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FRACTURE
Definition

A fracture is a partial or complete break in the bone.

Causes
Causes of bone fracture includes:
• Fall from a height
• Motor vehicle accidents.
• Direct blow (A direct blow fracture
occurs when a bone is fractured due to a
direct impact or force applied to the bone at
the site of injury)
Causes (cont…)

• Repetitive forces, such as those caused

by running, can cause stress fractures of the
foot, ankle, tibia, or hip.
• Metabolic bone diseases like
osteoporosis
Types of Fractures

1) Simple Fracture:
The wound is non-communicating
between the skin
and bone.
2) Open or Compound Fracture:
The wound is communicating between
the skin and bone and the skin has been
penetrated by a bone fragment from
inside.
3) Transverse Fracture:
The fracture line is perpendicular to the
long axis of the bone.
It often occurs as a result of strong force
applied to the bone.
4) Oblique Fracture:
Fracture line occurs at an oblique angle
[45degree] to the shaft of bone.
5) Spiral Fracture:
It is a type of complete fracture which
fracture line extends in a spiral form
along the shaft of the bone. It occurs
due to rotational or twisting force.
6) Linear Fracture:
In this fracture there will be one thin
line of fracture on the bone and no
compression or distortion of bones.
7) Longitudinal Fracture:
Fracture that occurs along the axis of
the bone this is most often seen in long
bone fracture.
8) Avulsion Fracture:
Fracture of the bone at the site of
attachment of tendons or ligaments due
to strong pulling force.
9) Comminuted Fracture:
It is a fracture with more than two
fragments. The smaller fragments
appear to be floating.
10) Pathological Fracture:
Fracture of a point in the bone
weakened by a disease.
11) Stress Fracture:
These are small or micro-fracture
resulting from repeat Stress during
playing or exercise like jogging or
running
12) Depression Fracture:
Broken parts of the bone are driven
inwards. An example is skull fracture.
Pathophysiology of Fracture
Stress placed on a bone, exceeds the bone
ability to absorb it.

Injury in the bone.

Disruption in the continuity of bone.

Disruption of muscles and blood vessels

attached to the ends of the bone.
 Soft tissue damage.

Bleeding.

Hematoma forms in medullary canal.

Bone tissue surrounding the fractured site dies.

Inflammatory response.
Stages of Healing Bone Fracture

Hematoma Formation
(Week 1)
Hematoma forms at the site
of the bone break due to
the disruption of blood
vessels.
Development of Fibrocartilaginous
Callus (Week 2-3)
This is temporary formation of
fibroblasts which forms at the
area of a bone fracture as the
bone attempts to heal itself
Development of bony calluses
(Week 2-6)
A bone callus first starts off as
soft fibrous tissue and
cartilage. As healing continues,
the callus becomes bone,
which hardens and strengthens
over time.
Bone Remodeling
After a fracture, bone remodeling
is the final phase of the healing
process. The remodeling stage
starts around 6 weeks after the
injury
Clinical Manifestations

• Deformity – The abnormality in the shape or

structure of a body part.

• Swelling and Discoloration – Swelling occurs

due to an accumulation of fluid in tissues, while
discoloration results from the breakdown of blood
cells leaking into surrounding tissues.
• Pain - Continuous and increases severity
until the bone fragments are immobilized.

• Loss of function - Pain contributes to the

loss of function in addition normal function of
the muscles depends on the integrity of the
bones to which they are attached.
• Shortening - In fracture of the long
bones, there is actual shortening of the
extremity because of the compression of the
fractured bones. Some times, muscle spasm
can cause the distal and proximal site of the
fracture to overlap, causing the extremity to
shorten.
• Crepitus - When the extremity is gently
palpated, a crumbling sensation called
crepitus can be felt. It is caused by the
rubbing of the bone fragments against each
other.
• Hypovolemic Shock – This is a life
threatening condition that occurs when there
is a significant decrease in Blood volume.
Diagnostic Evaluations
 History and physical examination.
 X-ray studies: Determines location and extent of fracture
 Computed Tomography(CT)/Magnetic Resonance
Imaging (MRI): Visualizes fractures, bleeding, and soft-
tissue damage; differentiates between stress/trauma
fractures and bone neoplasms
 Blood chemistry, CBC: Haematocrit (Hct) may be
increased (hemoconcentration) or decreased
(haemorrhage).
 Coagulation profile: Alterations may occur because of
blood loss, multiple transfusions, or liver injury.
 Arteriograms: May be done when occult vascular damage
is suspected.
Medical Management
 Management of a patient with fracture can be either under
emergency care or under non-emergency care.
 Immediately after injury, if a fracture is suspected, it is
important to immobilize the body part before the patient is
moved.
 Adequate splinting is essential to prevent movement of
fracture fragments.
 The bleeding from the wound is stopped by applying firm
pressure using a clean piece of cloth.
Treatment of Fracture (Emergency Care)
Closed Fracture
 Before splinting remove any ring or bangles worn by the patient.
 Almost any available object( for eg: folded news paper, magazine, rigid cardboard,
stick, umbrella, pillow etc.) can be used for splinting at the site of the accident.
Open Fracture
 The bleeding from the wound is stopped by applying firm pressure using a clean
piece of cloth.
 Circular bandage can apply proximal to the wound in order to stop bleeding.
 If the wound is very dirty, it is washed with clean tap water and covered with a
clean cloth.
 The fracture is splinted
Treatment of Fracture (Emergency Care) contd…

