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What is a Fracture?
A fracture is a medical term describing a disruption in the continuity of bone structure that leads to a break or a crack. In this case, a fracture is defined based on its type and extent. In most cases, fractures occur when the affected bone is subjected to more stress than it can take. In this case, a fracture can occur following an injury due to a fall, a direct blow to the bone, or a medical condition that weakens bones, such as osteoporosis. When a fracture occurs and the bone gets broken, structures adjacent to the bone may be affected, leading to damaged blood vessels, hemorrhage into muscles and joints, soft tissue edema, ruptured tendons, joint dislocation, and severed nerves.
Classification of Fractures
There are different types of fractures a bone may have, and all require an immediate medical evaluation to ensure proper healing. In this case, all types of fractures should be treated as medical emergencies.
- Incomplete Fracture: In this type of fracture, there is an incomplete or partial break of the bone’s cross-section. This is the best-case scenario for a fracture since the bone is not broken into several pieces.
- Complete Fracture: This is a fracture type where the bone has a break across its entire cross-section, meaning it is broken into two or more pieces. A complete fracture is characterized by the complete separation or displacement of a piece of the bone. This type of fracture is further classified into:
- Transverse fracture: This is a complete fracture that occurs straight across the bone shaft (perpendicularly)
- Longitudinal fracture: This fracture causes a complete break along the bone’s axis.
- Comminuted fracture: This is a fracture that causes the bone to break into several pieces.
- Closed (Simple) fracture: This type of fracture does not cause a break out of the skin, meaning the broken bone remains in or within the body.
- Open (Compound) fracture: In this type of fracture, the broken bone breaks the skin or the mucus membrane. It may also fully puncture the skin, causing bleeding and exposing the wounded area to infections.
Causes of Fractures
The following factors could lead to a fracture:
- Direct blows. Direct hits or blows could cause bone fractures to the body by a great force leading to trauma in the hit area. This could be due to falls or being hit with an object.
- Crushing forces. This refers to strong forces or pressure that come into contact with a body and squeeze the bone leading to bone injury. This could include being trapped under a car, earthquakes, etc.
- Sudden twisting motions. Sudden twisting of bone joints could also lead to fractures.
- Repetitive Motions (Overuse). Repetitive motions such as running could lead to stress fractures on bones.
- Extreme muscle contractions. Serious fractures could occur when muscles contract and reach their contraction limits.
- Medical conditions. Medical conditions that weaken bones, such as bone cancer and osteoporosis, may also cause fractures.
Clinical Manifestations of a Fracture
Individuals suffering from a fracture may experience the following symptoms. However, the discussed signs and symptoms may not be present in every fracture:
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- Intense pain. The pain is mostly continuous and becomes more severe until affected bone fragments become immobile.
- Limited mobility or loss of function. After a fracture, the limb affected may not function properly or move freely since proper functioning of the limb depends on bone integrity.
- Deformity of the limb. Following a fracture, bone fragments’ rotation, angulation, or displacement may create a detectable deformity compared with the unaffected limb.
- Swelling, bruising or bleeding. Depending on the fracture type, one is likely to experience swelling, bruising, or bleeding in the affected area.
- Crepitus or crumbling sensation on palpation
- Ecchymosis and localized edema. This mostly occurs following a fracture due to trauma and tissue bleeding.
Complications of Fractures
- Fat embolism syndrome. Fat emboli may develop after a fracture of pelvic bones or the long bones following a crush or injuries.
- Hypovolemic shock. This a threatening condition characterized by a sudden drop in blood pressure following blood or fluid loss. It mainly occurs in patients with displaced or open fractures and those with pelvic fractures who experience hemorrhage.
- Compartment Syndrome. This limb-threatening condition occurs when pressure within a limb compartment increases, hindering blood flow to the affected area. This could damage the nerves and nearby muscles.
- Pulmonary embolism. This is a severe fracture complication that occurs when a clot forms inside the vein, breaks off and travels to the lung blocking an artery in the lung. This prevents the body from getting sufficient oxygen which may lead to death.
- A fracture that tears the skin may cause a wound. The wound may become infected, spreading the infection to the bone and leading to osteomyelitis.
Assessment and Diagnostic Findings
The following diagnostic tools and assessments may be used to establish the presence of a fracture:
- X-ray Exams. X-ray is used to help establish the location and the extent of a fracture. This may also help reveal undiagnosed or preexisting fractures.
