Fractures

FRACTURES

Causes -

Trauma - blow to body, fall

Pathologic - if a bone is weakened, fracture may be pathologic, consisting of a collapse of the bone - osteoporosis, bone cancer

Stress - if there is usual or repetitive force on a bone because of excessive muscle usage or strain, a stress fracture may occur - seen in athletes

Prevention:

Accident prevention - hand rails, no throw rugs, obstacles on floor, education concerning automobile safety, protective sports equipment

Avoid osteoporosis - small framed, non-obese, white females most at risk; contributing factors - diet low in calcium throughout life, smoking, excessive coffee intake, high protein diet, sedentary life style

Types of fractures:

Complete - complete separation of the bone, two fragments

Incomplete - only part of the bone is broken; not broken into two fragments

Simple - skin over break is intact

Compound or open - communication between skin wound and fracture site; high risk of contamination and infection

Fracture without displacement - bone ends in good alignment

Fracture with displacement - bone segments separated at the point of fracture

Greenstick - splintering on one side of the bone (young children)

Transverse - break straight across the bone

Oblique - line of fracture angled across bone

Spiral - fracture line partially encircling the bone

Telescoped or impacted - bone ends jammed together

Comminuted - several bone fragments

Healing of Fractures -

Immobilization is necessary for healing

Bone heals during a process called callus formation, in which new blood vessels are formed, dead bone is reabsorbed, new bone matrix is laid down and becomes filled with calcium; this area of healing, the new bone is called the callus.

Process of healing:

Hematoma forms - bone is vascular; blood collects in the periosteal sheath; fastens the broken ends together

Fibrin meshwork - further clot formation

Invasion of osteoblasts - invade the fibrin, make it firm; blood vessels develop, supplying nutrients to build collagen; collagen begins to incorporate calcium deposits

Callus formation - osteoblasts continue to lay meshwork for bone growth; osteoclasts destroy the dead bone; collagen continues to be impregnated with calcium

Remodeling - excess calcium is reabsorbed

Factors interfering with healing - poor nutrition, poor circulation, inadequate reduction of fracture (bone ends not brought well into alignment), insufficient immobilization, infection at the site of injury

If callus formation does not take place, the resulting lack of repair is called non-union of fracture.

S/S of Fracture -

Pain - immediate, severe, aggravated by movement, aggravated by pressure

Loss of normal function

Obvious deformity

Crepitus or grating sound/sensation if the limb is moved (don't try to elicit this sign)

Edema

Ecchymosis of skin in injured area (more noticeable after 1-2 days)

Loss of sensation or paralysis distal to the injury (evidence of nerve impingement)

Signs of shock due to severe tissue injury, hemorrhage with large fractures or multiple fractures

Diagnosis - evidence of fracture seen on x-ray

Medical treatment:

Reduction of fracture - bring bone ends into alignment

Immobilization of fracture - cast or hardware

Immediate care of fracture -

Splinting to prevent movement - splint joints both above and below the fracture

Preserve body alignment

Elevate part to reduce edema

Application of ice for 1st 24 hours - reduce swelling, pain, bleeding

Analgesics

Watch for changes in color, temperature, sensation, movement, pulses/capillary refill

Watch for signs of shock

Secondary management of simple fracture:

Reduction of the fracture - methods: manual manipulation (usually done with IV analgesic), traction, open reduction (surgical procedure)

Immobilization - methods: external immobilization with a cast or splint; traction; internal fixation with pins, screws, plates; insertion of prosthesis; or any combination of these methods

Surgical procedure in which the fracture is reduced and immobilized is called an Open Reduction Internal Fixation (ORIF)

Secondary management of a compound fracture:

Surgical debridement to remove dirt, debris, dead tissue, bone fragments

Administration of tetanus toxoid if the person has been immunized but with 7 years or more since the most recent booster

Administration of tetanus anti-toxin to non-immunized patient

Take cultures of wound

Prophylactic antibiotic therapy

Greatly increased risk of infection with compound fracture; many organisms; specific