FRACTURE

Lhakpa Tshering
Lecturer, AAHS
 Objectives:
At the end of this session, an individual
should be able to know:
Meaning/definition of fracture
Types of fracture
Causes and risk factors for fracture
Signs and Symptoms of fracture
Diagnosis of fracture
Management of fracture (medical, surgical

and nursing)
Preventive measures
 Introduction
Fractures are broken bones. Fractures

can occur from trauma such as motor

vehicle accidents, age-related conditions
like osteoporosis or from overuse such as
stress fractures in athletes.
Fracture can be open and closed as well

as partial and full bone fracture.

 Definition
Fracture is a medical condition in which
there is a partial or complete break in
the continuity of a bone in the body.
Types of bone fracture.
I. Closed fracture : If the injury doesn’t
break /open the skin.
II. Open/ compound fractures :If the
injury breaks the skin and open.
 Classifications
Fracture are classified based on its
characteristics
I. Complete fractures: The break goes
completely through the bone, separating
it into two.
II. Displaced fractures: A gap forms where
the bone breaks. Often, this injury
requires surgery to fix.
III. Partial fractures: The break doesn’t go all
the way through the bone.
IV. Stress fractures: The bone gets a crack
(small line) in it, which is sometimes tough
to find
V. incomplete / greenstick fracture: When
the bone cracks and bends but does not
completely break.
VI. Avulsion: A tendon or ligament pulls part
of the bone off(tearing of the bone)
VII. Comminuted: The bone shatters into
several different pieces.
VIII. Compression: The bone gets crushed
or flattened.
IX. Oblique: The break goes diagonally
across the bone.
X. Spiral: The fracture spirals around the
bone.
XI. Transverse: The break goes in a straight
line across the bone.
Causes:
Fractures commonly happen because of

car accidents, falls, or sports injuries.

Other causes are low bone density and

osteoporosis, which cause weakening of

the bones.
Stress fracture
Most fractures are caused by a bad fall.
Signs and Symptoms
Symptoms of a bone fracture can vary
wildly depending on the affected region,
severity and the type of bone affected,
the patient’s age and general health, as
well as the severity of the injury.
However, they often include some of the
following:
Intense pain
Swelling
Bruising
Discolored skin around
the affected area
Angulation :(the affected

area may be bent at an

unusual angle)
The patient is unable to

put weight on the

injured area
The patient cannot

move the affected area

The affected bone or joint may have a
grating sensation
If it is an open fracture, there may be

bleeding
When a large bone is affected, such as the

pelvis or femur:
 The sufferer may look pale and clammy.
 There may be dizziness (feeling faint).
 Feelings of sickness and nausea.
 Diagnosis:
Physical examination
(Identify signs and
symptoms)
History collection
X-ray.
MRI and
CT scan.
 Treatment
Bone heals in five stages, two phases
Initial treatment is same to dislocation( RICE
and Medication)
Primary phase:
I. Hematoma
II. Inflammation.
III. Soft callus
Secondary phase:
IV. Hard callus
V. Remodeling
Treatment also focuses on
providing the injured bone with
the best for optimum healing.
Reduction: For the natural

healing process to begin, the

ends of the broken bone need
to be lined up. Fracture
reduction may be done by
manipulation, closed reduction
(pulling the bone fragments), or
surgery, open reduction.
Immobilization :as soon as the bones are
aligned they must stay aligned while they
heal. This may done through bandaging,
plaster casting(PoP) and splinting like
fixation.
Fixation can be of :
Internal: intramedullary fixation involves

the use of devices internally (under the

skin) positioned within the patient's body
like special screws, plates,
rods, wires, or nails that your surgeon
places inside the bones to fix them in
the correct place.
External: The devices are screwed

into fractured bones to exit the skin

and are attached to a stabilizing
structure outside the body like
metal pins or screws are placed into the
bone through small incisions into the
skin and muscle. The pins and screws are
attached to a bar outside the skin.
External fixation is done, if internal

fixation is not possible or not preferred.

Delayed unions and non-
unions
 Non-unions are fractures

that fail to heal, while

delayed unions are those
that take longer to heal.
 Ultrasound therapy:

low-
intensity ultrasound is
applied to the affected
area daily.
 Surgery
Bone graft : if the fracture does not heal,

a natural or synthetic bone is

transplanted to stimulate the broken
bone.
Stem cell therapy :studies are currently

underway to see whether stem cells can

be used to treat fractures that do not
heal.
 Rehabilitation:
 Nursing management
Nursing Diagnosis and interventions
I. Acute pain related to movement of
bone fragments/edema/ injury to the
soft tissue as evidenced by Reports of
pain,
 Assess and record the patient’s level of

pain using pain score scale.

 Provide pain management

(pharmacological and non-

pharmacological)
 Encourage the patient to discuss
problems related to the injury.
 Maintain immobilization of affected
part using bed rest, cast, splint,
traction.
 Elevate and support injured extremity.
 Prescribed the medication as per the
prescribed.
Support fracture site with pillows or
folded blankets.
 Maintain a neutral position of the

affected part with sandbags, splints and

footboard.
 Use sufficient personnel when turning.
II. Impaired physical mobility related to
Neuromuscular skeletal impairment;
pain/discomfort; restrictive therapies
(limb immobilization) as evidenced by
Inability to move purposefully within the
physical environment, imposed
restrictions
 Assess the degree of immobility

produced by injury or treatment and

note the patient’s perception of
immobility.
Teach patient or assist with active and
passive ROM exercises of affected and
unaffected extremities.
Provide and assist with mobility aids such

as wheelchairs, walkers, crutches, and

canes.
III. Self-Care Deficit related to physical
limitations (immobilizers) as evidenced
by inability to do activities of daily
living(ADL)
Assess the self-care limitations of the

patient.
Initiate an efficient exercise regimen that

will promote endurance, strength,

and improvement of muscle groups
necessary for the particular activity
deficit of the patient.
Instruct significant others how to assist

the patient during self-care activities.

IV. Risk for falls related to loss of skeletal
integrity (fractures)/movement of bone
fragments.
Maintain bed rest or limb rest as

indicated. Provide support of joints

above and below the fracture site,
especially when moving and turning.
Secure a bed board under the mattress

or place the patient on the orthopedic

bed.
V. Risk for infection related to surgical
procedure( screw, pins and open
incisions).
Inspect the wound( surgical sit), metal

plates, screws and whole systems for sign

of infection.
Follow the strict aseptic procedures.
Educate the advocate the Patient and

attendant about the hygiene.

Administer anti-biotic as per the

prescribed.
THANK YOU