaction related to restricted mobility and changes in lifestyle

 Fractures can impact a patient's ability to engage in social activities and

interactions. Nursing interventions may include facilitating social support
networks, providing opportunities for socialization within the patient's limitations,
and addressing feelings of isolation or loneliness.

6. Risk for Falls related to impaired mobility and environmental hazards

 Fractures can increase the risk of falls, especially during activities of daily living.
Nursing interventions may include implementing fall prevention measures, such as
keeping the environment clear of obstacles, providing assistive devices, and
educating the patient and caregivers about fall risks.

Nursing intervention

1. Pain Management:

 Administer prescribed pain medications as ordered, ensuring timely and

appropriate pain relief.
  Implement non-pharmacological pain relief measures such as positioning,
distraction techniques, relaxation exercises, and therapeutic touch.

 Assess pain regularly using pain scales and adjust interventions as needed.

2. Mobility Assistance:

 Assist the patient with mobility, transfers, and positioning to prevent further injury
and promote comfort.

 Educate the patient on safe movement techniques and the importance of adhering
to weight-bearing restrictions if applicable.

 Encourage and assist with range of motion exercises to prevent stiffness and
muscle atrophy.

3. Skin Care and Prevention of Complications:

 Perform regular skin assessments to identify areas at risk for pressure ulcers,
especially in patients with immobilization devices.

 Implement pressure-relief measures such as frequent repositioning, proper

padding, and using pressure-relieving devices.

 Monitor for signs of infection at the fracture site and provide wound care as
directed by healthcare provider.

4. Emotional Support and Education:

 Provide emotional support and reassurance to alleviate anxiety and address

concerns related to the fracture and recovery process.

 Educate the patient and family about the nature of the fracture, treatment plan,
and expected outcomes.

 Encourage open communication and address any questions or misconceptions

about the injury and its management.

5. Nutritional Support:

 Assess the patient's nutritional status and dietary intake, addressing any deficits or
special dietary needs.

 Encourage a balanced diet rich in protein, vitamins (especially vitamin D and calc
ium), and minerals to support bone healing and overall health.

 Collaborate with dietitians or nutritionists as needed to develop individualized

nutrition plans.

6. Fall Prevention:

 Assess the patient's risk of falls and implement appropriate fall prevention
measures, such as keeping the environment clutter-free, using assistive devices,
and providing supervision during mobility.

 Educate the patient and family about fall risks and strategies to minimize them,
including proper footwear and home modifications if necessary.
7. Collaboration and Referral:

 Collaborate with the healthcare team, including physicians, physical therapists, and
occupational therapists, to coordinate care and optimize outcomes.

 Refer the patient to appropriate support services or community resources as

needed, such as rehabilitation programs or home health services.