Scribd
Upload
65 views

Fracture

Trauma is the leading cause of death in the US for those aged 1-37. A fracture is a break in the bone that can occur at any age from stress exceeding the bone's capacity. Fractures are classified as complete, incomplete, comminuted, closed or open. Clinical signs include pain, deformity, swelling and shortening. Management involves reduction, immobilization and monitoring for complications like infection, delayed healing or fat embolism. Nursing care focuses on pain control, mobility exercises and teaching self-care.

Uploaded by

Dwi Kurnia Sari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
65 views

Fracture

Trauma is the leading cause of death in the US for those aged 1-37. A fracture is a break in the bone that can occur at any age from stress exceeding the bone's capacity. Fractures are classified as complete, incomplete, comminuted, closed or open. Clinical signs include pain, deformity, swelling and shortening. Management involves reduction, immobilization and monitoring for complications like infection, delayed healing or fat embolism. Nursing care focuses on pain control, mobility exercises and teaching self-care.

Uploaded by

Dwi Kurnia Sari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 34

Fracture

Tony Suharsono

Epidemiology
Trauma is the leading cause of death in the USA

for those between the ages of 1 37, and the


fourth leading cause of death for all age group
(American Academy of Orthopaedic Surgeon)
Fracture can create significant change in oness
quality of life by causing activity restriction,
disability, and economic loss

Definition
A fracture is a break in the continuity of bone and is

defined according to its type and extent


A fracture is a break in a bone and can occur at any age
and in any bone
Fractures occur when the bone is subjected to stress
greater than it can absorb
When the bone is broken, adjacent structures are also
affected, resulting in soft tissue edema, hemorrhage into
the muscles and joints, joint dislocations, ruptured
tendons, severed nerves, and damaged blood vessels

Types of Fracture
A complete fracture involves a break across the entire cross-section

of the bone and is frequently displaced (removed from


normal position).
Incomplete fracture (eg, greenstick fracture), the break occurs
through only part of the cross-section of the bone.
A comminuted fracture is one that produces several bone fragments.
A closed fracture (simple fracture) is one that does not cause a
break in the skin.
An open fracture (compound, or complex) is one in which the
skin or mucous membrane wound extends to the fractured
bone

Types of Fracture
Open Fracture

Open fractures are graded accordingto the

following criteria:
Grade I is a clean wound less than 1 cm long

Grade II is a larger wound without extensive soft

tissue damage
Grade III is highly contaminated, has extensive soft
tissue damage, and is the most severe.

Clinical Manifestation
Pain

The pain is continuous and increases in severity

until the bone fragments are immobilized


Loss of function
Deformity
Shortening
Crepitus
Swelling and discoloration

Patofisiology
Hematome or inflamatory stage
Immediate formation of a hematoma at the site of fracture
Amount of bone damage, soft tissue injury, and blood vessel determining
size of the hematoma
Providing a small amoun of stabilitation
1-3 day
Fibrocartilage formation
Fibroblast, osteoblast, and condroblast migrate to the fracture site as a
result of the acute inflammation and form fibrocartilage
Periosteal elevation and granulation tissue formation create a collar
around and end of each fracture fragment
Early formation of fibrous tissue called the primary callus
3 days to 3 weeks

Pathofosiology
Callus formation
Granulation tissue matures into a provisional callus as a newly

formed cartilage and bone matrix disperse through the primary


callus
Proper bone alignment is essential during this stage. If it slowed
or interupted, the final two stages cannot occur.
2-6 weeks
Ossification
A permanent callus of rigid bone crosses the fracture gap

between the periosteum and the cortex to join the fragment


Trabecullar bone gradually replaces the callus along stress line
3 weeks-6 months

Pathofisiology
Consolidaton and remodelling
Unnecessary callus is resorbed from the healing bone
The actual amount and timing of remodelling depend on the

stresses imposed on the bone by muscle, weight bearing, and


age
6 weeks to 1 year

Diagnostic Procedure
X Ray

Menentukan lokasi/luas/jenis fraktur


Dua posisi (AP/Lat), dua sendi terlibat
Bone Scanning

Menunjukkan tingkat keparahan fraktur,

identifikasi kerusakan jar lunak


Arteriogram
Jika terdapat kerusakan vaskuler

Goal of Management Fracture


Prompt and thorough assessment of the client to

discover all injuries


Reduction and stabilization of the fracture with
immobilization
Observation for complication
Remobilization and rehabilitation

Thorough Assessment
Assessment and treatment are performed simultaneusly

during emergency management of fracture


During primary assessment, the rescue focused on airway
management, bleeding and manisfestation of shock
Any potential life threatening injury must be stabilized
immediately
Most fracture do not pose a serious treat to life, their
management becomes a secondary priority in trauma care
The only exception this rule is a cervical spine injury
Suspected injury to extremity should be carefully splinted
Extensive bleeding can occur even with close fracture

