Fractures

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Alteration in Musculoskeletal System

• Fractures

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Objectives

• Identify the types of bone fractures and
  dislocations.
• Recognized different types of traction and the
  principles of each.
• Describe the physiological process of bone
  healing.
• Describe the pathophysiology, management,
  complication and nursing care of fractures and
  dislocations.

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Overview

• Musculo-skeletal system includes
• Bones
• Skull, vertebrae, rib cage pelvis
• Joints
• Muscles
• Tendons
• Ligaments
• Bursae of the body

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• 206 bones
• Long bones (femur)
• Short bones (metacarpals)
• Flat bones (sternum)
• Irregular bones (vertebrae)

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Fracture

• A break in the continuity of bone
• Can occur under stress greater than the bone can
  absorb
• Caused by direct blows, crushing forces, sudden
  twisting motions and extreme muscle contractions.

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Fracture

• Broken bone? soft tissue edema ? muscle and joint
  hemorrhage ? joint dislocations, ruptured
  tendons, severed nerves, and damage blood
• vessels

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Types of Fractures

• Complete- involves a break across the section of
  the bone and is move from its normal place.
• Incomplete- AKA greenstick fracture is when the
  bone cracks on one side only, not all the way
  through.

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Types of Fractures

• A comminuted-bone is broken into more than two
  pieces or crushed. (fragmented)
• Closed or simple the bone does not cause a break
  in the skin
• Open- the bone is sticking through the skin.

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Types of Fractures
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Clinical Manifestations

• Acute pain
• Loss of function
• Deformity
• Shortening of the extremity
• Crepitus (popping sound) should not test for
  crepitus
• Local swelling and discoloration

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Emergency Management

• Immobilization of the body part
• To prevent rotation an angular motion
• Adequate splinting
• To prevent movement
• Firmly bandage over clothing
• Neurovascular checks prior after bandaging
• Open fracture
• Application of sterile dressing
• Do not reduce the fracture
• Clothes removed from the uninjured side first

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Medical Management

• Principles
• Reduction
• Immobilization
• Regaining normal function and strength through
  rehabilitation

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Reduction

• Setting the bone restoring the bone back into
  alignment

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Reduction

• Closed Reduction
• the pieces of bone are realigned by manual
  manipulation and traction and held in place for
  healing.
• Cast or splint
• Open Reduction
• Surgical approach
• Internal fixation devices
• Metallic pins, wires, screws, plates, nails or
  rods

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Immobilization

• After reductions
• Bone fragments immobilized
• Held into correct position and alignment
• External or internal fixation
• Bandages, cast, splints, continuous traction and
  external fixators

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Internal Dixation Device
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Maintaining and Restoring Function

• Elevate injured extremity and apply ice
• To control Edema
• Neurovascular status
• CMS
• Isometric and muscle setting exercise
• To minimize muscle atrophy

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Closed Fracture Nursing Management

• Encourage return to their usual activities ASAP
• Teach how to control edema and pain
• Teach how to use assistive devices
• Crutches, walkers, special utensils

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Open Fracture Nursing Management

• Open fracture risk of osteomylitis, tetanus, and
  gas gangrene
• Prevent wound infection
• Administration of tetanus prophylaxis
• Serial irrigation and debridement
• CS of wounds
• Administration IV antibiotics
• Open fractures may be left open
• Monitor for ss infection

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• THE END