Angelite Nurses: Fractures

Fractures

General information

A break in the continuity of bone, usually caused by trauma
Pathologic fractures: spontaneous bone break, found in certain diseases or conditions (osteoporosis, osteomyelitis, multiple myeloma, bone tumors)
Types

Complete: separation of bone into two parts

transverse
oblique
spiral

Incomplete (partial): fracture does not go all the way through the bone, only part of the bone is broken.
Comminuted: bone is broken or splintered into pieces.
Closed or simple: bone is broken without break in skin.
Open or compound: break in skin with or without protrusion of bone.

Medical management

Traction
Reduction

Closed reduction through manual manipulation followed by application of cast
Open reduction

Application of a cast

Assessment findings

Pain, aggravated by motion; tenderness
Loss of motion; edema, crepitus (grating sound), ecchymosis
Diagnostic test: x-ray reveals break in bone

Nursing interventions

Provide emergency care of fractures.
Perform neurovascular checks on affected extremity.
Observe for signs of compartment syndrome (swelling causes an increase within muscle compartment which causes edema and more pressure; irreversible neuromuscular damage can occur within 4 to 6 hours); signs include weak pulse, pallor followed by cyanosis, paresthesias and severe pain.
Observe for signs of fat emboli (respiratory distress, mental disturbances, fever, petechiae) especially in the client with multiple long-bone fractures.
Encourage diet high in protein and vitamins to promote healing.
Encourage fluids to prevent constipation, renal calculi, and UTIs.
Provide care for the client in traction, with a cast, or with open reduction.
Provide client teaching and discharge planning concerning

Cast care if indicated
Crutch walking if necessary
Signs of complications and need to report them

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