CONDYLAR FRACTURE

RELATED TO VEHICULAR
ACCIDENT

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Introduction

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Vehicular Accident
- Occurs when a vehicle collides with
another vehicle, pedestrian,
animal, road debris, or other
stationary obstruction, such as a tree
or utility pole.
- Traffic collisions may result in
injury, death, vehicle damage, and
property damage.

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SIGNIFICANCE OF THE STUDY

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To equip the researchers and other

people the knowledge about the said
condition.
For the researchers to manage future
patients better with the same
condition.
To develop and enhance the
researchers skills in nursing
research.

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GENERAL OBJECTIVE

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Acquisition and application of

knowledge, skills and attitude
through the utilization of the nursing
process in providing care to patients
with condylar fracture with emphasis
on curative, rehabilitative and
preventive aspects in the hospital.

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Specific Objectives

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At the end of student- nurse patient

interaction, the researchers must be able to:
Establish and maintain rapport to achieve
optimal well-being of the patient;
Perform a comprehensive assessment on
the patient with condylar fracture secondary
to vehicular accident;
Identify the needs and problems of the
patient;
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Specific Objectives

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Formulate appropriate nursing diagnoses for

the patient with condylar fracture;
Formulate nursing care plans appropriate to
the problems identified to allow client to
return to normal functioning by:

- Construct goals and desired outcomes

needed for the clients fast recovery;
- Formulate interventions appropriate to the
patients needs, problems thus preventing any
complications;

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Specific Objectives

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Identify and understand different

types of medical treatment necessary
for condylar fracture;
Be updated with the latest trends in
the intervention of condylar fracture;
Carry out an in-depth study of
condylar fracture and its possible
complications;
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Specific Objectives

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Conduct a drug study on the

pharmacological agents used on the client,
aiming to teach to the client the possible
adverse effects and what to do in cases of
complications; and
Formulate conclusions based on the findings
and enumerated recommendations
concerning condylar fracture.

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ANATOMY AND PHYSIOLOGY

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Risk factors:

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Demographic factors :age and sex

mode of travel
mixture of high-speed motorized traffic
with vulnerable road users
insufficient attention to integration of road
function with decisions about speed limits
road layout and designs,

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Risk factors:

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Fatigue
travelling in darkness,
inadequate visibility because of
environmental factors
poor eyesight of road users
inappropriate or excessive speed
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PATHOPHYSIOLOGY

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Damaged ends of
the interrupted
bone and
surrounding tissue
bleed

Bone tissue
necrosis
IMPACT

Vasodilation
Inflammation
Disruption in the
periosteum and blood
vessels serving the
bone marrow, cortex,
and surrounding tissue

Local
numbness
Muscle flaccidity
due to temporary
loss of nerve
function

Subsequen
t muscle
spasms in
the
mandibular
area
Pain, swelling
and tenderness at
mandibular area

Exudation of plasma
and leukocytes
Infiltration of mast
cells
Shortening of
the opening of
the
mandibular
area

Process of
bone
healing
occurs

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BIOGRAPHIC DATA

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Name: A.A
Age: 20
Birth date: August 16, 1993
Sex: Male
Ethnic group: Tausug
Nationality: Filipino
Occupation: Student
Marital Status: Single
Religion: Islam
Address: Manicahan, Aplaya,
Zamboanga City, 7000
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BIOGRAPHIC DATA

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Chief Complaint: Vehicular Accident

Date of admission: November 25,
2013 at 11:30 pm
Date of discharge: December 02, 2013
at 1:44 pm
Attending Physician:
Dr. J. C. I., M.D

Dr. G. T. L., M.D

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Admitting Diagnosis:

To consider Open Fracture Right

Arm; Cerebral Concussion
Final Diagnosis:

Fracture, open, type 1 comminuted

middle third, ulnar and radius, closed,
comminuted, complex mandibular
fracture involve the right body and
left condyle, complete displaced.

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Surgery/ Procedure done:

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Open Reduction and Internal

Fixation plating radius, right;
pinning ulna, right

Application of Interdental Arch Bar

Braces

Wound Exploration; close reduction

of condylar fracture

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HISTORY OF THE PAST ILLNESS

HISTORY OF THE PRESENT ILLNESS
FAMILY HISTORY

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ASSESSMENT

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HEAD
INSPECTION
Head Structure and symmetry: all are
symmetrical except the Left mandible
area related to swelling

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ASSESSMENT

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MOUTH
Teeth and Gums: complete brace,
slightly pale gums
EARS
Canal:

R: with cerumen
L: with blood
Discharges: ( ) Yes
amount: minimal ( ) Left

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MUSCULO-SKELETAL SYSTEM
Deformities: fractured right arm
Upper Extremities:
Radial:
R:
with cast
L: 77bpm
Ulnar:
R:
with cast
L: 77bpm
Brachial :
R:
with cast
L: 77bpm

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RANGE OF MOTION:
() No, area: right arm (fracture)
Deformity: fractured at right arm and
left mandible area

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PSYCHOSOCIAL
Recent Stress: due to the accident that
happened
NUTRITION
Diet: NPO after surgical intervention
Meal Pattern: NPO after
surgical intervention

