Fracture
- 2. Definition ā¢ A fracture is a break in the continuity of bone. ā¢ Fracture is a break in any bone in the body.
- 3. Causes of fracture direct blows crushing forces sudden twisting motions extreme muscle contractions
- 4. Types of fracture a. Complete fracture : a break across the entire cross-section of the bone. b. An incomplete fracture the break occurs through only part of the cross-section of the bone.
- 5. a. Closed fracture (simple fracture) is one that does not cause a break in the skin. b. An open fracture (compound, or complex, fracture) is one in which the skin or mucous membrane wound extends to the fractured bone. Open fractures are graded according to the following criteria: ā¢ Grade I is a clean wound less than 1 cm long. ā¢ Grade II is a larger wound without extensive soft tissue damage. ā¢ Grade III is highly contaminated, has extensive soft tissue damage, and is the most severe.
- 6. CLASSIFICATION According to the Anatomical placement
- 7. Greenstick fracture A fracture in which one side of a bone is broken while the other is bent (like a green stick).
- 8. Spiral Fracture A fracture, sometimes called torsion fracture, in which a bone has been twisted apart.
- 9. Comminuted Fracture A fracture, in which bone is broken, splintered or crushed into a number of pieces.
- 10. Transverse Fracture A fracture, in which the break is across the bone, at a right angle to the long axis of the bone.
- 11. Compound Fracture A fracture in which the bone is sticking through the skin. Also called an open fracture.
- 12. Compression Fracture A fracture caused by compression, the act of pressing together. Compression fractures of the vertebrae are especially common with osteoporosis.
- 13. Other fracture ā¢ Avulsion: fracture which occurs when a fragment of bone tears away from the main mass of bone. ā¢ Depressed: A fracture in which fragments are driven inward (seen frequently in fractures of skull and facial bones)
- 14. ā¢ Pathologic: it occurs through an area of diseased bone (eg, osteoporosis, bone cyst, bony metastasis, tumor); can occur without trauma or a fall ā¢ Stress: A fracture that results from repeated loading without bone and muscle recovery
- 15. Pathophysiology Due to any etiology(crushing movement) | Fracture occurs , muscle that were attached to bone are disrupted and cause spasm | Proximal portion of bone remains in place, the distal portion can become displaced in response to both causative force & spasm in the associated muscles
- 16. In addition, the periosteum and blood vessels in the cortex and marrow are disrupted | Soft tissue damage occurs, leads to bleeding and formation of hematoma between the fracture fragment and beneath the periosteum | Bone tissue surroundings the fracture site dies, creating an intense inflammatory response
- 17. release chemical mediators histamins,prostaglandins | Resulting in vasodilation, edema, pain, loss of function, leukocytes and infiltration of WBC
- 18. Clinical manifestations ā¢ pain ā¢ loss of function ā¢ deformity ā¢ shortening ā¢ crepitus ā¢ swelling and discoloration
- 19. Diagnosis of fracture ā¢ History collection ā¢ Physical examination ā¢ X ray ā¢ CT scan ā¢ MRI scan
- 21. MEDICAL /SURGICAL MANAGEMENT OF FRACTURES: 1.Reduction Reduction of a fracture (āsettingā the bone) refers to restoration of the fracture fragments to anatomic alignment and rotation. Itās a surgical approach, the fracture fragments are reduced. External/Internal fixation devices (metallic pins, wires, screws, plates, nails, or rods) may be used to hold the bone fragments in position until solid bone healing occurs.
- 24. Difference between internal or external fixation
- 25. Closed reduction ā¢ closed reduction is accomplished by bringing the bone fragments into apposition (ie, placing the ends in contact) through manipulation and manual traction. ā¢ Extremity is held in the desired position while the physician applies a cast, splint, or other device. ā¢ X - rays are obtained to verify that the bone fragments are correctly aligned. ā¢ Traction (skin or skeletal) may be used to effect fracture reduction and immobilization.
