FRACTURE

Break in the continuity of the bone. When force is applied that exceeds the tensile
strength or compressive strength of the bone.

TYPES
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.

CLINICAL MANIFESTATION

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.

COMPLICATIONS

Osteomyelitis

The open area is a rich culture medium for infection. It retards healing by
destroying newly formed bone and interrupting its blood supply.

S. aureus is the usual cause.

Osteomyelitis The open area is a rich culture medium for infection. It retards
healing by destroying newly formed bone and interrupting its blood supply.

Delayed union Increased healing time; may result from a breakdown in the
early stages of healing which may occur from Inadequate immobilization,
breakdown in hematoma formation or poor alignment.

Nonunion fragments fail to unite over a 5-month period. May be due to

varying factors like: health, degree of trauma, underlying disease, infection
and movement. Infection causes continuous bleeding and breakdown of
osteoid matrix. Movement causes repeated bleeding and decalcification at
the fragmented ends

Malunion union of the fragments in an abnormal position that may modify

function.

Internal Bleeding - (Usually from closed Fx) The bleeding may occur from the
bone itself or from surrounding soft tissues.

Embolism

Fat Embolism -Fractures of long bones may release enough fat (and
other substances in bone marrow) to travel through the veins, they
attract platelets which become part of the microembolus and deplete
circulating platelets.

Pulmonary Embolism

Osteoarthritis - Fractures that extend into joints usually damage cartilage (a

smooth, tough, protective tissue that reduces friction as joints move). Damaged
cartilage tends to scar, causing osteoarthritis and impairing motion in the joints.
Nerve Damage - Bone fragments may rupture and compress nerves that may also
be damaged by dislocation or direct trauma

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

Nerve Damage

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

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

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

Myoglobinuria (Rrabdomyolysis)
Severe muscle trauma.

An excess myoglobin

Muscles damage, with disruption of sarcolemma, releases myoglobin which

would lead to renal failure

(intracellular muscle protein)

in the urine.

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.

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.

DIAGNOSTIC TEST
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

Blood 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

Blood 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

Hemoglobin
-

- main component of erythrocyte & serve

as the vehicle for transportation of O2 and CO2.

- NORMAL VALUES
Male: 14-16.5 g/dL

Female: 12-15 g/dL

Hematocrit
-

- Determinations are important in identifying anemia.

- Fasting is not required.

- NORMAL VALUES
- Male: 42%-52%

Female: 35%-47%

WBC
- Immune defense system of the body.
- Cell count assess each leukocytes distribution.
- increase WBC, normal response to trauma.
NORMAL VALUE
4,500 11, 000 cells/L

activated Partial Thromboplastin Time (aPTT)

- Test screens
deficiencies & inhibitors of all factors
except factor VII & XIII.
- Screen for coagulation disorders.
- NORMAL VALUE
20-36 seconds

Prothrombin Time (PT)

- Measures the amount of time it takes for clot formation
- within 2 sec (+ or - ) of the control is considered
normal.
NORMAL VALUES
- Male: 9.6 -11.8 seconds Female: 9.5 -11.3 seconds

PT > 30 seconds at risk for HEMORRHAGE