Fractures

Fracture

Break in the continuity of the bone.

When force is applied that exceeds the tensile strength

or compressive strength of the bone.

Types of Fracture

Closed (simple) The bone is broken, but the skin is not lacerated.Open (compound) If the skin is open. The bone may or may not be

visible in the wound.

SIMPLE COMPRESSION

GREENSTICK COMPOUND

SPIRAL OCCULT

COMMINUTED TRANSVERSE

OBLIQUE

RISK FACTORS

Risk factor

Toddler

Risk factor

Risk factor

Paget’s Disease

Risk factor

Risk factor

Pathophysiolgy of Fracture

Bone impact exceed tensile

strength

Break in the continuity of the

bone

SwellingPain

Moderate to severe energy transmitted

Fat embolus

Myoglobinurea

Compartment syndrome

DeformityLoss of function

Impaired sensation Decrease mobility Bleeding

Hematoma formation

Bone tissue dies

Decalcify fracture bone ends

Bone tissue revascularization

Stimulates inflammatory response

Procallus

Callus

Remodeling

New bones

Osteoblast

Clinical Manifestations• Local Swelling• Loss of function or abnormal movement of affected

part• Deformities such as shortening, rotation• Crepitation • Pain/ local tenderness• Anesthesia and flaccidity (few minute to hrs) - This is due to a temporary loss of nerve function at

the site associated vascular injury.

Complication

Osteomyelitis The open area is a rich

culture medium for infection. It retards healing by destroying newly formed bone and interrupting it’s blood supply.S. aureus is the usual cause.

Embolism Fat & Pulmonary Embolism Fractures of long bones may

release enough fat to travel through the veins, they attract platelets which become part of the microembolus and deplete circulating platelets

Complications

Disseminated Intravascular CoagulationDisseminated Intravascular Coagulation

Precipitating mechanism

Tissue damage

Treat the underlying

problemEndothelial

damage

Increased tissue thromboplastin

Intrinsic pathway of coagulation

Extrinsic pathway of coagulation

Heparin to prevent microclotting

(controversial)Intravascular coagulation

(production of microthrombi)

Production of thrombi

Activation of fibrinolytic system

Digestion of fibrin clots

Inhibition of platelet function

Consumption of clotting factors

Decreased clotting factors

Cryoprecipitate factor VIII

Fresh frozen plasma

Platelets

Occlusion of small blood vessels

Tissue necrosis

Thrombocytopenia

BleedingBlood

Key: = treatment

Delayed union

Complications

Failure

incorrect

Nerve Damage - Bone fragments may

rupture and compress nerves that may also be damaged by dislocation or direct trauma

Complications

Dislocation temporary displacement of one or more bones in a joint in which the opposing bone surface loss contact entirely.

Complications

Subluxation if the contact bone between the opposing bone surface is partially lost.

Myoglobinuria (Rrabdomyolysis)

Severe muscle trauma. An excess myoglobin

(intracellular muscle protein) in the urine.

Muscles damage, with disruption of sarcolemma, releases myoglobin which would lead to renal failure

Complication

COMPARTMENT SYNDROME - Pressure build within the

compartment due to bleeding.- swelling reaches the point at which the fascia permits no outward enlargement

- increasing pressure is directed inward and compresses components in the compartments.

Complication

Nursing Diagnosis

1. Acute pain r/t stimulation of free nerve endings 2 to soft tissue injury.

2. Risks for peripheral neurovascular dysfunction r/t reduction/interruption of blood flow.

3. Impaired Gas Exchange r/t altered blood flow/fat emboli.

4. Impaired physical mobility r/t skeletal instability 2 to physical trauma.

5. Impaired Tissue integrity r/t insertion of traction pins wires and screw/ physical immobilization

6. Situational low Self –Esteem r/t loss of body parts/ change in functional abilities.

7. Ineffective peripheral tissue perfusion r/t reduced arterial venous blood flow; tissue edema; hematoma formation.

Nursing Diagnosis

Diagnostic Tests

RADIOLOGIC EXAM

Radiologic exam- to determine location extent of fracture/trauma; may reveal preexisting undiagnosed fracture.

Bone scan, tomograms, CT, MRI scan- Visualized fractures, bleeding and soft tissue damage.

May be prepared for diagnostic tool because of superior ability to image some types of injuries.

Arteriogram- May be done when occult vascular damage is suspected.

Urine creatinine clearance

- Muscle trauma increases load of Cr for renal clearance.- Creatinine level and urea nitrogen level should be analyzed when renal function is

elevated.- NORMAL VALUE

- .6-1.3 mg/dL.6-1.3 mg/dL

URINE ANALYSIS

Blood Urea NitrogenBlood Urea Nitrogen- - Urea normally freely filtered through renal glomeruli, small amount reabsorbed in the tubule and the remainder excreted in the urine.

-NORMAL VALUE 8-25 mg/dl 8-25 mg/dl

URINE ANALYSIS

BLOOD ANALYSIS Hemoglobin - main component of erythrocyte & serve as the vehicle for transportation of O2 and CO2. - NORMAL VALUES - NORMAL VALUES Male: 14-16.5 g/dL Female: 12-15 g/dLMale: 14-16.5 g/dL Female: 12-15 g/dLHematocrit - Determinations are important in identifying anemia. - Fasting is not required. - NORMAL VALUES - Male: 42%-52% Female: 35%-47%- Male: 42%-52% Female: 35%-47%

BLOOD ANALYSIS

- Immune defense system of the body.- Cell count assess each leukocytes distribution.- increase WBC, normal response to trauma.

NORMAL VALUE NORMAL VALUE 4,500 – 11, 000 cells/4,500 – 11, 000 cells/LL

WBC

Coagulation profile

activated Partial Thromboplastin Time (aPTT) - Test screens deficiencies & inhibitors of all factors except factor VII & XIII. - Screen for coagulation disorders. - NORMAL VALUE 20-36 seconds20-36 seconds

Coagulation profileProthrombin Time (PT) - - Measures the amount of time it takes for clot Measures the amount of time it takes for clot

formationformation - within 2 sec (+ or - )2 sec (+ or - ) of the control is considered normal.NORMAL VALUES - Male:Male: 9.6 -11.8 seconds Female: 9.5 -11.3 seconds 9.6 -11.8 seconds Female: 9.5 -11.3 seconds -

PT PT > 30 seconds30 seconds at risk for HEMORRHAGEHEMORRHAGE

The end….