Care of Clients with

fractures
Presented by
Stephen James
 Objectives
 Define fractures
 Distinguish between different types of
fractures
 Describe causes, pathology and
complications of fractures
 Identify common diagnostic and laboratory
tests used in the evaluation of fractures
 Objectives cont’d
 Discuss the principles of fracture treatment
 Discuss possible nursing diagnoses,
relevant nursing interventions and expected
outcomes for clients who sustain fractures
 Discuss essential elements in the
discharge plan for clients with fractures
 Definition
 Complete break in the continuity of a bone
or it may be an incomplete break or crack
(Adams and Hamblen, 2002).

 Break in the continuity of bone (Smeltzer,

Bare, Hinkle, Cheever, 2006).
 Types of fractures

 pattern  severity
 Transverse fracture
 Usually caused by
direct applied force to
limb.
 Oblique fracture
 Caused by
violence
transmitted
through limb from
a distance
(twisting
movement).
 Spiral fracture
Caused by violence
transmitted through a
limb by distant force.
 Pathological fracture
 Cause by erosion of a
disease bone.
 Comminuted fracture
 Two or more bone
pieces- high energy
impact.
 Compound fracture
 Bone fragments
pierce skin.
 Avulsion fracture
 Bone fragments
usually torn off by
ligaments or tendons.
 Impacted fracture
 Bone fragments
impact into each other
 Compressed fracture
 Commonly found in
vertebrae,
 Greenstick fracture
 Occur in
children:
bones soft and
bend without
fracturing
completely.
 Clinical manifestations
 Pain
 Deformity (visible & palpable)
 Swelling and discoloration
 Marked impairment of function
 Crepitus or grating
 Wound
 Circulatory and neurological impairment
 Etiology
 Sudden injury: direct and indirect injury

 Fatigue: repeated stress

 Pathological: infection, tumours,

congenital, nutritional, Paget’s dx,
osteoporosis, rickets.
 Pathophysiology
 Fractures occur when the force of an
object is greater than the strength and
resilience of the bone then breakage
occur.

 Erosion cause by disease.

 Complications
 Infection
 Delayed union
 Non union
 Mal union
 Avascular necrosis
 Shortening
 Compartment syndrome
 Complication cont’d
 Fat embolism

 Injury to adjacent structures

 Osteoarthritis
 Diagnostic and laboratory tests
 History and physical examination
 X-rays ( two views)
 Ct scan
 MRI
 Bone scan
 Diagnostic and laboratory tests
cont’d
 Blood test ( alk phos), ESR, FBC, U and
E’s.

 Bone biopsy

 Arthroscopy
 Principles of Treatment
 Reduction ( closed manipulative, mechanical
traction and operative reduction).

 Immobilization by plaster, splints or brace,

continuous traction, external and internal
fixation.

 Rehabilitative treatment.
Skeletal traction
Skin traction
 Internal fixation
 Use for large bones
and displaced
fractures.
 External fixators
 Use for fractures that
are to unstable for
casting.

 Use for open

fractures for easy
wound access.
 Scenario
 Mrs. X a 32 yr old mother of three was admitted
to the orthopedic unit after falling from a flight of
stairs. She is diagnosed with a fractured hip and
compound fracture to the humerus. She states
she is worried who would take care of her
children since she is a single parent, she is
experiencing severe pain and was place in
traction to immobilize her hip.
 Develop a care plan under the following needs:
Safety and Protection, Activity rest and comfort
and Psychological.
 Discharge planning
 Discuss the relevant elements in the
discharge plan for Mrs. X ?
THE END