FEMUR FRACTURE

A R R A N G E D B Y:
ANISA HUSNA RISKA
 DEFINITION

• Fractures or broken bones is the continuation of

continuity bone tissue and cartilage which is
generally caused by forced (Mansjoer, 2003).

• Femur fracture is severed continuity of the femur

shaft which can occur due to direct trauma (traffic
accident, fell from height). Broken bones femur
can give rise bleeding quite a lot as well result in
sufferers experiencing shock (Sjamsuhidajat,
2004).
 ETIOLOGY

• Causes of fracture physiological is a bone tissue

damage that is resulting from an accident, physical
exertion, sports and trauma can be caused by : direct
injury means a blow directly against the bone so the
bones break in a way spontaneous and indirect
injuries means the direct hit is located far from the
collision location. Accordingly pathological is a bone
damage that occurs due to disease processes where
with trauma can resulting in a fracture, this can occur
in a variety of conditions including : tumor bone,
osteomyelitis, scurvy (bleeding gum disease) as well
rickets (Mansjoer, 2003).
 PATHOPHYSIOLOGY

• Bones are fragile, but has enough the strength and the spring
force for withstand the pressure. But if external pressure comes
more greater than the pressure absorbed by the bone, so it
happens trauma to the bone that can resulting in damage or
loss of bone continuity (fracture) (Elizabeth, 2003).

• After a fracture occurs, periosteum and blood vessels as well as

nerves in the marrow cortex and soft tissue ones wrapping
bones become damaged thus causing it to occur bleeding. At
the time of bleeding hematoma is formed in bone medulla
cavity, so that immediately adjacent bone tissue got a broken
bone. Necrotic tissue will stimulate the occurrence marked
inflammatory response with vasodilation, exudation plasma and
leukocytes and infiltration white blood cell. This incident which
is the basis of the process bone healing later (Price, 2005).
 SIGNS AND SYMPTOMS

• Uncertain signs include : pain and tense, intense

pain when moving, loss of function due to pain or
unable to move and deformity because swelling
or effect bleeding and fragment position change.
Sure signs among them are : movements
abnormality ( false movement), friction from both
ends of the fragment broken bones (crepitations)
as well deformity due to fracture (generally the
form deformity rotation, angulation and
shortening) (Smletzer, 2004).
 DIAGNOSTIC CHECK

Radiological examination, include : X-Ray, can

be seen picture of fracture. Venogram or
anterogram describe the current vascularization.
CT scan for detect the structure of the fracture
complex. Another thing you can done is with
laboratory examination, at laboratory test fractures
that are necessary known : hemoglobin, hematocrit
often low due to bleeding, sedimentation rate
(LED) increase when tissue damage very broad
software (Mansjoer,2003).
MANAGEMENT FRACTURE REDUCTION

• Manipulation or closed decline, non-surgical

manipulation of drafting return manually from bone
fragments against previous autonomy position. Open
decline is repair of the canal alignment of surgical
incisions often insert internally fixation of the
fracture with wire, screw pin rod intra-medulation
and nails. Equipment traction : skin traction for short-
term treatment and muscle traction or surgery
usually for an extended period long. Immobilization
fracture : bandaging (plaster cast), ORIF and Open
Reduction Of External Fixation (OREF). Fracture
open : debridement surgery and irrigation, tetanus
immunization, antibiotic therapy (Smletzer, 2004)
 COMPLICATIONS

•  Complications due to fracture that might happen

according to Sjamsuhidajat (2004), including :
neurogenic shock, infection, necrosis divascular,
vascular injuries and nerves, mal-union, wound
due pressure and stiff joints.
 NURSING CARE

• Assessment conducted include : data

demographics (age, gender, work), main
complaint, history health, health patterns and
health maintenance, as well physical examination
which includes : the client’s state and awareness,
vital signs (TTV), circumstances local include :
look (inspection) attention to what will be seen,
feel (palpation) and move (movement especially
range motion) (Doengoes, 2004).
 DIAGNOSTIC AND INTERVENSION
NURSING
• Pre operation
• Acute pain associated with physical injury agents, bone
fractures, muscle spasms, edema, tissue damage soft.