- 26. 2.Immobilization ā¢ Immobilization may be accomplished by external or internal fixation. ā¢ Methods of external fixation include bandages, casts, splints, continuous traction, and external fixators. ā¢ Metal implants used for internal fixation serve as internal splints to immobilize the fracture.
- 27. Traction Traction is the use of weights, ropes and pulleys to apply force to tissues surrounding a broken bone.
- 28. Traction 1. Skin traction- ā¢ Bucks traction used for knee,hip bone fracture ā¢ Weight usually 5-7 pounds attach to skin 2. Skeletal traction ā ā¢ Needs invasive procedure ā¢ Weight is upto 10 kg attached to bone
- 29. ā¢ Splinting is the most common procedure for immobilizing an injury. Splinting
- 30. ā¢ To stabilize the extremity Why Do We Splint? ā¢ To decrease pain ā¢ Actually treat the injury
- 31. ā¢ Soft materials. Towels, blankets, or pillows, tied with bandaging materials or soft cloths. ā¢ Rigid materials. A board, metal strip, folded magazine or newspaper, or other rigid item. Possible items for Splinting
- 32. ā¢ Splinting Using a Towel ā¢ Splinting using a towel, in which the towel is rolled up and wrapped around the limb, then tied in place. Soft Splints
- 33. 1. Support the injured area. 2. Splint injury in the position that you find it. 3. Donāt try to realign bones. 4. Check for color, warmth, and sensation. 5. Immobilize above and below the injury. Guidelines for Splinting
- 34. The splint should go beyond the joints above and below the fractured or dislocated bone to prevent these from moving
- 36. 3. Maintaining and restoring function ā¢ Restlessness, anxiety, and discomfort are controlled with a variety of approaches, such as reassurance, position changes, and pain relief strategies, including use of analgesics. ā¢ exercises are encouraged to minimize disuse atrophy and to promote circulation. ā¢ Participation in activities of daily living (ADLs) is encouraged to promote independent functioning and self-esteem.
- 37. ā¢ Do not draw exposed bones back into tissue. Treating an Open Fracture
- 38. DO: ā¢ Cover wound. ā¢ Splint fracture without disturbing wound. ā¢ Place a moist 4" x 4" dressing over bone end to prevent drying. ā¢ Assist the surgeon in debridement of wound Treating an Open Fracture
- 39. Complication of fracture Early complications ā¢ Shock ā¢ fat embolism ā¢ compartment syndrome ā¢ deep vein thrombosis ā¢ disseminated intravascular coagulopathy ā¢ infection
- 40. Delayed complications ā¢ delayed union and nonunion ā¢ avascular necrosis of bone ā¢ reaction to internal fixation devices
- 41. Compartment syndrome ā¢ develops when tissue perfusion in the muscles is less than that required for tissue viability. ā¢ patient complains of deep, severe pain, which is not controlled by opioids.
- 42. Compartment syndrome ā¢ Reduction in size of muscle compartment ā¢ It increase pressure in the muscle compartment ā¢ Reduce microcircualtion,leads to muscle and nerve anoxia and necrosis
- 43. FAT EMBOLISM SYNDROME ā¢ occurs most frequently in young adults ā¢ fat globules may move into the blood because the marrow pressure is greater than the capillary pressure ā¢ usually occurring within 24 to 72 hours
- 44. NURSING MANAGEMENT Patients with closed fractures: ā¢ Encourage patient not to mobilize fracture site. ā¢ exercises to maintain the health of unaffected muscles for using assistive devices (eg, crutches, walker).
- 45. ā¢ teach patients how to use assistive devices safely. ā¢ Patient teaching includes self-care, medication information, monitoring for potential complications, and the need for continuing health care supervision.
- 46. Patients with open fractures: ā¢ administers tetanus prophylaxis if indicated. ā¢ wound irrigation and debridement in the operating room are necessary. ā¢ Intravenous antibiotics are prescribed to prevent or treat infection. ā¢ wound is cultured.
- 47. ā¢ fracture is carefully reduced and stabilized by external fixation or intramedullary nails. ā¢ Any damage to blood vessels, soft tissue, muscles, nerves, and tendons is treated. ā¢ Heavily contaminated wounds are left unsutured and dressed with sterile gauze to permit swelling and wound drainage.
