Fractures of Extremity
Etiology and Pathophysiology
- Breaks in the continuity of bone, usually accompanied by localized tissue response and muscle spasm.
- Cause usually trauma, but pathologic fractures may occur as a result of osteoporosis, multiple myeloma, or bone tumors, which weaken bone structure.
- Types
-
- Complete fracture – bone completely separated into two parts, may be transverse or spiral.
- Incomplete fracture – only part of the bone broken.
- Comminuted fracture – bone broken into several fragments.
- Greenstick fracture – splintering on one side of the bone, with bending of the other side; occurs only in p;iable bones, usually in children.
- Simple (closed) fracture – bone broken but no break in the skin.
- Compound (open) fracture – break in the skin at the time of fracture with or without protrusion of the bone.
- Stages of bone healing include:
-
- Formation of a hematoma
- Followed by cellular proliferation
- And callus formation by the osteoblasts
- Ossification
- Remodeling of the callus
Signs and Symptoms
Subjective
- Pain aggravated by motion
- Tenderness
Objective
- Loss of motion
- Edema
- Crepitus
- Ecchymosis
Diagnostic Procedure
- X-ray examination reveals break in continuity of bone
- Deformity caused by change in bone alignment; often results in shortening of the extremity.
Assessment
- Ability of the client to move extremity.
- Altered appearance of involved body part.
- Neurovascular assessment, soft tissue injury or edema may compromise circulatory or neurologic functioning.
- Factors precipitating injury.
- Nutritional status.
Nursing Diagnosis
- Disturbed body image
- Constipation
- Fear
- Risk for injury
- Pain
- Impaired physical mobility
- Altered role performance
- Self-care deficits
- Risk for skin integrity
Nursing Interventions
- Evaluate the client’s general physical condition
- Splint extremity in position found before moving the client; consider all suspected fractures until X-ray films are available.
- Cover open wound with sterile dressing if available.
- Observe for signs of emboli, severe chest pain, dyspnea, pallor, and diaphoresis.
- Observe for signs of circulatory impairment such as change in skin temperature or color, numbness and tingling, unrelieved pain, decrease in pedal pulse, prolonged blanching of toes after compression or inability to move toes.
- Protect the cast from damage until dry by elevating it on a pillow.
- Promote drying of the cast by leaving it uncovered; a light may be used with care to promote drying.
- Maintain bed rest until the cast is dry and ambulation is permitted.
- Observe for swelling and notify the physician if necessary.
- Check that weights are hanging freely and that the affected limb is not resting against anything that will impede the pull of the traction.
- Maintain in proper alignment.
- Observe for foot drop on clients with Russel traction or Buck’s extension, since this may indicative of nerve damage.
- Observe for signs of thrombophlebitis.
- Encourage high protein, high vitamin diet to promote healing.
- Encourage fluids to help prevent constipation, renal calculi, and urinary tract infection.
- Teach isometric exercises to prevent muscle strength and tone for crutch walking.
- Teach appropriate crutch-walking technique; non-weight bearing; weight bearing progressing to use of cane.
Complications
Early
- Shock
- Fat embolism syndrome
- Compartment syndrome
- Deep vein thrombosis
- Thromboembolism
- Pulmonary embolus
Delayed
- Delayed union and nonunion
- Avascular Necrosis
- Reaction to Internal Fixation devices
- Complex Regional Pain Syndrome
- Heterotrophic Ossification
More information about fracture
Daisy Jane Antipuesto RN MN
Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.
