FRACTURES

Aquino, Bianca Denisse C.

Aquino, Paula Nichaelle E.
BSN III-1 RLE2
The Skeletal System
The Skeletal System is composed of 206 bones and
associated cartilages, tendons ,and ligaments.
It gives the body a framework, maintains its shape,
and protects vital organs.
It provides a place for attachment of muscles and
supporting structures.
It produces body movements through a system of
levers.
A site for mineral storage and blood cell formation.
Two Parts of the Skeletal System
AXIAL SKELETON– composed of the skull, the hyoid
bone, the vertebral column (spine, sacrum, and
coccyx), the sternum, and the ribs. Its components are
aligned along the long axis of the body.
APPENDICULAR SKELETON- includes the bones of
the upper extremities (arms, forearms, and hands), the
pectoral (shoulder) girdle, the pelvic (hip) girdle, and
the bones of the lower extremities (thigh, knee, leg,
and foot). Its components are outside the body main
axis.
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Definition

Break in the continuity of the margins of a bone

Occurs whenever a force exceeds the tensile strength
of the bone
Maybe caused by stress, trauma, overuse, repeated
wear
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Risk Factors
Falls
Vehicular accidents
Sports
Use of drugs that impair judgement
Tumors
Infection
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Signs and Symptoms
Deformity
Edema
Ecchymosis
Redness
Muscle Spasms
Loss of function (affected part)
Crepitus
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Types of Fractures
AVULSION- fracture that pulls bones and other
tissues from their usual attachments

Ring Finger Avulsion

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Types of Fractures
CLOSED- skin closed but bone is fractured

Closed Fracture (Right Forearm)

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Types of Fractures
COMPRESSION- bone is squeezed or wedged
together at one side

Thoracic Compression Fracture

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Types of Fractures
GREENSTICK- break in only one cortex of the bone

Forearm Greenstick Fracture

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Types of Fractures
IMPACTED- one end wedged into the opposite end or
into the fractured fragment

Impacted Fracture
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Types of Fractures
OBLIQUE- fracture at an oblique angle across
bothecortices

Metatarsal Oblique Fracture

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Types of Fractures
OPEN- skin is open, bone is fratured; soft tissue
trauma may occur

Open Fracture
(Radius and Ulna)
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Types of Fractures
PATHOLOGIC- transverse, oblique or spinal fracture
of a bone weakened by tumor

Pathologic Fracture of the Spine

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Types of Fractures
STRESS- crack in one cortex of a bone

Stress Fracture
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Types of Fractures
TRANSVERSE- Horizontal break through the bone

Left Humerus Transverse Fracture

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Stages of Bone Healing
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Emergency Management
Assess for signs of respiratory distress, bleeding and head
injuries
 Provide lifesaving care before focusing on the fracture itself
Assess fracture injury
 Cut clothing from affected side
 Apply direct pressure on the area
 Apply digital pressure over proximal artery
Immobilize fractured area by splinting
 Prevent further damage, reduce pain, and increase circulation
 Splints are used to support, immobilize, and protect parts with
known or suspected fractures, dislocations or severe pain
Cover open fractures with a clean or sterile dressing
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Nursing Management

Assess vital signs and monitor signs of shock

 Significant blood loss may occur, especially with fractures involving
long bones
Apply ice bags to fracture site
 Vasoconstirction: decreases bleeding, edema, and pain
Help client sit in a chair with legs elevated
 Upright positions increase peripheral circulation: decrease edema
Administer analgesics and antibiotics as prescribed
Change dressing as needed using strict aspectic technique
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Medical and Surgical Management

Reduction – restores proper bone alignment

• Closed reduction: manual manipulation under local or
general anesthesia
• Open reduction: for fractures that cannot be managed
with closed reduction
Closed Reduction
• Manual manipulation of extremities to align the fractured
fragments
• Traction – exertion of a pulling force applied in 2 directions
to reduce muscle spasm and immobilize a fracture
– Skin traction: uses elastic bandages and coverings attached to
the patient’s skin
– Skeletal traction: use of pins or wires inserted through the
distal bone and attached to a weight, allowing a more prolonged
traction
• Casting
– Application of plaster of paris or fiberglass for the purpose of
stabilizing a fracture while bony union occurs
Cast

Balanced Skeletal Traction

Nursing care for patients with casts
Keep cast and extremity elevated
Allow wet cast to dry within 24-48 hours; handle with
palms of the hands
Monitor extremity for circulatory impairment
Inspect cast edges and underlying skin for irritation
Monitor for any signs of infection: “hot spots”
Instruct not to inset anything in the cast
Instruct to do isometric exercises
Help patient in using an ambulatory aid
Weight bearing is restricted until some bone union occurs
Open Reduction
Surgical intervention used to treat fractures with the use of
internal fixation devices
Either placed on a traction or a cast
Internal Fixation
 Involves application of screws, plates, pins, or nails to hold
fragments in alignment
 Provides immediate bone strength
External Fixation
 An external frame is used with multiple pins applied through the
bone
 Provides more freedom of movement than with a traction
Open Reduction Internal Fixation
(ORIF)

Open Reduction External Fixation

(OREF)
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Rehabilitative Use Assistive Devices
• Crutch Walking
– Used for aiding the client in ambulation
– Accurate measurement to avoid damage to the brachial plexus
– Distance between the axial and the arm pieces should be 2
finger widths in the axilla space
– Elbows should be slightly flexed, 20-30 degrees when walking
– Instruct never to rest the axilla on the bars
– Stop ambulation if numbness or tingling occurs
– Stand on the affected side
– Instruct to look upward and outward when ambulating
– Place crutches 6-10 inches diagonally in front of the foot
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Rehabilitative Use Assistive Devices
Crutch Gaits
• One leg can bear weight
– Swing to gait
– Swing thru gait
– 3 point gait
• Both legs can move separately and bear some weight
– 4 point gait
– 2 point gait
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Rehabilitative Use Assistive Devices
Going up and down the stairs
Up the stairs: unaffected leg first then moves the
affected leg and crutches up
Going down the stairs: affected leg and crutches down
first then unaffected leg