What is fracture?

A fracture is the medical term for a broken bone. A fracture is a break or disruption in the continuity of a bone A fracture occurs when physical force exerted on a bone is stronger than the bone itself. A fracture is sometimes abbreviated as FX, Fx or FRX. Although many fractures are the result of high force (impact or stress), some occur as a result of some medical condition.

TYPES

All fractures can be broadly described as:

Closed (simple) fractures: are those in which the skin is intact Open (compound) fractures: involve wounds that communicate with the fracture, or where fracture hematoma is exposed, and may thus expose bone to contamination. Open injuries carry a higher risk of infection

Closed & Open Fracture

Open fracture
Grade I -the least severe injury, and skin damage is minimal Grade II -an open fracture is accompanied by skin and muscle contusions Grade III -the most severe injury in which there is damage to skin, muscle, nerve tissue, and blood vessels

Based on extent of fracture line/break

Incomplete fracture: A fracture is considered incomplete when the bone is not broken completely, but cracked. Complete fracture: A fracture is considered complete when the bone is broken into two or more parts : displaced or non-displaced

Comminuted
fracture in which the bone is in fragments the bone is either crushed, shattered or splintered

Compression
the bone is crushed, causing the broken bone to be wider or flatter in appearance.

Greenstick
This is a common childhood fracture resulting when a bone breaks partially. Sometimes one side of the bone breaks and the other side is merely bent.

Impacted
An impacted fracture is a fracture in which the bone breaks into multiple fragments which are driven into each other.

Oblique
A fracture that is diagonal to a bone's long axis

Spiral
A fracture where at least one part of the bone has been twisted a type of bone fracture which is caused by a twisting force. They are also referred to as torsion fractures

Transverse
A fracture that is at a right angle to the bone's long axis is the result of a sharp, direct blow or may be a stress fracture caused, for example, by prolonged running

Incidence
about 6.8 million come to medical attention each year in the United States. The average citizen in a developed country can expect to sustain two fractures over the course of their lifetime. The most common fracture prior to age 75 is a wrist fracture. In those over age 75, hip fractures become the most common broken bone. Fractures account for 16% of all musculoskeletal injuries in the U.S. annually. More than 40% of fractures occur at home (22.5% inside and 19.1% outside). Approximately 6.3 million fractures occur each year in the U.S.

Incidence rate of 2.4 per 100 Fractures occur at an annual

population. Men are more likely to experience fractures (2.8 per 100 population) than women (2.0 per 100). After age 45, however, fracture rates become higher among women. Among persons 65 and over, fracture rates are three times higher among women than men. There are approximately 3.5 million visits made to emergency departments for fractures each year. Approximately 887,679 hospitalizations result each year from fractures.

 Modifiable Fall, blow or other traumatic event Vigorous exercise and excess physical activity Physical inactivity Smoking and excess alcohol Malnutrition and low Body Mass Index Vitamin D deficiency Bone diseases Non-modifiable Age Family history

Risk Factors

Anatomy

Anatomy and Physiology

FUNCTIONS OF BONE Bone provides shape and support for the body, as well as protection for some organs. Bone also serves as a storage site for minerals and provides the medium marrow - for the development and storage of blood cells.

Anatomy and Physiology makes up the body's Bone is a living tissue that
skeleton Bone tissue is a type of connective tissue that contains lots of calcium and phosphorous salts. About 25% of bone tissue is water, another 25% is made up of protein fibers like collagen. The other 50% of bone tissue is a mixture of mineral salts, primarily calcium and phosphorous.

Anatomy and Physiology

There are 206 bones in the human skeleton, not including teeth and sesamoid bones (small bones found within cartilage)

Anatomy and Physiology

3 TYPES OF BONE CELLS osteoblast - found within the bone, its function is to form the tissue and minerals that give bone its strength. osteoclast - a very large cell formed in bone marrow, its function is to absorb and remove unwanted tissue. osteocyte - found within the bone, its function is to help maintain bone as living tissue.

Anatomy and Physiology TYPES OF BONE TISSUE

compact tissue - the harder, outer tissue of bones. cancellous tissue SPONGY BONE - the sponge-like tissue inside bones. Looks like an irregular latticework (or sponge) with lots of spaces throughout. These spaces are filled with red bone marrow which is the site of hematopoiesis or formation of blood cells.

Anatomy and Physiology

BONE PARTS The Epiphysis refers to the end of the bone, and the Diaphysis refers to the main shaft of the bone. Each Epiphysis is connected to an adjacent bone using a structure called a joint. The ends of each bone are covered with articular cartilage which keeps the ends of the bones from grinding together when moving.