• The purpose of the diagnosis according to Wilkinson (2004),

are : pain decreases until missing criteria results : verbally
client say pain reduced, pain scale declining, calm client,
relaxed facial expressions and TTV is within normal limits,
blood pressure (TD) : 110-120/ 70-80 mmHg, pulse (N) : 60-100
x/minute, respiratory rate (RR) :16-22x/minute and
temperature (S) : 36-37,5 ℃. Nursing orders done is : do
approach to the client and family, assess location, intensity,
frequency and type pain, TTV observation, immobilization in
parts the sick, teach technique relaxation, collaborative
analgesic administration.
• Anxiety related with procedures surgery.

• The purpose from the diagnosis according to Wilkinson

(2004), anxiety decreases with yield criteria : TTV
inside normal limit, with TD : 110-120/70-80 mmHg, N :
60-100x/minute, RR : 16-22x/minute and S : 36-37,5 ℃,
the client is able to use coping mechanism which is
effective, the client says worry less, expression relax
and calm. Intervention nursing done are : assess the
causes and the level of client anxiety, give support
system and motivation to clients, give the environment
a comfortable, TTV monitor, explain the procedures and
actions briefly and clear, teach technique relaxation.
• Damage to physical mobility associated with order
damage neuromuscular, restriction motion.

• The purpose of the diagnosis according to Wilkinson

(2004), client able to do mobility physical as optimal
as possible with result criteria : client can do activities
independently, strength increased muscle tone.
Intervention nursing done is : assess client immobility,
maintain body posture and comfortable position, do
collaboration with family in care client, keep dressing
or splint as a tool immobilization of that part pain,
client motivation for restrict movement to the fracture
part, collaborative action operations.
• Intra surgery
• Impaired tissue perfusion peripherally related to decreased
blood flow, direct vascular injury, excessive edema.

• As for the purpose of the diagnosis according to Wilkinson

(2004), dysfunction does not occur peripheral neurovascular
with the result criteria : TTV within normal limits, TD : 110-
120/70-80 mmHg, N : 60-100x/minute, RR : 16-22x/minute
and S : 36-37,5 ℃, capable client maintain perfusion network
proven by the palpability of the veins and acral warm.
Intervention nursing done are as follows : color observation,
skin temperature, mucous membrane, observation client
awareness, monitor TTV, evaluation of externalities, the
quality of the pulse, tenderness and edema.
• Risk of hypovolemic shock associated with bleeding due
surgery.

• The purpose from the diagnosis according to Wilkinson

(2004), hypovolemic shock can minimized or did not occur
with yield criteria : no there are signs of shock
hypovolemic, TTV inside normal limit, TD :110-120/70-80
mmHg, N : 60-100x/minute, RR : 16-22x/minute and S :
36-37,5 ℃. Nursing orders done is : monitor bleeding in
the area surgery after incision made, remind operator and
asiasten when there was heavy bleeding. TTV monitor,
fluid monitor which passes through dower catheter (DC),
give Ringer’s Lctate Fluid (RL) for fluid resuscitation,
monitor for signs of shock hypovolemic.
• Risk of infection is related with barrier decline secondary
body defense against disconnection network continuity.

• As for the purpose of the diagnosis according to

Wilkinson (2004), infection does not occur with yield
criteria : none signs of inflammation (tumor, dolor, heat,
rubor and functionolesa), TTV inside normal limits, by
reference as follows : TD : 110-120/70-80 mmHg, N : 60-
100x/minute, RR : 16-22x/minute and S : 36-37,5 ℃.
Nursing orders are as follows : monitor TTV, examine the
signs infection inflammation, do wound care with aseptic
technique, do it wound care for invasive procedures,
collaboration administration of antibiotics.
• Post operation
• Damage to the integrity of the skin associated with circulation damage
and decreased sensation due surgical incision.

• As for the purpose of the diagnosis according to Wilkinson (2004),

achieve healing wound at the appropriate time with yield criteria : no
there are signs of inflammation (tumor, dolor, heat, rubor and
functionoles), wounds clean, TTV is within limits normal, with TD
references : 110-120/70-80 mmHg, N : 60-100x/minute, RR : 16-
22x/minute and S : 36-37,5 ℃. Nursing orders done is as following : skin
assessment and identification at stages wound development, assess
location, size, color, smell, and the amount and type of liquid wound,
monitor improvement body temperature, give wound care with aseptic
technique, wound dressing with dried gauze, and sterile, client’s
motivation for meet the high college high protein carbohydrates (TKTP),
give fluids adequately, motivated client to break adequately during the
recovery period and reduce motion.
THANKYOU FOR
YOUR ATTENTION