In the emergency department

 Basic life support
 Bleeding is recognized and stopped by local
pressure.
 Wooden plank, Cramer-wire splint, Thomas’ splint,
inflatable splint are some of the splints used in
emergency department.
 After emergency care is provided, suitable
radiological and other investigations are carried out.
Surgical Management
Reduction:
Reduction of a fracture (setting the bone) refers
to restoration of the fracture fragments to
anatomic alignment and rotation. Reduction of a
fracture can be carried out by following methods
1) Closed Reduction:
• Nonsurgical, manual realignment of bone
fragments to their previous anatomic position.
• Traction and counter traction are manually
applied to the bone fragments
• This is usually performed under local or general
anesthesia.
Open reduction:
 It is a surgical approach by which the fracture fragments are reduced.
 It usually includes internal fixation of the fracture with the use of
wires, screws, pins, plates, intra medullary rods or nails.
Splint and Braces
 Splint: Splints are often used for simple and stable fractures., sprains,
tendon injuries, and other soft tissue injuries. They offer many
advantages over casts in that they are faster and easier to apply.
Splints are easily removed, facilitating inspection of injury site.
FRACTURE REDUCTION
Braces: Braces are used to provide support,
control movement and prevent additional
injury. They are custom fitted to various parts
of the body; thus, they tend to be indicated for
longer term use than splints.
Traction
The two most common types of traction are
Skin Traction and Skeletal Traction
Purposes of Traction
Prevent or reduce muscle spasm
Immobilize a joint or part of the body
 Pain Relief
Treat a pathologic condition
Skin Traction:
 It is generally used for short term treatment (48
to 72 hours) until skeletal traction or surgery is
possible.

 The traction weights are usually limited to 2.3 to

4.5 kg.
 Pelvic or cervical skin traction may require
heavier weights applied intermittently.
Skeletal Traction
 Provides long term pull that keeps the injured
bones and joints aligned.
 Applied directly on the bone by inserting K-wire or
Steinmann pin through the bone to align and
immobilize the injured body part.

 Weightfor skeletal traction ranges from 2.3 to

20.4 kg. The use of too much weight can result in
delayed union or non-union.
Principles Of Effective Traction

 Traction must be continuous to be effective in reducing and

immobilizing fractures.

 Weights are not removed unless intermittent traction is

prescribed

 The patient must be in good body alignment should be in the

center of the bed when traction is applied
Cast
 A cast is a rigid external immobilizing device that is
molded to the contours of the body.
 The purposes of a cast are to immobilize a body part
in a specific position and to apply uniform pressure
on encased soft tissue.
Types of Cast

 Short arm cast: Extends from below the elbow to the

palmar crease, secured around the base of the thumb.
 Ifthe thumb is included, it is known as a thumb spica
or gauntlet cast.
 Long arm cast: Extends from the upper level of
the axillary fold to the proximal palmar crease .
 Short leg cast: Extends from below the knee to
the base of the toes
 Long leg cast: Extends from the junction of the
upper and middle third of the thigh to the base of
the toes
 Walking cast: A short or long leg cast reinforced for
strength.

to immobilize the movement of the ankle when walking.
Body cast: Encircles the trunk of the body
Shoulder spica cast: A body jacket that
encloses the trunk and the shoulder and
elbow.
Hip spica cast: Encloses the trunk and a lower
extremity.
Nursing Management
 Administer drug therapy as ordered by health care provider
 Report the diagnosis to the local health department
 Focus on preventing the spread of the infection
 Discuss pain management, handling fatigue, importance of
good nutrition
 Ensuring effective skin traction
 Monitoring and managing potential complication
 Maintaining positioning
 Promoting exercises
Nursing Diagnosis

 Acute Pain is a primary concern post- fracture,

often due to tissue injury and muscle spasms.

 Impaired Physical Mobility

 Risk for Infection

 Risk for Compartment Syndrome

Complications
Local Complications
 Infection
 Vascular injury – Injury to a blood vessel
 Nerve injury - Nerves are fragile and can be damaged by
pressure, stretching, or cutting
 Visceral injury – Damage of the internal organs of the
body
 Hemarthrosis - Bleeding inside a joint.
 Compartment syndrome - A painful and dangerous
condition caused by pressure build-up from internal
bleeding or swelling of tissues.
General Complications
Hemorrhage and shock
Fat embolism
Venous thrombosis and pulmonary embolism
Complications of prolonged bed rest and
recumbency especially in elderly and aged
patients. Eg., DVT, bedsores, etc
Summary

During this class we have discussed about the

definition, causes, types, pathophysiology, clinical

manifestations, diagnostic measures, treatment

medical and nursing management of Fracture.

Thank You