 Closed/simple fracture

Fracture Does not cause a break in the skin.

 Open/compound fracture
A break in the continuity of the bone and is defined
A fracture that causes a break in the skin
according to its type and extent.
Other Types of Fractures
Cause
 Avulsion
 Occurs when the bone is subjected to stress  Comminuted
greater than it can absorb
 Compound
 Severe mechanical stress to bone - bone
 Compression
fracture
 Depressed
 Direct Blows
 Greenstick
 Crushing forces
 Impacted
 Sudden twisting motion
 Oblique
 Extreme muscle contraction
 Pathologic
Clinical manifestations of fractures
 Simple
 Pain  Stress
Continuous and increases in severity until
 Spiral
the bone fragments are immobilized.  Transverse
 Loss of function
Avulsion
B/c normal function of the muscles depends
A fracture in which a fragment of bone has
on the integrity of the bones to which they
been pulled away by a tendon and its attachment.
are attached
Comminuted
Pain contributes to the loss of function
A fracture in which bone has splintered into
 Crepitus
several fragments.
Crumbling sensation felt caused by the
Compression
rubbing of the bone fragment against each
A fracture in which bone has been
other
compressed (seen in vertebral fractures).
 Localized edema and ecchymosis
Depressed
Localized edema & ecchymosis occur after
A fracture in which fragment are driven
a fracture as a result of trauma & bleeding
inward (seen frequently in fractures of skull and
into the tissue
facial bones)
 Deformity
Greenstick
Displacement, angulations, or rotation of
A fracture in which one side of a bone is
the fragments
broken and the other side is bent.
 Shortening
Impacted
B/c of the compression of the fractured
A fracture in which a bone fragment is
bone.
driven into another bone fragment.
Muscle spasms can cause the distal &
Oblique
proximal site of the fracture to overlap,
A fracture occurring at an angle across the
causing the extremity to shorten.
bone.
Spiral
 Diagnosis of Fracture
A fracture that twists around the shaft of the
 Clinical: history of trauma bone.
 Pain, swelling, inability to use the injured Stress
part - Tenderness, swelling and bruising A fracture that results from repeated loading
 Deformity, abnormal movement (sure sign without bone and muscle recovery.
of fracture) Transverse
 X-ray: A suspected fractured bone should A fracture that is straight across the bone
be X-rayed. shaft
 X-ray should be taken in at least two Emergency Management
planes (AP and lateral) Apply sling if forearm fracture is suspected
or the suspected fractured arm may be bandaged
Types of Fractures to the chest.
 Complete fracture Open fracture is managed by covering a
Involves a break across the entire cross- clean/sterile gauze to prevent contamination
section DO NOT attempt to reduce the fracture.
 Incomplete fracture
The break occurs through only a part Reduction
of the cross-section
Refers to restoration of the fracture fragments to  Body cast
anatomic alignment and rotation  Shoulder spica cast
1. Closed Reduction  Hip spica cast
2. Open Reduction
Short-Arm Cast
 Closed Reduction  Extends from below the elbow to the palmar
Is accomplished by bringing the bone crease, secured around the base of the thumb
fragments into proper position through  If thumb is included, it is known as thumb spica
manipulation and manual traction or gauntlet cast
 Open Reduction Short arm posterior mold
This is done through a surgical approach  Fracture of the wrist, carpals & metacarpals
Internal fixation devices ( metallic pins, with open wound, swelling & infection
wires, screws, plates, nails or rods ) may be Purpose:
used to hold the bone fragments in position - To change dressing
until solid bone healing occurs. - To adjust the elastic bandage
- To assess presence of infection & swelling
Immobilization
After the fracture has been reduced, bone Long-Arm Cast
fragments must be immobilized or held in the  Extends from the axillary fold to proximal
correct position and alignment through external and palmar crease
internal fixations.  The elbow usually is immobilized at a right
Ex. External fixation (bandages, casts, angle
splints, tractions) Fuenster’s cast/Munster cast
 Fracture of radius/ulna with callus formation
Nursing Management Long arm posterior mold
 Patients with closed Fractures  Fracture of radius/ulna with open wound,
 Encourage to return to their usual activities swelling or infection
as rapidly as possible Short-Leg Cast
 Encourage exercises to maintain the  Extends from below the knee to the base of the
health of unaffected muscles and to toes
increase strength  The foot is flexed at a right angle in a neutral
 Teach how to use assistive devices safety position
 Patient teaching include self care, Short leg cast
medication information, monitoring for  Fracture of ankle, tarsals & metatarsals
potential complication Patellar tendons bearing cast
 Patient with Open Fracture  For fracture of tibia fibula with callus formation
 Objectives of management is to prevent Delvit cast
infection and to promote healing of soft  Fracture of distal 3rd of tibia with callus
tissue and bone formation
 Nurse administers tetanus prophylaxis if Boot leg
indicated  For post poliomyelitis with residual paralysis
 Nurse elevates the extremity to minimize Internal rotator splint or board
edema  Fracture with post op hip surgery
 Assess neurovascular status frequently  To maintain abduction & prevent internal
 Assess temperature at regular interval and rotation
monitor for signs of infection  With pillow in between legs
Short leg posterior mold
Musculoskeletal Modalities  Fracture of ankle, tarsals & metatarsals with
 Cast OSI
A rigid external immobilizing device molded Long leg cast
to contours of body part  Extends from the junction of the upper and
 Traction middle third of the thigh to the base of the toes;
Application of a pulling force to a part of the the knee may be slightly flexed.
