What is Fracture? • Extreme muscle contractions.

When the
Injury to one part of the musculoskeletal system results muscles have reached their limit in contraction,
in the malfunction of adjacent muscles, joints, and it could lead to serious fractures.
tendons.
• A fracture is a complete or incomplete Clinical Manifestations
disruption in the continuity of the bone The clinical signs and symptoms of a fracture may
structure and is defined according to its type include the following but not all are present in every
and extent. fracture:
• Fractures occur when the bone is subjected • The pain is continuous and increases in severity
to stress greater than it can absorb. until the bone fragments are immobilized.
• When the bone is broken, adjacent structures • Loss of function. After a fracture, the extremity
are affected, resulting in soft tissue cannot function properly because the normal
edema, hemorrhage into muscles and joints, function of the muscles depends on the
joint dislocations, ruptured tendons, integrity of the bones to which they are
severed nerves, and damaged blood vessels. attached.
• Displacement, angulation, or rotation of the
Classification fragments in a fracture of the arm or leg causes
There are several kinds of fracture that may occur in a a deformity that is detectable when the limb is
bone: compared with the uninjured extremity.
• Complete fracture. A complete fracture • There is an actual shortening of the extremity
involves a break across the entire cross-section because of the compression of the fractured
of the bone and is frequently displaced. bone.
• Incomplete fracture. An incomplete fracture • When the extremity is gently palpated,
involves a breakthrough only part of the cross- a crumbling sensation, called crepitus, can be
section of the bone. felt.
• Comminuted fracture. A comminuted fracture • Localized edema and ecchymosis. Localized
is one that produces several bone fragments. edema and ecchymosis occur after a fracture as
• Closed fracture. A closed fracture is one that a result of trauma and bleeding into the tissues.
does not cause a break in the skin.
• Open fracture. An open fracture is one in which Complications
the skin or mucous membrane wound extends Complications of fractures may either be acute or
to the fractured bone. chronic.
• Hypovolemic shock resulting from hemorrhage
is more frequently noted in trauma patients
with pelvic fractures and in patients with
displaced or open femoral fractures.
• Fat embolism syndrome. After fracture of long
bones and or pelvic bones, or crush injuries, fat
emboli may develop.
• Compartment syndrome. Compartment
syndrome in an extremity is a limb-threatening
condition that occurs when perfusion pressure
falls below tissue pressure within a closed
anatomic compartment.

Assessment and Diagnostic Findings

To determine the presence of fracture, the following
diagnostic tools are used.
• X-ray examinations: Determines location and
extent of fractures/trauma, may reveal
preexisting and yet undiagnosed fracture(s).
Causes
• Bone scans, tomograms, computed
Fractures may be caused by the following:
tomography (CT)/magnetic resonance imaging
• Direct blows. Being hit directly by a great force
(MRI) scans: Visualizes fractures, bleeding, and
could cause fractures in the bones.
soft-tissue damage; differentiates between
• Crushing forces. Forces that come into contact
stress/trauma fractures and bone neoplasms.
with the bones and crush them could also result
• Arteriograms: May be done when occult
in fractures.
vascular damage is suspected.
• Sudden twisting motions. Twisting the joints in
a sudden motion leads to fractures.
 • Complete blood count (CBC): Hematocrit (Hct) Nursing Interventions
may be increased (hemoconcentration) or Nursing care of a patient with fracture include:
decreased (signifying hemorrhage at the • The nurse should instruct the patient regarding
fracture site or at distant organs in multiple proper methods to control edema and pain.
trauma). Increased white blood cell (WBC) • It is important to teach exercises to maintain
count is a normal stress response after trauma. the health of the unaffected muscles and to
• Urine creatinine (Cr) clearance: Muscle trauma increase the strength of muscles needed for
increases the load of Cr for renal clearance. transferring and for using assistive devices.
• Coagulation profile: Alterations may occur • Plans are made to help the patients modify the
because of blood loss, multiple transfusions, home environment to promote safety such as
or liver injury. removing any obstruction in the walking paths
around the house.
Medical Management • Wound management. Wound irrigation and
Management of a patient with a fracture can belong to debridement are initiated as soon as possible.
either emergent or post-emergent. • Elevate extremity. The affected extremity is
• Immediately after injury, if a fracture is elevated to minimize edema.
suspected, it is important to immobilize the • Signs of infection. The patient must be assessed
body part before the patient is moved. for presence of signs and symptoms of
• Adequate splinting is essential to prevent the infection.
movement of fracture fragments.
• In an open fracture, the wound should be Evaluation
covered with a sterile dressing to prevent The following should be evaluated for a
contamination of the deeper tissues. successful implementation of the care plan.
• Fracture reduction refers to the restoration of • Pain was relieved.
the fracture fragments to anatomic alignment • Achieved a pain-free, functional, and stable
and positioning and can be open or closed body part.
depending on the type of fracture. • Maintained asepsis.
• Maintained vital signs within normal range.
Nursing Assessment • Exhibited no evidence of complications.
Assessment of the fractured area includes the following:
• Close fracture. The patient with close fracture is Discharge and Home Care Guidelines
assessed for absence of opening in the skin at After completion of the home care instructions, the
the fracture site. patient or caregiver will be able to:
• Open fracture. The patient with open fracture is • Control swelling and pain. Describe approaches
assessed for risk for osteomyelitis, tetanus, and to reduce swelling and pain such as elevating
gas gangrene. the extremity and taking analgesics as
• The fractured site is assessed for signs and prescribed.
symptoms of infection. • Care of the affected area. Describe
Diagnosis management of immobilization devices or care
Based on the assessment data gathered, the nursing of the incision.
diagnoses developed include: • Consume diet to promote bone healing.
• Acute pain related to fracture, soft tissue injury, • Mobility aids. Demonstrate use of mobility aids
and muscle spasm. and assistive devices safely.
• Impaired physical mobility related to fracture. • Avoid excessive use of injured extremity and
• Risk for infection related to opening in the skin observe weight-bearing limits.
in an open fracture.
Planning & Goals Documentation Guidelines
Main Article: 8 Fracture Nursing Care Plans The focus of documentation should include:
Planning and goals developed for a patient with fracture • Client’s description of response to pain and
are: acceptable level of pain.
• Relief of pain. • Prior medication use.
• Achieve a pain-free, functional, and stable body • Level of function.
part. • Ability to participate in specific or desired
• Maintain asepsis. activities.
• Maintain vital signs within normal range. • Signs and symptoms of infectious process.
• Exhibit no evidence of complications. • Wound/ incision site.
• Plan of care.
• Teaching plan.
• Response to interventions, teaching, and
actions performed.
• Attainment or progress toward desired
outcomes.
• Modifications to plan of care.
• Long term needs.
CAST CARE CHECKLIST: