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….