PATHOPHYSIOLOGY OF FRACTURE

Nonmodifiable
Personal history of fracture as an
adult
History of fracture in first degree
relative
Female sex
Advanced age

TRAUMA

Bone Breakage
Death of bone cells

Osteoblastic activity is immediately stimulated, both

intraosseous and periosteal from osteoproginenitor
cell

Bleeding typically occurs around

the site and into the soft tissues
surrounding the bone. The soft
tissues are usually damaged by
the injury.

Modifiable
Current cigarette smoking
Low body weight
Estrogen Deficiency
Early menopause (45 years old) or
bilateral ovariectomy
Prolonged premenstrual
amenorrhea
Low Calcium Intake
Alcoholism
Recurrent falls
Inadequate physical activity
Poor health/Frailty

Disruption in fracture hematoma due to

displaced and comminuted bone

Immature new bone or callus is formed

Intense Inflammatory Reaction
Fibrin clot is soon reabsorbed and the new
bone cells are slowly remodeled to from true
bone

Vasodilation

Fixation or proper bone alignment is

needed to facilitate bone healing

Increased blood flow to the area of injury

True bone replaces callus and is slowly
calcified. (Several weeks to few months)

SURGICAL MANAGEMENT
Leukocytes and mast cells accumulate

Phagocytosis and removal of dead cell debris

A fibrin clot (fracture hematoma) forms at the break and
acts as a new network to which new cells can adhere.

Screws, Wires, Rods, Nails or other

fixation apparatuses hold both ends
of broken bone together
Stress on the opposed of the broken bones,
which accelerates osteoblastic activity at the
break leading to hastened normal bone healing

Impaired skin and tissue integrity

related to surgical repair:
insertion of fixation apparatuses

Risk for Infection related to

tissue trauma

Skin and tissue breakage

Additional inflammation aside from

response surrounding the bone

Maintenance of immobilization to
facilitate bone healing

Impaired physical mobility related to

musculoskeletal impairment

Limited ROM and decreased

muscle strength

Self care deficit related to immobility

Increased nociception
Risk for Deficient Fluid Volume related
to Blood vessel damage secondary to
multiple fracture

Risk for Ineffective Tissue Perfusion related

to Immobility

Increased Vital Signs, Moaning,

Irritable, Guarding Behavior

Risk for Peripheral Neurovascular

Dysfunction

Acute Pain related to physical

trauma
Asks questions about
operation and post operative
activities

Deficient Knowledge regarding fracture and

surgical treatment and care related to lack of
exposure