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    Bone Fractures

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    gwyn
    A report about Bone Fractures its types, classifications, diagnosis, managements and possible diagnosis.

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    Bone Fractures

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    gwyn
    130 views26 pages
    A report about Bone Fractures its types, classifications, diagnosis, managements and possible diagnosis.

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    A report about Bone Fractures its types, classifications, diagnosis, managements and possible diagnosis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    130 views26 pages

    Bone Fractures

    Uploaded by

    gwyn
    A report about Bone Fractures its types, classifications, diagnosis, managements and possible diagnosis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 26

    RLE 116

    BONE
    FRACTURES

    By: Buday, Gwyneth Nicole C.


    Topic Outline
    Definition
    Causes of Fracture
    Types of Bone Fractures
    Classification of Bone Fractures
    Pathophysiology
    Clinical Manifestations
    Diagnosis
    Medical Management
    Nursing Management

    TODAY'S
    DISCUSSION
    FRACTURE
    A complete or incomplete disruption of the
    continuity of the bone structure and is
    defined according to its type and extent.
    Causes of Fracture

    DIRECT CRUSHING
    BLOWS FORCES

    EXTREME
    SUDDEN
    MUSCLE
    TWISTING
    CONTRAC-
    MOTIONS TIONS
    Types of fracture

    Complete fracture
    a break across the entire cross-section of the
    bone.

    An incomplete fracture
    the break occurs through only part of the cross-
    section of the bone
    Types of fracture
    Closed fracture
    (simple fracture) is one that does not cause a brek
    in the skin

    An open fracture
    (compound, or complex, fracture) is one in which
    the skin or mucous membrane wound extends to
    the fractured bone.
    open fracture are graded according to the
    following criteria:
    Grade I is a clean wound less that 1 cm long.
    Grade II is a larger wound without extensive
    soft tissue damage.
    Grdae III is highly contaminated, has extensive
    soft tissue danage, and is the most severe.
    CLASSIFICATION
    ACCORDING TO
    THE ANATOMICAL
    PLACEMENT
    Avulsion Compression
    A fracture in which
    A fracture in which bone has
    fragments of bone has Comminuted been compressed (seen in
    term-15been pulled away by A fracture in which bone was several vertebral fractures)
    a tendon and its attachment splintered into several
    fragments
    Depressed
    A fracture in which Greenstick
    fragments are driven inward
    A fracture in which other
    (seen frequently in fractures Epiphyseal side of the bone is broken
    of skull and facial bones) A fracture through the epiphysis and the other side is bent
    Impacted Open
    A fracture in which a bone
    Oblique A fracture in which damage
    A fracture occuring at an angle also involves the skin or
    fragment is driven into
    across the bone (less stable mucous membranes, also
    another bone fragment
    then a transverse fracture) called a compound fracture
    Pathologic
    A fracture that occurs through an
    area of disease bone (e.g., Simple Spiral
    osteoporosis, bone cyst, Paget Afracture that remians
    disease, bony metastasis, A fracture that twist around
    contained, with no disruption of
    tumor); can occur without trauma the shaft of the bone
    the skin integrity
    or fall.
    Stress Transverse
    A fracture that results from repeated A fracture that is straight across the bone
    loading of bone and muscle shaft
    PATHOPHYSIOLOGY
    Due to any etiology (crushing movement)
    I
    Fracture occurs, muscle that were attached to the bone are disrupted and cause
    spasm.
    I
    Proximal portion of the bone remains in place, the distal portion can become
    displaced in response to both causative force & spasm in the associated muscles.
    I
    In addition, the periosteum and blood vessels in the cortex and marrow are
    disrupted
    I
    Soft tissu damage occurs, leads to bleeding and formation of hematoma between
    the fracture fragment and beneath the periosteum
    I
    Bone tissue surrounding the fracture site dies, creating an intense inflammatory
    response
    I
    Release chemical mediators histamins, prostaglandins
    I
    Resulting in vasodilation, edema, pain, loss of function, leukocytes and
    infiltration of WBC
    CLINICAL MANIFESTATIONS
    pain
    loss of function
    deformity
    shortening
    crepitus
    localized edema and ecchymosis
    DIAGNOSIS OF FRACTURE
    History collection
    Physical examination
    X-ray
    CT scan
    MRI scan
    MANAGEMENT
    MEDICAL/SURGICAL
    MANAGEMENT OF FRACTURES:
    1. Reduction
    refers to restoration of the fracture fragments to anatomic alignment
    and positioning.
    a. Open reduction - Its a surgical approach,
    in which the fracture fragments are
    reduced.
    Internal fixation - Involves the use of
    devices internally (under the skin)
    positioned within the patient's body.
    External fixation - The devices are
    screwed into fractured bones to exit
    the skin and are attached to a
    stabilizing structure outside the
    body.
    b. Closed reduction - is accomplished by bringing the bone fragments into
    anatomic alignment through manipulation and manual traction. The extremity is
    held in the aligned position while a cast, splint, or other device is applied.
    Traction - may be used until the patient is physiologically stable to
    undergo surgical fixation.

    2. Immobilization - It is done after the fracture has been reduced to


    immobilized and maintained bone fragments in proper position and alignment
    until union occurs. May be accomplished by external or internal fixation.
    Methods used:
    External fixation including bandages, casts, splints, continous traction,
    and external fixators.
    3. Maitaining and restoring functions
    Reduction and immobilazation are mainatained
    Edema is controlled
    Neurovascular status is monitored
    Restlessness, anxiety and discomfort are controlled
    Isometric and muscle setting exercise are encouraged
    Participation in activities of daily living (ADLs)
    Gradual presumption of actvotirs is promoted
    Complication of fracture
    Early complications
    Shock
    Fat embolism
    Acute compartment syndrome
    Deep vein thrombosis (DVT)
    Pulmonary embolism
    Disseminated intravascular coagulapathy (DIC)
    Infection
    Complication of fracture
    Late complications
    Delayed union
    Malunion
    Nonunion
    AVN of bone complex regional pain syndrome (CRPS)
    Heterotropic ossification
    NURSING MANAGEMENT/INTERVENTION
    After a fracture confirm the patient is safe (out of harm’s way) and stable then…..
    Immobilize the fracture by using a device to splint it:
    Stop bleeding, if present, by applying pressure with a clean cloth.
    If the fracture is an opened “compound” fracture, cover with sterile dressing!
    Elevate extremity to decrease swelling.
    Apply ice wrapped in towel to the injury to decrease swelling
    Keep NPO (nothing by mouth) until evaluated by surgeon…may need surgery.
    X-ray will be ordered to diagnose a possible fracture and what type.
    Pain management with prescribed medications
    Monitor for fat embolism , especially if this is a long bone fracture: Assess mental
    status and respiratory system: confusion, restless, increased respiration, difficulty
    breathing
    Assess neurovascular status! Assess the 6 P’s
    It should be be performed every 20 minutes for 4 hours
    NURSING DIAGNOSIS
    Acute pain related to breakdown of continuity of the bone as evidenced
    by facial expressions and verbalization of pain by patient
    Impaired physical mobility related to application of traction or cast as
    evidenced by loss of skeletal integrity
    Self-care deficit related to fracture as evidenced by poor personal
    hygiene
    REFERENCE
    Ratheeshkrishnakripa. (2019) Fracture.
    https://www.slideshare.net/Ratheeshkrishnakripa/fracture-153978230

    Hinkle J., Cheever K., & Overbaugh K., (2022). Bunner & Suddarth's
    Textbook of Medical-Surgical Nursing, fiftenth edition. Wolters Kluwers
    publication, Volume 1, Page no. 1157-1169.

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