- CT/MRI, tomograms, and bone scans. These scans are used to visualize the body to establish fractures, soft tissue damage, and bleeding. It also helps differentiate between neoplasms and trauma or stress fractures.
- Complete blood count (CBC). A CBC can be used to identify decreased Hematocrit levels indicating possible hemorrhage at the area of fracture of other organs due to multiple trauma fractures. In addition, high white blood cells (WBCs) count may indicate stress in response to trauma.
- This assessment can be done when occult vascular injury due to penetrating trauma is suspected.
- Coagulation profile. This screening test may be necessary to test for abnormal blood clotting and other problems associated with bleeding.
- Urine Creatinine Clearance test. This test is used to establish how well kidneys filter out creatinine out of the bloodstream by comparing creatinine levels in urine and the blood. Muscle trauma may lead to increased creatinine load for renal clearance.
Medical Management of a Fracture
The management of a patient with a fracture may include the following:
- Immobilize the affected body part. Immediately following a suspected fracture injury, it is crucial to immobilize the body part before moving the patient.
- Splinting. Adequate splinting is important to help avoid movement of the fractured segments.
- Wound dressing. Dressing the wound with a sterile dressing in an open fracture is extremely important since it helps prevent contamination and possible infection of the wound and surrounding tissues.
- Fracture reduction. This involves restoring fracture fragments and positioning them to anatomic alignment.
Nursing Management (Care Plan) for a Fracture
Nursing management for open and closed fractures differs.
Nursing Assessment of a Fracture
The assessment of a fracture may include the following:
- Open Fracture.
- Assess the patient with an open structure for risks of tetanus, osteomyelitis, and gas gangrene.
- Assess the patient for signs and symptoms of infection
- Close fracture
- Assess the patient for the presence or absence of skin opening at the fracture site.
Nursing Diagnosis for a Fracture
After analyzing the assessment data, the nursing diagnosis for a fracture patient could include:
- Impaired physical mobility related to the fracture
- Acute pain related to the fracture, muscle spasm, and soft tissue injury
- Impaired skin integrity related to a compound fracture.
- The risk for infection related to skin opening in an open fracture.
- Risk for injury due to immobility and limb instability.
- Risk for falls related to loss of skeletal integrity and limb weakness
Nursing Planning and Goals for a Fracture Patient
The planning and goals for a fracture patient are:
- Pain relief
- Achieve functionality and stability of the affected body part
- Keep the affected area free from infection (maintain asepsis)
- Keep the patient free from complications
- Maintain vital signs within the recommended range
Nursing Interventions for a Fracture Patient
The nursing care interventions for a patient with a fracture include:
- Instructing the patient about proper approaches to control pain and edema
- Make plans to help the patient modify the home environment to keep it safe by clearing walking paths around the house.
- Teach the patient exercises to help maintain muscle health and increase the strength of muscles needed to assist in walking with assistive devices.
- Initiating wound management through wound debridement and irrigation.
- Elevating the affected limb to the proper angle to minimize edema.
- Continuously assessing the patient for signs and symptoms of infection for immediate action.
A nurse should evaluate the following to successfully implement the care plan:
- Ensure pain was relieved.
- Ensure functionality and stability of the affected body part were achieved
- Ensure asepsis was maintained.
- Assess to establish whether vital signs were kept within normal range.
- Check to ensure the patient was kept free from complications
Discharge and Home Care Guidelines for a Fracture Patient or Caregiver
After discharge instructions, the caregiver or patient will be able to:
- Care for the affected area. Describe to the patient/caregiver the management of immobilization devices.
- Control pain and swelling. Describe methods to manage pain and reduce swelling, such as elevating the limb and using analgesics as prescribed.
- Eat healthy foods. Inform the patient about the diets to consume to promote faster bone healing.
- Use mobility aids. Demonstrate how to use assistive devices and mobility aids safely.
- Avoid putting pressure on the injured limb. Instruct the patient to observe weight-bearing limits.
Documentation Guidelines for a Fracture Patient.
The nurse should focus on documenting the following:
- The patient’s report of response to pain.
- The patient’s level of function.
- Signs and symptoms of infection.
- Patient’s ability to participate in desired or specific activities.
- The plan of care.
- The incision or wound site.
- The teaching plan.
- Patient’s response to interventions.
- The patient’s progress or attainment of desired outcomes
- Modifications to the care plan.