Immediate management of a fracture may determine the patient’s outcome and may mean the difference between recovery and dis-ability. When the patient is being examined for fracture, the body part is handled gently and as little as possible. Clothing is cut off to visualize the body.
Assessment is conducted for pain
over or near a bone, swelling (from blood, lymph, and exudate infiltrat-ing the
tissue), and circulatory disturbance. The patient is assessed for ecchymosis,
tenderness, and crepitation. The nurse must re-member that the patient may have
multiple fractures accompanied by head, chest, spine, or abdominal injuries.
Immediate attention is given to the patient’s general
condition. Assessment of airway, breathing, and circulation (which includes
pulses in the extremities) is conducted. The patient is also evalu-ated for
neurologic or abdominal injuries before the extremity is treated, unless a
pulseless extremity is detected.
If a pulseless extremity is identified, repositioning of
the ex-tremity to proper alignment is required. If the pulseless extrem-ity
involves a fractured hip or femur, Hare
traction (a portable in-line traction device) may be applied to assist with
alignment. If repositioning is ineffective in restoring the pulse, a rapid
total-body assessment should be completed, followed by transfer of the patient
to the operating room for arteriography and possible arterial repair.
After the initial evaluation has been completed, all
injuries identified are evaluated and treated. The fractured body part is
inspected. Using a systematic head-to-toe approach, the clinician inspects the
entire body, observing for lacerations, swelling, and deformities, including
angulation (bending), shortening, rota-tion, and asymmetry. All peripheral
pulses, especially those distal to the fractured extremity, are palpated. The
extremity is also as-sessed for coolness, blanching, and decreased sensation
and motor function, which are indicative of injury to the extremity’s
A splint is applied before the patient is moved.
Splinting im-mobilizes the joint above and below the fracture, relieves pain,
restores or improves circulation, prevents further tissue injury, and prevents
a closed fracture from becoming an open one. To splint an extremity, one hand
is placed distal to the fracture and some traction is applied while the other
hand is placed beneath the fracture for support. The splints should extend
beyond the joints adjacent to the fracture. Upper extremities must be splinted
in a functional position. If the fracture is open, a moist, sterile dress-ing
After splinting, the vascular status of the extremity is
checked by assessing color, temperature, pulse, and blanching of the nail bed.
If there is evidence of neurovascular compromise, the splint is removed and
reapplied. In addition, any complaints of pain or pressure are investigated.