Fracture
Content
Avenado, Ivan L. POC BN31 FRACTURE Definition: A fracture is a break in the continuity of bone and is defined according to its type and extent. Fractures occur when the bone is subjected to stress greater that it can absorb. Fractures are caused by: o direct blows o crushing forces o sudden twisting motions o extreme muscle contractions When the bone is broken, adjacent structures are also affected, resulting in: o soft tissue edema o hemorrhage into the muscles and joints o joint dislocation o ruptured tendons o severed nerves o damaged blood vessels. There are different types of fractures and these include: o complete fracture
The two pieces of the bone, resulting from the fracture, completely separate from each other.
o
incomplete fracture
In this, the two pieces of bone, resulting from the fracture do not completely separate from each other; the bone pieces are still joined to some extent. This happens when the crack (or fracture) does not traverse along the entire width of the bone.
o o
closed fracture
A closed fracture does not penetrate the skin.
open fracture
An open fracture is one in which the broken bone has penetrated through the skin.
There are also types of fractures that may also be described according to the anatomic placement of fragments, particularly if they are displaced or non displaced. Such as: o greenstick fracture Greenstick fractures are childhood injuries wherein the bone breaks on one side but remains attached on the other. This type of fracture is so named because the break is similar to what happens if you try to break a fresh twig. o oblique fracture
Instead of break being at right angle, it goes in oblique direction to the long axis of the bone.The fracture is confined to one plane. In other words the bone has broken at an angle.
o
spinal fracture
A fracture line that twists around the bone is a spiral fracture. As you might expect, this type of injury occurs when a twisting force is applied to the bone. These are typically high-force injuries.
o
impacted fracture
An impacted fracture is one wherein one bone fragment is forcibly jammed into another. These high-force injuries require surgical repair
o
transverse fracture
A break that runs straight across a bone is a transverse fracture. An oblique fracture is an angled break of the bone. A longitudinal break runs along the long axis of the bone rather than across it.
o
compression fracture
A compression fracture occurs when a bone collapses. This type of fracture is usually limited to the spine. Osteoporosis is a significant risk factor for compression fractures of the spine.
o
Pathological fracture A pathological fracture is one that occurs because of weakness in the bone caused by a disease or abnormal condition. Osteoporosis is a common cause of pathological fractures. Cancers that spread to the bones also predispose them to pathological fracture
5 Cardinal Signs of Fracture: 1. 2. 3. 4. 5. Swelling Tenderness Pain Crepitus Loss of function
Treating Fractures: Reduction
Open reduction refers to the method wherein the fracture fragments are exposed surgically by dissecting the tissues. Closed reduction refers to manipulation of the bone fragments without surgical exposure of the fragments. Once the fragments are reduced, the reduction is maintained by application of casts, traction, or held by implants which may in turn be external or internal. It is very important to verify the accuracy of reduction by clinical tests and x-ray, especially in the case with joint dislocations
five “Ps” – pain, pulse, pallor, paresthesia, and paralysis
Realignment Rehabilitation
Nursing Management 1. Provide emergency management when situation warrants, for a new fracture. Assess the five “Ps”. Immobilize the part. Move injured parts as little as possible. Cover any open wounds with a sterile, or clean dressing. Reassess the five “Ps”. Apply traction if circulatory compromise is present. Elevate the injured limb, if possible. 2. Assess for circulatory impairment (cyanosis, coldness, mottling, decreased peripheral pulses, positive blanch sign, edema not relieved by elevation, pain or cramping). 3. Assess for neurologic impairment (lack of sensation or movement, pain, or tenderness, or numbness and tingling). 4. Administer analgesic medications. 5. Explain fracture management to the child and family. 6. Maintain skin integrity and prevent breakdown. Institute appropriate measures for cast and appliance care. 7. Prevent Complications Prevent circulatory impairment by assessing pulses, color and temperature, and by reporting changes immediately. Prevent nerve compression syndromes by testing sensation and motor function, including subjective symptoms of pain, muscular weakness, burning sensation, limited ROM, and altered sensation. Correct alignment to alleviate pressure if appropriate, and notify the health care provider. Prevent compartment syndrome by assessing for muscle weakness and pain out of proportion to injury. Early detection is critical to prevent tissue damage. Causes of compartment syndrome include tight dressings or casts, hemorrhage. trauma, burns and surgery. Treatment entails pressure relief, which sometimes require performing a fasciotomy. 8. Prevent infection, including osteomyelitits, bys using infection control measures. 9. Prevent renal calculi by encouraging fluids, monitoring I&O, and mobilizing the child as much as possible. 10. Prevent pulmonary emboli by carefully monitoring adolescents and children with multiple fractures. Emboli generally occur within the first 24 hours
Nursing Management: Repositioning the patient Promoting strengthening exercise Monitoring and managing complications Health promotion Relieving pan Promoting physical mobility Promoting positive psychological response to trauma
The two pieces of the bone, resulting from the fracture, completely separate from each other.
