This case presentation aims to identify and determine the general heath problems and needs of the patient with an admitting diagnosis of Open Complete Comminuted Fracture at the left tibia, fibula. This presentation also intends to help patient promote health and medical understanding of such condition through the application of the nursing skills.
- To raise the level of awareness of patient on health problems that he may
- To facilitate patient in taking necessary actions to solve and prevent the
identified problems on his own.
- To help patient in motivating him to continue the health care provided by the
- To render nursing care and information to patient through the application of
the nursing skills.
A fracture is any break in the continuity of bone. Fractures are named according to their severity, the shape or position of the fracture line, or even the physician who first described them. It is defined according to type and extent. In some cases, a bone may fracture without visibly breaking. Fractures occur when the bone is subjected to stress greater than it can absorb. It can be caused by a direct blow, crushing force, sudden twisting motion, or even extreme muscle contraction. When the bone is broken, adjacent structures are also affected, resulting in soft tissue edema, hemorrhage into the muscles and joints, joint dislocations, ruptured tendons, severed nerves, and damaged blood vessels. Body organs may be injured by the force that caused the fracture or by the fracture fragments. Among the common kinds of fractures are the following:
- Open (compound) fracture: The broken ends of the bone protrude through the skin. Conversely, a closed (simple) fracture does not break the skin.
- Comminuted fracture: The bone splinters at the site of impact, and smaller bone bone fragments lie between the two main fragments.
- Greenstick fracture: A partial fracture in which one side of the bone is broken and the other side bends; occurs only in children, whose bones are not yet fully ossified and contain more organic material than inorganic material
- Impacted fracture: One end of the fractured bone is forcefully driven into the interior of the other.
- Pott’s fracture: A fracture of the distal end of the lateral leg, with one serious injury of the distal tibial articulation.
- Colles’ fracture: A fracture of the distal end of the lateral forearm in which the distal fragment is displaced posteriorly.
Fractures may also be described according to anatomic placement of fragments, particularly if they are displaced or nondisplaced. Injuries to the skeletal structure may vary from a simple linear fracture to a severe crushing injury. The type and location of the fracture and the extent of damage to surrounding structures determine the therapeutic management. Maximum functional recovery is the goal of management.
The most common fracture below the knee is one of the tibia and fibula that results from a direct blow, falls with the foot in a flexed position, or a violent twisting motion. Fractures of the tibia and fibula often occur in association with each other. The patient presents with pain, deformity, obvious hematoma, and considerable edema. Frequently, these fractures are open and involve severe soft tissue damage because there is little subcutaneous tissue in the area.
The signs and symptoms of a fracture include unnatural alignment, swelling, muscle spasm, tenderness, pain and impaired sensation and decreased mobility. The position of the bone segments is determined by the pull of attached muscles, gravity, and the direction and magnitude of the force that caused the fracture.
ANATOMY AND PHYSIOLOGY
Each lower limb has 30 bones in four locations: (1) the femur in the thigh; (2) the patella; (3) the tibia and fibula in the leg; (4) and the 7 tarsals in the tarsus, the 5 metatarsals in the metatarsus, and the 14 phalanges in the foot.
The femur, or thigh bone, is the longest , heaviest and strongest bone in the body. Its proximal end articulates the acetabulum of the hip bone. Its distal end articulates with the tibia and patella.
The patella, or kneecap, is a small, triangular bone located anterior to the knee joint. It is a sesamoid bone that develops in the tendon of the quadriceps femoris muscle.The patella functions to increase the leverage of the tendon of the quadriceps femoris muscle, to maintain position of the tendon when the knee is bent, and to protect the knee joint.
The tibia, or shin bone, is the larger, medial, weight-bearing bone of the leg. The tibia articulates at its proximal end with the femur and fibula, and its distal end with the fibula and the talus bone of the ankle. An interosseous bone connects the tibia and fibula.
The fibula is parallel and lateral to the tibia, but it is considerably smaller than the tibia. The proximal end, the head of the fibula, articulates with the inferior surface of the lateral condyle of the tibia below the level of the knee joint to form the proximal tibiofibular joint. The distal end has a projection called the lateral malleolus that articulates with the talus bone of the ankle.
The tarsus is the proximal region of the foot and consists of seven tarsal bones. They include the talus and calcaneus, the cuboid, the three cuneiform bones called the first, second, and third cuneiforms.
The metatarsus is the intermediate region of the foot and consists of five metatarsal bones numbered I to V, from the medial to the lateral position. The first metatarsal is thicker than the others because it bears more weight.
The phalanges comprise the distal component of the foot and resemble those of the hand both in number and arrangement. They are numbered I to V being with the great toe, which is medial.