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Mastication/Swallowing Problem
() Yes
Appetite: () Decreased
Stool frequency: has not defecated

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PAIN ASSESSMENT
Location of pain: located at mandible
area and fractured hand right
Frequency: as moved
Intensity Pain Scale (0-10):
6
Quality: radiating
Onset: after surgery
Duration: long period but it gradually
lessens
Body Reaction: facial grimace;
guarded position
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Special Assessment Devices:

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( ) Braces
Others: Long Cast with sling on Right
Hand

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SELF-CARE

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Need Assist With:

() Ambulating
() Elimination
( ) Bed Mobility
() Meals
() Hygiene
() Dressing

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Gordons 11 Functional Health

Pattern

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I. Health Perception and Management

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The patient had a Vehicular Accident

and because of that he has poor
Activities of Daily Living (ADL).
Difficulty in moving and hes not used
to it unlike what he does before. He
needs Assistance when moving.

II. Nutritional Metabolic Pattern

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Due to Vehicular Accident the patient

has a low/Decreased appetite
condition. The patient has to go on
Soft diet like Lugaw (Fish&Chicken
Mixed) and Still in Fluids but strict
aspiration precautions method.

III. Elimination

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Since his confinement, the patient

hasnt defecated because of diet
restrictions due to his vehicular
accident happened on his mouth
(jaw) and a surgery that was done.
The Patient Still urinates 3-5 times a
day approximately 250-500ml/day.

IV. Activity and Exercise

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Patient is unable to do his Activities of

Daily Living due of his Vehicular
Accident. He needs assistance such as
eating, moving, and other ADLs.

V. Sleep and Rest

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Patient is having an intermittent sleep

and been very lethargic because of
the pain he feels on his mouth (jaw)
and affected arm.

VI. Cognitive Perceptual

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The patient was shocked and

confused because of the vehicular
accident. He still had a stable sensory
and can hear properly on his right ear
than his left ear because hes left ear
is affected in connection with his
mandible fracture. He still responds
appropriately of what was being
asked.

DIAGNOSTIC EXAM

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A complete slightly oblique fracture is

seen just anterior to the angle of the
mandible on the right.
Partially sclerosed mastoids, bilateral

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LABORATORY RESULTS

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TEST

RESULT

UNIT

REFER
ENCE
RANGE

IMPLICATION

WHITE BLOOD 30.49

CELLS

X 10^3/uL

5.0010.00

- infection,
tissue necrosis

DIFFERENTIAL
COUNT:
NEUTROPHILS

0.89

0.400.75

- infection,
ischemic necrosis,,

LYMPHOCYTES

0.06

0.200.40

Steroid use

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Discharge plan

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Medications
Celecoxib

Sultamicillin

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Economy/ Exercise
Physical activity should be kept to a
minimum for at least 6-8 weeks after
surgery.
It is very important to advise patient that
he just had a significant operation that
requires a well-rested recovery period.
Excessive activity (running, exercising,
swimming, heavy lifting, house cleaning,
contact sports, going up and down stairs
quickly, etc.) can cause bleeding and/or
dizziness.
Patient was advised to consult with his
physician first if he wished to perform any
strenuous activity.

Treatment/ Therapy

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Improve Patients Jaw Movement

Physical therapists use skilled hand movements
called manual therapy to increase movement and
relieve pain in tissues and joints. The therapist
also might use manual therapy to "stretch" the
jaw in order to:
Restore normal joint and muscle flexibility (so that
you won't feel tight)
Break up the scar tissues ("adhesions") that may
occur when disease or injury limits movement for
a period of time
Therapist may teach the special "low-load"
exercises. These are exercises that don't exert a
lot of pressure on mandible but can strengthen the
muscles of the jaw and restore a more natural,
pain-free motion. The therapist will also teach the
patient some exercises that help to increase the
opening of the jaw and improve the way it works.

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Diet
Patient was advised to continue soft
diet such as porridge, blended foods
and;
Instruct patient to avoid foods that is
difficult to chew such as meat, apple
and the like.

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Health teachings/ Hygiene

Patient was advised to maintain soft diet
to avoid pain and further dislocation;
Patient was advised to strictly follow
pharmacologic therapy: the right time,
dose and route for the administration of
the medicines;
Patient was advised to properly clean and
change dressings to avoid infection;
Patient was advised to strictly follow
doctors advises and;
Patient was advised to continue oral
hygiene by using mouthwash.

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Out-patient consultation
Advised patient to visit doctor for
regular check-up and to report any
unusual or any deviation from normal
such as infection, fever, headache,
numbness in the face and has trouble
breathing/ shortness of breath.

Evaluation:

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Patient verbalized alleviation of pain

Patient was rendered health
teachings regarding the proper
cleaning and dressing of the wound to
prevent further infection and was
compliant to it.
Patient verbalized feeling of relief
and improved self- esteem.
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Recommendation

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Patient was advised to continue taking his

medications regularly with the appropriate
time, route and side effects;

Patient was advised to continue his regular

check- ups and to monitor the wound site
for any infection or deviation from normal.

Patient was advised to follow his doctors

advices and continue his soft diet to avoid
pain on the affected site
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Thank You