body  Fracture of tibia fibula
Cylindrical leg cast
Type of Cast  Fracture of patella
 Short-arm cast Quadrilateral/Ischial weight bearing cast
 Long-arm cast  Fracture of femur with callus formation
 Short-leg cast
 Walking cast
Cast brace 2. Handle a wet cast with the palms not the
 Fracture of distal 3rd of femur with callus fingers
formation & proximal 3rd of tibia fibula 3. Keep the casted extremity elevated using a
Long leg posterior mold pillow
 Fracture of tibia fibula with open wound, 4. Petal the edge of the cast to prevent crumbling
swelling and infection (ISO) of the edges
Basket cast 5. Examine the skin for pressure areas and
 Fracture of patella with massive bone injury regularly check the pulses and skin
Walking cast 6. Instruct the patient not to place sticks or small
 A short or long leg cast reinforced for strength objects inside the cast
Body cast
7. Monitor for the following: pain, swelling,
 Encircles the trunk discoloration, coolness, tangling or lack of
 For lower dorsolumbar injuries sensation and diminished pulses
Hanging cast
 Fracture of the shaft of humerus
 Hot spots occurring along the cast may
Functional arm cast
indicate infection under the cast
 Fracture of the shaft of humerus with callus
 A patient’s unrelieved pain must be
formation
immediately reported to avoid possible
 Allows abduction & adduction
paralysis and necrosis.
Shoulder Spica Cast
 A body jacket that encloses the trunk and the Traction
shoulder and elbow
 Is the application of a pulling force to a part of
 Fracture of upper portion of humerus & the body
shoulder joint
 Is used to minimize muscle spasms; to reduce,
Airplane cast
align and immobilize fractures; to reduce
 Fracture of neck of humerus deformity; and to increase space between
 Fracture with recurrent shoulder dislocation opposing surfaces
Hip Spica Cast
 Enclose the trunk and a lower extremity; a Principles of Effective Traction
double hip spica cast includes both legs  Traction must be continuous to be effective in
One & one half hip spica cast reducing and immobilizing fractures
 Fracture of ½ hip femur  Skeletal traction is never interrupted
Unilateral hip spica cast  Weight are not removed unless intermittent
 Fracture of 1 hip & 1 femur traction is prescribed
Pantalon cast  Any factor that might reduced the effective pull
 For pelvic fracture or alter its resultant line of pull must be
 At level of knees with abduction eliminated
Frog cast  The patient must be in good body alignment in
 Congenital hip dislocation the center of the bed when the traction is
Double hip spica posterior mold applied
 Fracture of both hips & both femur with OSI  Ropes must be unobstructed
One & one half hip spica posterior mold  Weight must hang freely and not rest on the
 Fracture of 2 hips & 1 femur bed or floor
Single hip spica posterior mold  Knots in the ropes or the footplate must not
 Fracture 1 hip or 1 femur with OSI touch the pulley or the foot of the bed
 Pelvic bone with callus formation
Types of traction
Casting Materials  Skin traction
 Non Plaster  Buck’s extension traction
 Fiberglass cast; lighter, stringer, water  Bryant’s traction
resistant and durable  Russell’s traction
 Dries in 20-30 minutes  Skeletal traction
 Plater  Gardner wells tongs
 Traditional cast - plaster of paris  Cruthfield tongs
 Requires 24 to 72 hours to dry completely  Balance suspension traction
 Halo jacket
CAST: General Nursing Care
1. Allow the cast to air dry ( usually 24 - 72 Skin Traction
hours )
  Is used to control muscle spasms and to  External skull traction device used to provide
immobilize an area before surgery stabilization/immobilition of cervical
 This is accomplished by using a weight to spine;Consists of metal/semi-metal arc with2
pull on traction tape or on a foam boot insertion pins attached.
attached to the skin
Crutchfield tongs
Skin Traction  For fracture of cervical spine.
2 types  C1-C5 cervical spine tension.
