FRACTURES

Ns. Frengki Apryanto, S.Kep., M.Kep

Medical/Surgical VII: Musculoskeletal
 A fracture is a break in the continuity of a
bone.
Fractures may affect tissues or organs near the
bones as well.
 Pathophysiology and Etiology
When force applied to a bone exceeds maximum
resistance, the bone breaks.
Sudden direct force from a blow or fall causes
most fractures; however, some result from
indirect forcefor example, from a strong muscle
contraction, such as during a seizure.
A few fractures result from underlying weakness
created by bone infections, bone tumors, or more
bone resorption than production (as occurs in
clients who are inactive or aging).
 The tissue surrounding the fracture swells from
hemorrhage and edema.
Healing begins when blood in the area clots and a
fibrin network forms between the broken bone ends.
The fibrin network changes into granulation tissue.
Osteoblasts, which proliferate in the clot, increase the
secretion of an enzyme that restores the alkaline pH.
As a result, calcium is deposited and true bone forms.
The healing mass is called a callus.
 Bone repair is a local process. About 1 year of
healing must pass before bone regains its
former structural strength, becomes well
consolidated and remodeled (re-formed), and
possesses fat and marrow cells.
 FIGURE 2. Process of bone healing.
( A) Immediately after a bone fractures, blood seeps into
the area,
and a hematoma (blood clot) forms.
( B) After 1 week, osteoblasts form as the clot retracts.
After about 3 weeks, a procallus forms and stabilizes the
fracture.
( C) A callus with bone cells forms in 6 to 12 weeks. In 3 to 4
months, osteoblasts begin to remodel the fracture site.
( D) If the fractured bone has been accurately aligned
during healing, remodeling will be complete in
about 12 months.
 Assessment Findings
Signs and Symptoms
The signs and symptoms of a fracture vary,
depending on the type and location.
They include the following:
PainOne of the most consisten t symptoms of a
fracture is pain, which may be severe. Attempts
to move th e part and pressure over the fracture
increase pain.
Loss of function Skeletal muscular function
depends on intact bone.
DeformityA break may cause an extremity to
bend backward or to assume another unusual
position.
False motionUnnatural motion occurs at the
site of the fracture.
 CrepitusThe grating sound of bone ends
moving over one another may be audible (this
term also refers to a popping sound caused by air
trapped in soft tissue ).
EdemaSwelling usually is greatest directly over
the fracture.
SpasmMuscles near fractures involuntarily
contract. Spasm, which accounts for some of the
pain.
If a nerve is damaged, paralysis may result.
Diagnostic Findings
CT scan
MRI
Radiography
Medical and Surgical Management
Treatment includes one or more methods:
traction,
closed or open reduction,
internal or external fixation,
or cast application .
 Nursing Management
When caring for the client with a fracture, the
nurse assesses for neurovascular and systemic
complications.
General nursing measures include
administering analgesics, providing comfort
measures, assisting with ADLs, preventing
constipation, promoting physical mobility,
preventing infection, maintaining skin
integrity, and preparing client for self-care.
FRACTURED FEMUR
 A fracture of the femur commonly occurs in
automobile accidents but may also occur in
falls from ladders or other high places, or in
gunshot wounds.
Multiple injuries often accompany fractures of
the femur, because they usually occur with
severe trauma.
Assessment Findings
Severe pain, swelling, and ecchymosis may be
seen .
The client usually cannot move the hip or
knee.
If a compound fracture has occurred, an open
wound or a protrusion of bone is seen.
Radiographic films show the type and location
of the fracture
Medical and Surgical Management
Fractures of the femur usually are treated
initially with some form of traction to prevent
deformities and soft-tissue injury.
Skeletal traction or an external fixator
 Nursing Management
Because the client is confined to bed, the
nurse implements measures to prevent
complications of immobility and inactivity.
FRACTURED HIP
 This type of fracture commonly results from a
fall and occurs more frequently in older adults
with osteoporosis.

Assessment Findings
The client reports severe pain that increases
with leg movement.
A large blood loss may accompany
subtrochanteric and intertrochanteric
fractures, leading to hypovolemic shock.
Radiographic
Medical and Surgical Management
Traction
Plates, bands, screws, and pins may be
removed after the bone has healed.
 Nursing Management
After surgery, the nurse implements measures
to prevent skin breakdown, wound infection,
pneumonia, constipation, urinary retention,
muscle atrophy, and contractures.
The client usually has a wound drain in place
for 1 to 2 days after surgery.
The nurse monitors the drainage and
administers antibiotics as prescribed
 Eventually the client progresses to ambulating
with a walker.
Before discharge, the nurse needs to explore
ways to ensure safety in the clients home to
avoid future injuries and falls.