Fracture: Causes, Types, Diagnosis, management, Complications

Fracture

A fracture is a break in the continuity of bone and is defined according to type and extent,

Causes:

1.    Direct blow.

2.     crushing force.

3.     Sudden twisting  motion

4.     Extreme muscle contraction.

Types of fracture:

1.A complete Fracture: Involves      a break        across         the entire cross     section of the bone and  is usually  displaced (removed  from normal position.)

2.An Incomplete Fracture: Involves a   portion of the cross section of the bone or may be longitudinal.

1.     A closed fracture or Simple fracture: Does not produce a break in the skin.

2.     Open fracture/compound fracture/complex fracture: Is one in which the skin or mucous membrane rapture extends to the fractured bone. It can be classified or graded into

Grade I  : Is a clean wound less than 1 cm long.

Grade II: Laceration grater than 1 cm without extensive soft tissue flaps.

Grade III: Which is highly contaminated and has extensive soft tissue injury, including skin, muscle, neurovascular structure, with crushing, is the most severe.

5. Pathologic: A fracture that occurs through an area of diseased bone (bone cyst, pager' s disease, bony metastasis, tumor).

Fractures are also are classified as, 1.    Greenstick: A fracture in which one side of a bone is broken and the other side is bend.

2.     Transverse: A fracture that is straight across the bone

3.     Oblique: A fracture occurring at an angle across the bone (less stable than the transverse)

4.     Spiral: a fracture twists around the half of the bone.

5.     Communicated: A fracture in which bone has splintered into several fragments.

6.    Depressed: A fracture in which fragments of skull and facial bones.

7.     Compression: A fracture in which has been compressed on collapses in on itself.( Seen in vertebral fractures)

8.     Avulsion: A pulling away of a fragment of bone by a ligament or tendon and its attachments.

9.     Impacted: A fracture in which a bone fragment is driven into another bone fragment.

10.                        Others: Described according to anatomic location: Epiphyseal, supracondylar, mid shaft, intra articular etc.

Signs and symptoms:

1.     Pain at sick of injury.

2.     Swelling.

3.     Tenderness

4.     False motion and crepitus.

5.     Deformity.

6.     Loss of function.

7.     Ecchymosis.

8.     Parasthesia

9.     Injured        muscle, blood vessels and nerves.

10.            Compression of structures resulting in ischemia.

11.            Loss of active motion.

12.            Bone is very vascular so hemorrhage can be detected and treated and if not will lead to fatality.

Diagnosis:

1.     X-ray and other imaging studies to define integrity of bone.

2.     Blood studies

3.     Arthroscopy:  To detect joint involvement.

4.     Angiography: It associated with blood vessel injury.

5.     Nerve conduction and electromyogram studies to detect nerve injury.

Management:

Factors influencing choice of fracture management:

Type, location, and severity of fracture.

Soft tissues damage.

Age and health status of patient, including type and extent of other injuries.

Process:

Reduction: May be used to reduce a fracture.

Closed reduction: In most instances, closed reduction is accomplished by bringing the bone fragment into apposition by manipulation and manual fraction restore alignment.

Open reduction: Operative intention to achieve reduction, alignment and stabilization.

Immobilization: After the fracture has been reduced, bone fragments must be immobilized or hold in correct position. It can be achieved by Cast  or  splint  applied  he  immobilize     extremity  and maintain reduction.    

Skin traction: Force applied to the skin   using   foam, rubber, tape etc.

Skeletal traction: Force applied to the body skeleton directly using wires, pins or tongs placed into or through the bones.

Rehabilitation:

Regaining normal fraction of the infected part by traction, exercises, or physiotherapy.

Nursing Management:

1.     Monitor vital signs for evaluating hemorrhage and shock.

2.     Watch for evidence of hemorrhage or dressing.

3.     Administer  prescribed       fluid/blood  to  maintain circulating routine.

4.     Monitor neurovascular status for compression of nerve, diminished circulation, development of compartment syndrome.

5.     Pain - on passive stress, localized, persistent, unrelieved by immobilization and medication.

6.     Weakness and pulselessness

7.     Altered sensation hypothesis

8.     Skin colour- pale.

9.     Position to enhance respiratory effort.

10.            Encourage deep coughing and deep breathing exercise to promote lung expression.

11.            Administer oxygen as prescribed.

12.            Reduce swelling by elevating injured extremity (unless compartment syndrome is suspected - may contribute vascular compromise).

13.            Relieve pressure caused by immobility device as prescribed.

14.            Relieve pressure on skin to prevent development of pressure sore by frequent positioning, skincare and special mattress.

15.            Encourage active and passive exercise.

16.            Use elastic stockings.

17.            Encourage ambulation

18.            Administer anti coagulants as prescribed.

19.            Immobilize the injured part.

20.            Position the patient in correct alignment and support with splint or cast.

21.            Provide high caloric diet and plenty of liquids.

22.            Monitor intake and output chart.

Complications

1.     Muscle atrophy

2.     Joint contrasture

3.     Pressure sore

4.     Venous stasis and thromboembolism.

5.     Infection- especially in open fracture.

6.     Shock-due to significant hemorrhage.

7.     Pulmonary emboli.

8.     Fat emboli syndrome

a.     respiratory

b.     Mental disturbances.

c.      Fever