Pathophysiology

Stress placed on the bone

Injury in the bone

Disruption in the continuity of bone

Disruption of muscle and blood vessels attached to the ends of the bone

Soft tissue damage

Bleeding

Hematoma forms in the medullary canal

Bone tissue surrounds the fractured site dies

Inflammatory response

Signs/Symptoms
Swelling or bruising over a bone. Deformity of an arm or leg. Pain in the injured area that gets worse when the area is moved or pressure is applied. Loss of function in the injured area. In compound fractures, bone protruding from the skin. warmth, bruising, or redness in the injured area Crepitus (bony grating) may be heard or felt

Diagnostic & Laboratory Test BLOOD TESTS

Full blood count and ESR to detect anemia and infection Renal function, electrolytes and liver function tests especially to test for alkaline phosphatase, calcium and phosphorus. Bone metastases may cause elevated alkaline phosphatase and calcium. Multiple myeloma may have evidence of renal failure and may have elevated calcium, protein and uric acid. Paget's disease can have elevated alkaline phosphatase. Hyperparathyroidism may cause elevated calcium PSA and serum acid phosphatase if suspect prostate cancer as cause for bone metastases and pathological bone fracture

Diagnostic & Laboratory Test RADIOLOGICAL INVESTIGATIONS

X-Ray of the affected bones and joints can diagnose fractures, bone tumors, Paget's disease and osteoporosis With fractures, note how many bone fragments and displacement of the bones CT Scan or MRI of spine if suspect a bone tumor or compression of spinal cord or nerve roots - e.g. radiation of pain down arms or legs.

Medical Management
splint/cast - immobilizes the injured area to promote bone alignment and healing and to protect the injured area from motion or use. traction - the application of a force to stretch certain parts of the body in a specific direction. Traction consists or pulleys, strings, weights, and a metal frame attached over or on the bed. The purpose of traction is to stretch the muscles and tendons around the broken bone to allow the bone ends to align and heal.

Medical Management
MEDICATIONS: Alendronate - is used to prevent and treat certain types of bone loss in adults
This medication works by slowing bone loss. This effect helps maintain strong bones and the risk of broken bones (fractures) Biphosphonate reduce

Ketorolac
used for the short-term treatment of moderate to severe pain.

Medical Management
Pain relievers (NSAIDS, narcotic analgesics, etc.) and muscle relaxants (e.g., baclofen), if needed. SUPPLEMENTS: Calcitonin - it prevents the action of cells that break down old bone cells (a process that releases calcium into the bloodstream) Vitamin D - used for treating weak bones Vitamin C and Zinc promote bone healing

External Fixation

Surgical Management

External fixation is a method of immobilizing bones to allow a fracture to heal. External fixation is accomplished by placing pins or screws into the bone on both sides of the fracture. The pins are then secured together outside the skin with clamps and rods. The clamps and rods are known as the "external frame."

Surgical Management
INTERNAL FIXATION Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone. An internal fixator may be made of stainless steel or titanium. Open reduction refers to open surgery to set bones, as is necessary for some fractures. Internal fixation refers to fixation of screws and/or plates, intramedullary bone nails (femur, tibia, humerus) to enable or facilitate healing.

Nursing Management when situation warrants, for a 1. Provide emergency management

new fracture. Assess the five Ps(pain, pulse, pallor, paresthesia, and paralysis) Determine the mechanism of injury. Immobilize the part. Move injured parts as little as possible. Cover any open wounds with a sterile, or clean dressing. Reassess the five Ps. Apply traction if circulatory compromise is present. Elevate the injured limb, if possible. Apply cold to the injured area.

Nursing Management
2. Assess for circulatory impairment (cyanosis, coldness, decreased peripheral pulses, positive blanch sign, edema not relieved by elevation, pain or cramping). 3. Assess for neurologic impairment (lack of sensation or movement, pain, or tenderness, or numbness and tingling). 4. Maintain skin integrity and prevent breakdown. Institute appropriate measures for cast and appliance care. 5. Ensure that calcium and vitamin D intake are adequate, and that diet is well-balanced and nutrient-rich

Nursing Management 6. Prevent Complications

Prevent circulatory impairment by assessing pulses, color and temperature, and by reporting changes immediately. Prevent nerve compression syndromes by testing sensation and motor function, including subjective symptoms of pain, muscular weakness, burning sensation, limited ROM, and altered sensation. Correct alignment to alleviate pressure if appropriate, and notify the health care provider. Prevent compartment syndrome by assessing for muscle weakness and pain out of proportion to injury. Early detection is critical to prevent tissue damage.
Causes of compartment syndrome include tight dressings or casts, hemorrhage. trauma, burns and surgery. Treatment entails pressure relief, which sometimes require performing a fasciotomy.

