Fracture

1
Fracture BENTY GEORGE MSC NURSING SINHGAD
COLLEGE OF NURSING,PUNE
2
Definition of Fracture

• Fracture A fracture is a break in the
  continuity of the bone.

3
Etiology

• Motor Vehicle Accident
• Fall
• Direct blow to the bone or an indirect force from
  muscle contraction
• Sports
• Vigorous Exercise
• Malnutrition
• Bone Diseases like Osteoporosis

4
Types of Fracture
Fracture
5
Butterfly Fracture

• This type of fracture has slight comminution
  at the fracture site

6
Closed Fracture

• There is no broken skin. The bones which are
  broken do not penetrate the skin.

7
Compound Bone Fracture

• The skin is broken, leading directly into
  fracture
• Grade I Minimal soft tissue injury
• Grade II Laceration greater then 1cm without
  extensive soft tissue flaps.
• Grade III Extensive soft tissue injury,
  including skin, muscles, neuro vascular
  structures, with crushing.

8
Compression Fracture

• A fracture in which bone has been compressed.

9
Greenstick Fracture

• The fracture in which one side of the bone is
  broken and the other side is bent.

10
Hairline Fracture

• In this type of the fracture the crack only
  extends into the outer layer of the bone but not
  completely through the entire bone. It is also
  known as a Fissure Fracture.

11
Incomplete Fracture

• A fracture in which the end of the bone do not
  completely separate leaving the bone with a crack

12
Multiple Fractures

• A bone with several fracture. It can also
  mean several fractures in one patient but on
  separate bones but generally due to the same
  injury.

13
Oblique Fractures

• A fracture occurring at an angle across the
  bone. It is an unstable fracture, it can be
  easily diagnosed as spiral fracture.

14
Spiral Fractures

• A fracture twisting around the shaft of the
  bone. It is highly unstable. It can be diagnosed
  as oblique fracture unless a proper X-ray has
  been taken.

15
Unstable Fracture

• An unstable fracture is generally a broken
  bone which is comminuted, oblique or a spiral
  fracture requiring external or internal fixation.
  

16
(No Transcript)
17
Sign and Symptoms of Fracture

• Arm and leg fractures
• 5 Ps Pain and point tenderness.
• Pallor
• Pulse loss
• Paresthesia
• Paralysis
• Deformity
• Swelling
• Discoloration
• Crepitus (grating, crackling or popping sounds )
• Loss of limb function
• Numbness
• Cool skin at the end of
• extremity
• Loss of pulse

18

• Skull Fracture
• Bleeding
• Hypertension
• Loss of consciousness
• Agitation
• Irritability
• Changes in responses
• Seizures
• Vomiting
• Facial ecchymosis
• CSF leakage from ears and nose
• Altered pupillary and motor
• responses
• Abrasion
• Laceration

19

• Jaw dislocation or fracture
• Mal occlusion
• Mandibular S/S Pain
• Swelling
• Ecchymosis
• Loss of
  function
• Asymmetry
• Paresthesia
  of chin
• and lower
  lip
• Maxillary S/S Infra orbital Paresthesia
• Nasal and
  orbital fracture

20
Diagnostic Evaluation

• X-ray
• MRI, CT-scan
• Blood studies
• Arthroscopy
• Angiography
• Nerve conduction / electromyogram studies

21
Management of Fracture

• Assessment
• Type, location and severity of fracture
• Soft tissue damage
• Age and health status of patient
• Extend of other parts of organs

22
Approaches to Management
23
Closed reduction

• Is the most common non surgical method for
  managing a simple fracture.
• Bandages are elastic or muslin bandage used to
  immobilize the bone during healing.
• Splints as upper extremity bones do not bear
  weight, splints may be sufficient to keep bone
  fragments in place.

24

• Casts A cast is an immobilizing device made up
  of layers of plaster or fiber glass. A cast also
  allows early mobility and reduces pain.
• Types of cast
• Arm cast
• Leg cast
• Cast braces
• Body or spica cast

25

• Traction its the application of a pulling
  force to a part of the body. It uses a system of
  ropes, pulleys, and weights to provide reduction,
  alignment and rest.

26
Open reduction

• Internal fixation Open reduction with internal
  fixation permits early mobilization. It is often
  the preferred surgical method for an elderly
  client who is susceptible to the complications of
  immobility. Internal fixation uses pins, screws,
  rods, plates and / or protheses to immobilize a
  fracture during healing. After the bone achives
  union, the hardware may be removed, depending on
  the location and type of fracture.

27

• External fixation Open reduction with external
  fixation. The physican makes small percutaneous
  incisions so that pins may be implanted into the
  bone. The pins are held in place by a large
  external metal frame to help in bone healing.

28
Goals of management

• To regain and maintain correct position and
  alignment.
• To regain the function of involved part.
• To return the patient to usual activities in the
  shortest time and at the least expenses.

29
Complications of Fracture

• Acute compartment syndrome.
• Shock.
• Fat embolism syndrome.
• Thrombo embolic complication.
• Infection.
• Avascular necrosis.
• Delayed union, non union and
• mal union.

30
QUESTIONS

• ?