Fractures

Break in bone continuity from excessive force. Traumatizes muscles, blood
vessels, and nerves leading to inflammation and possible hemorrhage

Types of Fractures

Simple (closed): Skin remains intact
Compound (open): Fragments penetrate skin
Transverse: Straight across
Oblique: Angled across
Spiral: Twists around shaft
Comminuted: Multiple fragments
Compression: Compressed bone mass
Depressed: Fragments forced inward
Green stick: Break partially extends across and then along length; more
common in children
Pathological: Force than normal needed to break bone due to ↑age, porous,
brittle bones (osteoporosis), metastatic or primary tumors, Paget’s disease

Signs and Symptoms
■ Pain, spasms, shortening of extremity, ecchymosis
■ Grating sound when moved (crepitus)
■ ↓Mobility, deformity, paresthesia 2° nerve damage
■ Shock 2° hemorrhage
■ Fat emboli: Dyspnea; ↑R; ↑P; ↑T; copious white sputum; crackles;
↑mentation; buccal, conjunctival and chest petechiae
■ Compartment syndrome: ↑Muscle compartment pressure 2°
edema/bleeding → ↓circulation → tissue hypoxia → ↑pain and damage


Treatment
■ Closed reduction: Fragments aligned and stabilized with cast, splint, or
traction
■ Open reduction and internal fixation (ORIF) with wires, pins, nails, rods, or
plates
■ Hemiarthroplasty (surgery for femur head prosthesis)

Nursing Management
■ Immobilize (↓trauma and pain); pain management
■ Peripheral neurovascular assessment: Peripheral pulses, color, T, capillary
refill, motor/sensory function
■ Monitor for compartment syndrome (elevate limb and notify MD)
■ Patient with a cast: ↑On pillow, uncover to ↑drying, handle with palms
not fingertips until dry, isometric exercise to ↓atrophy; odor may indicate
infection
■ Patient with traction: Hang weights freely, functional alignment, pin care
as ordered for skeletal traction
■ Postoperative care for patient with hemiarthroplasty:
■ ↓Pain (patient controlled analgesia)
■ ↓Displacement of prosthesis (abduction pillow, avoid internal rotation
or flexing >90 degrees, ↑toilet seat/chair)
■ Prevent DVT (anticoagulants and compression devices as ordered,
dorsiflexion, avoid popliteal pressure)
■ ↓Atelectasis/pneumonia (incentive spirometry, coughing, deep
breathing)