1. Non-adhesive type - uses laces, buckles,  Use for 4 weeks.
leather & canvas
 Ex. Head halter strap Vinke’s skull caliper
2. Adhesive type - uses adhesive tape or elastic  C1-C5 cervical spine tension.
bandages  Use for 4 weeks
 Ex. Dunlop skin traction
Halo-pelvic traction
Buck’s Extension Traction  For scoliosis
 It is used to immobilize fractures of proximal  Temporal to accipital part of pelvic area.
femur before surgical fixation
 Shock blocks at the foot of the bed produce Halo-femoral traction
counter traction and prevent patient from  For sever scoliosis
sliding down in bed.  Avoid progression of scoliosis
 From temporal to femural area
Brayant’s Traction
 Both legs raised at 90 degrees angle to bed 90-90 degrees traction
because the weight of the child is not adequate  For subtrochanteric fracture of femur or
to provide countertraction. intertrochanteric fracture of femur.
 Used for children under 2 years and 30 pounds
to treat fractures of femur and hip dislocation. Balanced Suspesion Traction
 Buttocks must be slightly off the mattress.  Produced by a counter force other than the
patients weight
Russell’s Traction  Extremity floats or balances in rhe traction
 Knee is suspended in a sling attached to a apparatus
rope and pulley on a balkan frame,creating  Patient may change position without disturbing
upward pull from the knee. the line of traction
 Used to treat fracture of femur.
TRACTION:General Nursing Care
Dunlop’s skin traction 1 ALWAYS ensure that the weights hang freely and
 For supracondylar fracture of the humerus. do not touch the floor
 Minimun 4 weeks of application. 2.NEVER remove the weights.
 Boot leg traction - fracture of hip and femur. 3.Maintain proper body alignment.
 Post poliomyelitis with residual paralysis. 4.Ensure that the pulleys and ropes are properly
functioning and fastened by trying square knot.
Stove in chest 5.Observe and prevent foot drop
 For multiple rib fracture.  Provide foot plate
6 Observe for DVT,skin irritation and breakdown.
Cervical Skin Traction 7 Provide pin care for clients in skeletal traction-
 Relieved muscle spasm & compression in the use of hydrogen peroxide.
upper extremities & neck. 8.Promote skin integrity
 Uses a head halter & chin pad.  Use special mattress if possible
 Provide frequent skin care
SKELETAL TRACTION  Asses pin entrance and cleanse the pin with
 The traction is applied directly to the bone use hydrogen peroxide solution
of metal pin or wire that is inserted through the  Turn and reposition within the limits of traction
bone distal to the fracture,avoiding  Use the trapeze
nerves,blood vessels,muscles,tendons and
joints. 1.HYPOVOLEMIC SHOCK
 Used to treat fractures of the femur,tibia,and  Rsult from hemorrhage and loss of
cervical spine. intravascular volume into the interstitial space
within damaged tissues that may occur in
Gardner Wells Tong fracture.
 Tx:
 Stabilize the fracture
 Restore blood volume and circulation Fracture, tight dressings, tight cast
 Relieve the pain ↓
 Provide adequate splinting Edema of content of compartment
↓
3. FAT EMBOLISM SYNDROME Increase pressure within compartment
 Occurs usually in fraction of the lomg bones ↓
 Fat globules may move into the blood stream Pain, pallor, pulselessness, paresthesia, paralysis
because the marrow pressure is greater than ↓
capillary pressure. Contractures & disability
 Fat globules occlude the small blood vessels of
the lungs,brain kidneys and other organs. Assessment findings:
- Hallmark Sign: Pain that intensifies with ROM
Fat Embolism Syndrome
 Onset is rapid,within 24-72 hours 1. Pain may be caused by:
 ASSESSMENT FINDINGS - The enclosing muscle fascia is too tight or a
cast or dressing is constrictive
1.Suddenly dyspnea and repiratory distress. - An increase in compartment content because
2.tachycardia of edema or hemorrhage
3.Chest pain 2. Paresthsia - burning or tingling sensation
4.Crackles,wheezes and cough 3. Numbness
5.Petechial rashes over the chest,axilla and hard 4. Motor weakness
palate 5. Pulselessness, impaired capillary refill time and
cyanotic skin
NURSING MANAGEMENT
Nursing Management
1.Support the respiratory function 1. Assess frequently the neurovascular status of
 High Fowler’s Position the casted extemity
 Administer 02 in high concentration 2. Elevate the extremity above the level of the heart
 Prepare for possible intubation and ventilator 3. Assist in cast removal and FASCIOTOMY
intubation and ventilator support
2.Institute preventive measures Fasciotomy
 Immesiate immobilization of fracture  Surgical decompression with excision of the
 Minimal fracture manipulation fascia; may be needed to relieve the
3.Institute preventive measures constrictive muscle fascia
 Immediate immobilization of fracture
 Minimal fracture manipulation
 Adequate support for fractured bone during
turning and positioning
 Maintain adequate hydration and electrolyte
balance
4. Comparment Syndrme
 An anatomic compartment is an area of the
body encased by bone or facia 9