Nursing Management
Prevent infection, including osteomyelitits, by using infection control measures. Prevent pulmonary emboli by carefully monitoring adolescents and children with multiple fractures. Emboli generally occur within the first 24 hours.

Prognosis
Simple, uncomplicated fractures usually heal in 6 to 12 weeks without loss of function. Any increase in severity of the fracture or added complications will delay recovery for weeks to months and may compromise function. While the fracture may heal, damage to the surrounding structures can result in poor function of an extremity and a less than optimum outcome. Fracture risk may be significantly reduced in individuals over age 50 by using calcium and vitamin D supplements

 Instruct patient to arrange household to keep the items he/she needs within reach. Encourage client about weight-bearing movements Instruct client to avoid sitting or lying in the same position for long periods. Carefully reposition at least every 60 minutes. Tell client to take medication exactly as directed If the client wears a leg brace or immobilizer, instruct to cover it with plastic to keep it dry while showering

Discharge Teaching

Discharge Teaching
If the client is not wearing a leg brace or immobilizer, instruct to carefully wash the incision with soap and water. Gently pat it dry. Dont rub the incision, or apply creams or lotions to it. To avoid falling while showering, instruct client to sit on a shower stool Tell patient to take vitamin-C and zinc supplements to promote bone healing

Discharge Teaching
Instruct client to go to the nearest hospital or call the healthcare provider immediately if she/he has any of the following: Chest pain Shortness of breath Numbness or tingling in your leg or toes Cool, pale, red- or blue-colored leg or toes Fever above 100.4F or shaking chills Increased pain Swelling of the fracture site Drainage with foul odor coming from the dressing A rash

Reduction is the process of restoring the bone ends (and any fractured fragments) into their normal anatomical position When reduction is decided upon it may be carried out in three ways: 1. by closed manipulation 2. by mechanical traction with or without manipulation 3. by open operation

REDUCTION

IMMOBILIZATION
METHODS OF IMMOBILIZATION 1. by a plaster of Paris cast or other external splint 2. by continuous traction 3. by external fixation 4. by internal fixation INDICATIONS FOR IMMOBILIZATION 1. to prevent displacement or angulation of the fragments 2. to prevent movement that might interfere with union 3. to relieve pain.

REHABILITATION
Rehabilitation is the regaining of strength and normal function in the affected area The two essential methods of rehabilitation are 1. active use 2. active exercises

REHABILITATION
active use This implies that the patient must continue to use the injured part as naturally as possible within the limitations imposed by necessary treatment Although in some injuries rest may be necessary in the early days or weeks, there should be a graduated return to activity as soon as it can be allowed without risk.

REHABILITATION
active exercises These comprise exercises for the muscles and joints. They should be encouraged from an early stage Physiotherapy is often enormously helpful, but it should supplement, not supplant, the patients own independent efforts

Reference
BOOK: Medical-Surgical Nursing Authors: Ignatavicius and Workman, 7th Edition Volume 2 Year Published: 2012 Essentials of Anatomy and Physiology 6th Edition Authors: Seeley, et.al Year Published: 2008

 INTERNET: http://www.uptodate.com/contents/general-principles-offracture-management-bone-healing-and-fracture-description http://www.uchospitals.edu/online-library/content=P00109 http://www.personal.psu.edu http://nursingcrib.com/nursing-notes-reviewer/fractures/ http://www.newcastlehospitals.org.uk/downloads/policies/Nursi ng/SurgicalScrubProcedure201001.pdf http://jech.bmj.com/content/44/3/241.full.pdf http://armymedical.tpub.com/md0916/md09160049.htm http://www.medicaltextbooksrevealed.com/files/11224-53.pdf

Reference

Reference
INTERNET: http://www.rightdiagnosis.com/symptoms/fractures/tests.htm http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/orthopaedics /fracture.html http://www.healthinaging.org/aging-and-health-a-toz/topic:fractures/info:care-and-treatment/ http://orthopedics.about.com/cs/brokenbones/g/exfix.htm http://en.wikipedia.org/wiki/Internal_fixation http://www.medicinenet.com http://majorhospital.kramesonline.com/HealthSheets/3,S,86395 http://www.scribd.com/doc/44135497/Pathophysiology-of-Fracture