Management of Fracture
Reduction

restoration of the fracture fragments to anatomic alignment

and rotation
closed reduction or open reduction may be used to reduce a
fracture
Usually,the physician reduces a fracture as soon as possible
to prevent loss of elasticity from the tissues through
infiltration by edema or hemorrhage
Before fracture reduction and immobilization, the patient is
prepared for the procedure; permission for the procedure is
obtained, and an analgesic is administered as prescribed

Management of Fracture
Closed Reduction

bringing the bone fragments into position

through manipulation and manual traction


The immobilizing device maintains the
reduction and stabilizes the extremity for bone
healing
X-rays are obtained to verify that the bone
fragments are correctlyaligned

Management of Fracture
Open Reduction

Internal fixation devices may be used to hold

the bone fragments in position until solid bone


healing occurs
Internal fixation devices ensure firm
approximation and fixation of the bony
fragments

Internal Fixation

Management of Fracture
Immobilization

After the fracture has been reduced, the bone

fragments must be immobilized, or held in


correct position and alignment, until union
occurs
Immobilization may be accomplished by
external or internal fixation

Management of Fracture
Maintaining and restoring function

Swelling is controlled by elevating the injured extremity and

applying ice
Neurovascular status (circulation, movement, sensation) is
monitored, and the orthopedic surgeon is notified
immediately if signs of neurovascular compromise are
identified
Isometric and muscle-setting exercises are encouraged to
minimize disuse atrophy and to promote circulation
Participation in activities of daily living (ADLs) is encouraged
to promote independent functioning and self-esteem

Factors That Enhance Fracture Healing


Immobilization of fracture fragments
Maximum bone fragment contact
Sufficient blood supply
Proper nutrition
Exercise: weight bearing for long bones
Hormones: growth hormone, thyroid,
calcitonin, vitamin D

Factors That Inhibit Fracture Healing


Extensive local trauma
Bone loss
Inadequate immobilization
Space or tissue between bone fragments
Infection
Local malignancy
Age

Complication of Fracture
Fat Embolism Syndrome

Fat embolism is a potentially life threatening

complication of long bone trauma, blunt


trauma, and intramedularry manipulation
This syndrome manifest anywhere from 4 hours
to several days after injury or orthopedic
surgery.
Fat globules, release from bone marrow, can
embolize and occlude blood vessels in the brain,
kidnes, lungs and other tissue

Complication of Fracture
Osteomyelitis
Osteomyelitis is an infection of the bone, most

commonly a result of direct contamination from


open fracture, penetrating wound, or surgical
procedures
it takes 10 to 14 days from the time of infection
exposure before radiographs will demonstrate
visible changes
The most common causative organism is
staphylococcus aureus

Complication of Fracture
Compartment Syndrome

Compartment syndrome develops when the presure in a

muscle compartment exceeds the intraarterial hydrostatic


pressure, causing collapse of capilaries and venules, which
lead to iskhemia and tissue necrotic
The exact pressure at which this develops is unclear, but
intracompartment pressure greater than 30 mmHg generally
are considered greatly elevated
A grace periode of about 6 hours exists before irreversible
soft tissue demage occurs
It is important to suspect compartment syndrome early

Complication of Fracture
Bleeding

Delayed union and non union


Avascular necrosis of bone
Reaction to internal fixation devices

Assessment
Neurovascular assessment

Use five P to evaluate limb circulation,

sensation and motor function


Pain : a description of pain is helpful
Pallor
Pulses
Parasthesia
Paralysis

Assessment
Inspection, the injured area for the

following:
Color
Disrupted skin integrity
Extremity position
Edema, swelling, or echhimosis
Range of motion
Symmetry, alignment, deformity

Assessment
Palpation, the injury to identify the

following :
Skin temperature
Pain
Bony crepitus, joint instability
Peripheral nerve function : sensory and
motor

Nursing Diagnose
Acute pain

Impaired physical mobility


Risk for peripheral neurovaskuler

dysfunction
Risk for imbalance fluid volume

Nursing intervention
Teach patients how to control swelling and pain

associated with the fracture and with soft tissue


trauma and
Assess neurovascular status frequently
Encourages them to be active within the limits of
the fracture immobilization

Nursing intervention
Teach exercises to maintain the health of

unaffected muscles and to increase the strength of


muscles needed for transferring and for using
assistive devices
Teach patients how to use assistive devices safely
Patient teaching includes self-care, medication
information, monitoring for potential
complications, and the need for continuing health
care supervision

You might also like