- 48. Care of client with cast Before application of a cast preparation of the client includes: ā¢ Detailed explanation of the procedure ā¢ Skin preparation involves through cleansing of the skin ā¢ Presence of unremovable particle or dust should be reported to the physician ā¢ Roll the cast material are individually submerged in clean water and excess water is squeezed from the roll ,apply bandage is applied to encircle the injured the body parts
- 49. ā¢ As the water evaporates the cast will dry ā¢ plaster cast generates while drying so instruct patient for heat sensation ā¢ Do not cover the cast ā¢ Windowing or bivalving a cast means cutting a cast along both sides then splitting it to decrease pressure on underlying tissue. ā¢ Window may also be cut into cast to allow the physician or nurse to visualize wounds under the cast or removes drains.
- 50. Windowing
- 51. ā¢ Neurovascular assessment: It should be performed every 30 minutes for 4 hours. ā¢ Assess the cast extremity for color, warmth, pulse distal to the cast, capillary refill. ā¢ Movement of the distal fingers or toes, awareness of light touch distal to the cast, change in the sensation. ā¢ Assessment of the pain: Assess the degree of pain
- 52. ā¢ Assessment of the cast: The skin around the cast edges should be observed for damage or swelling. āHot spotsā areas of the cast that feel warmer than other section may indicate tissue necrosis or infection under the cast. āWet spotsā may indicate drainage under the cast
- 53. Care of external fixation ā¢ Assessment- pain, nerve supply,infection,pin site etc. ā¢ Small bleeding from pin site is normal ā¢ Critical, If extend more than 24 hours ā¢ Administer antibiotics, analgesic medicine
- 54. Care of traction ā¢ Assessment ā skin breakdown, pain, neurovascular ,constipation ā¢ Stool softner ā¢ Plenty of fluids ā¢ Provide bedpan and urinals for elimination ā¢ Encourage clients activity
- 56. Acute pain related breakdown of continuity of the bone as evidenced by facial expressions and verbalization of patient. ā¢ Goals: Patient will not feel pain ā¢ Intervention: ā¢ Assess the onset, duration, location, severity and intensity of pain. ā¢ Administer the analgesic according to physician order. ā¢ Provide comfort devices like sand bags for immobilization of affected parts. ā¢ Provide diversion therapy
- 57. Impaired physical mobility related to application of traction or cast as evidenced by assessment ā¢ Goal: Patient will able to move unaffected area. ā¢ Intervention: ā¢ Provide range of motion exercises to the patient. ā¢ Assist the patient in ambulation after recovery of fracture. ā¢ Provide assistance while using walker or crutches if required. ā¢ Prevent from complication which usually occurs due to immobility. ā¢
- 58. Self care deficit related to fracture as evidenced by poor personal hygiene. ā¢ Goal: Patient will maintain the personal hygiene ā¢ Intervention: ā¢ Assess the need of self care ā¢ Encourage the patient or relatives to do self care activity ā¢ Head to foot care to be provided to the patient. ā¢ Educate about importance of maintaining personal hygiene.
- 59. Imbalanced nutrition less than body requirement relate to increase demand of nutrient for bone healing as evidenced by observation. ā¢ Goal: Maintain the nutritional status of the patient ā¢ Intervention: ā¢ Assess the nutritional status by intake/output chart, biochemical measures, body mass. ā¢ Maintain intake output chart daily. ā¢ Encourages the patient to take protein rich diet. ā¢ Plenty of fluids and frequent intake of meal is necessary. ā¢ Try to assess the daily weight of the client
- 60. References ā¢ Joyce M. Black Jane Hokanson, medical surgical nursing,7th edition, Elsevier publication, volume 1,page no. 619-651 ā¢ Suddarthās & burnner, text book of medical surgical nursing, eleventh edition,Wolters publication, Page no. 2079 -2104 ā¢ www.authorstream.com ā¢ www.slideshare.com