o
incomplete fracture
In this, the two pieces of bone, resulting from the fracture do not completely separate from each other; the bone pieces are still joined to some extent. This happens when the crack (or fracture) does not traverse along the entire width of the bone.
o o
closed fracture
A closed fracture does not penetrate the skin.
open fracture
An open fracture is one in which the broken bone has penetrated through the skin.
There are also types of fractures that may also be described according to the anatomic placement of fragments, particularly if they are displaced or non displaced. Such as: o greenstick fracture Greenstick fractures are childhood injuries wherein the bone breaks on one side but remains attached on the other. This type of fracture is so named because the break is similar to what happens if you try to break a fresh twig. o oblique fracture
Instead of break being at right angle, it goes in oblique direction to the long axis of the bone.The fracture is confined to one plane. In other words the bone has broken at an angle.
o
spinal fracture
A fracture line that twists around the bone is a spiral fracture. As you might expect, this type of injury occurs when a twisting force is applied to the bone. These are typically high-force injuries.
o
impacted fracture
An impacted fracture is one wherein one bone fragment is forcibly jammed into another. These high-force injuries require surgical repair
o
transverse fracture
A break that runs straight across a bone is a transverse fracture. An oblique fracture is an angled break of the bone. A longitudinal break runs along the long axis of the bone rather than across it.
o
compression fracture
A compression fracture occurs when a bone collapses. This type of fracture is usually limited to the spine. Osteoporosis is a significant risk factor for compression fractures of the spine.
o
Pathological fracture A pathological fracture is one that occurs because of weakness in the bone caused by a disease or abnormal condition. Osteoporosis is a common cause of pathological fractures. Cancers that spread to the bones also predispose them to pathological fracture
5 Cardinal Signs of Fracture: 1. 2. 3. 4. 5. Swelling Tenderness Pain Crepitus Loss of function
Treating Fractures: Reduction
Open reduction refers to the method wherein the fracture fragments are exposed surgically by dissecting the tissues. Closed reduction refers to manipulation of the bone fragments without surgical exposure of the fragments. Once the fragments are reduced, the reduction is maintained by application of casts, traction, or held by implants which may in turn be external or internal. It is very important to verify the accuracy of reduction by clinical tests and x-ray, especially in the case with joint dislocations
five “Ps” – pain, pulse, pallor, paresthesia, and paralysis
Realignment Rehabilitation
Nursing Management 1. Provide emergency management when situation warrants, for a new fracture. Assess the five “Ps”. Immobilize the part. Move injured parts as little as possible. Cover any open wounds with a sterile, or clean dressing. Reassess the five “Ps”. Apply traction if circulatory compromise is present. Elevate the injured limb, if possible. 2. Assess for circulatory impairment (cyanosis, coldness, mottling, decreased peripheral pulses, positive blanch sign, edema not relieved by elevation, pain or cramping). 3. Assess for neurologic impairment (lack of sensation or movement, pain, or tenderness, or numbness and tingling). 4. Administer analgesic medications. 5. Explain fracture management to the child and family. 6. Maintain skin integrity and prevent breakdown. Institute appropriate measures for cast and appliance care. 7. Prevent Complications Prevent circulatory impairment by assessing pulses, color and temperature, and by reporting changes immediately. Prevent nerve compression syndromes by testing sensation and motor function, including subjective symptoms of pain, muscular weakness, burning sensation, limited ROM, and altered sensation. Correct alignment to alleviate pressure if appropriate, and notify the health care provider. Prevent compartment syndrome by assessing for muscle weakness and pain out of proportion to injury. Early detection is critical to prevent tissue damage. Causes of compartment syndrome include tight dressings or casts, hemorrhage. trauma, burns and surgery. Treatment entails pressure relief, which sometimes require performing a fasciotomy. 8. Prevent infection, including osteomyelitits, bys using infection control measures. 9. Prevent renal calculi by encouraging fluids, monitoring I&O, and mobilizing the child as much as possible. 10. Prevent pulmonary emboli by carefully monitoring adolescents and children with multiple fractures. Emboli generally occur within the first 24 hours
Nursing Management: Repositioning the patient Promoting strengthening exercise Monitoring and managing complications Health promotion Relieving pan Promoting physical mobility Promoting positive psychological response to trauma
