FRACTURE Fracture is sometimes abbreviated FRX or Fx, Fx.

It is a medical condition in which there is a break in the continuity of the bone. A bone fracture can be the result of high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture. Other name Break

Incidence The results of the study sample show that 117 (84.8%) males were affected. The major cause of mandibular fracture was alleged assaults or mauling comprising 60 (43.5%) cases of the entire study. The symphysis was the part of the mandible most susceptible to fracture having 75 (54%) cases of the study. The main sources of information were the different government hospitals namely, East Avenue Medical Center, Jose R. Reyes Memorial Hospital, Philippine Orthopedic Hospital, and V. Luna Memorial Hospital. This paper was based on information gathered from actual cases and medical records of the patients treated in the above mentioned government hospitals from July 1995 to July 1996. Risk Factors Precipitating factors:

Health- Diet habits can greatly affect the health of your bones, and hence make you more or less susceptible to bone fractures Occupation- Athletes, sportsperson are more prone than people with sedentary jobs, housewives, etc.

Predisposing factors:

Age: Old people are more susceptible to fractures, since their bones are brittle; children rarely suffer from fractures, since their bones are flexible Which bone- Different bones in the body have different capacities to bear impact and hence vary in degree of susceptibility to fractures Nature of impact- The amount and direction of force or pressure that the bone was subjected to (in other words, the momentum) Gender (males)

Types of fractures When a fracture occurs, it is classified as either open or closed, complete or greenstick (incomplete) fracture

Open fracture (compound, or complex fracture) is a fracture where the broken bone is exposed. It is dangerous because of increased chances of infection. It is graded according to the following criteria: Grade I is a clean wound less than 1 cm long. Grade II is a larger wound without extensive soft tissue damage. Grade III is highly contaminated, has extensive soft tissue damage, and is the most severe.

Closed fracture (simple fracture) - The bone is broken, but the skin is intact. Greenstick or incomplete fracture - The broken bone is not completely separated. This happens when the crack (or fracture) does not traverse along the entire width of the bone. Complete fracture- The two pieces of the bone, resulting from the fracture, completely separate from each other.

Classification as to Pattern

Transverse fracture- the break is in a straight line across the bone. Spiral (torsion) fracture - the break spirals around the bone; common in a twisting injury. Oblique fracture - diagonal break across the bone.

Classification as to appearance

Compression fracture - the bone is crushed, causing the broken bone to be wider or flatter in appearance. It commonly occurs to the bones of the spine and may be caused by falling into a standing or sitting position, or a result of advanced osteoporosis. Comminuted there are more than two bony fragments. Impacted fracture- An impacted fracture is similar to a compression fracture, yet it occurs within the same bone. It is a closed fracture which occurs when pressure is applied to both ends of the bone, causing it to split into two fragments that jam into each other. This type of fracture is common in car accidents and falls.

Classification in relation to the joint: a). Intracapsular (within the capsule) b). Extracapsular (outside the capsule) c). Intra-articular (in the joint) Classification as to location a) Proximal b) Midshaft c) Distal Classifications by Cause 1. Traumatic fracture - This is a fracture due to sustained trauma. eg- Fractures caused by a fall, road traffic accident, fight etc. 2. Pathological fracture - A fracture through a bone which has been made weak by some underlying disease is called pathological fracture. eg- a fracture through a bone weakened by metastasis. Osteoporosis is the commonest cause of pathological fracture. Anatomical classifications of fracture

Skull fracture Spinal fracture Rib fracture Sternal fracture Shoulder fracture Arm fracture Hand fracture Pelvic fracture Femoral fracture (affecting the femur bone, i.e. upper leg; also known as hip fracture) Patellar fracture Crus fracture (affecting the tibia and/or fibula bones, i.e. lower leg) Foot fracture

Clinical Manifestations

Pain and tenderness in the injured area Swelling in the injured area Obvious deformity in the injured area Difficulty using or moving the injured area in a normal manner Warmth, bruising, or redness in the injured area

Crepitus (grating sensation either heard of felt as bone ends rub together) Bleeding from an open wound with protrusion of bone ends

Stages of Bone Healing Stage 1 Tissue destruction & Hematoma formation. After any fracture, bleeding occurs from the ends of the bone and from the surrounding tissues The vessels that are torn at the time of fracture lead to the formation of a fracture hematoma. Stage 2 Inflammation and Cellular proliferation and vascular ingrowths Within 8 hours of the fracture occurring, an acute inflammation reaction occurs, with proliferation of cells under the periosteum and within the breached medullary canal The bone fragment ends are surrounded by cellular tissues that bridge the fracture The hematoma is reabsorbed and fine new capillaries grow in the area. Stage 3 - Callus formation The proliferating cells are potentially chondrogenic and osteogenic in nature Under the right circumstances, the cell population changes to osteoblasts and osteoclasts The dead bone is mopped up and woven bone appears in the fracture callus. Stage 4 - Remodeling The woven bone is replaced by lamellar bone and the fracture is solidly united New bone is remodeled to resemble the original normal structure. Pathophysiology of Fracture Stress placed on a bone, exceeds the bone ability to absorb it Injury in the bone Disruption in the continuity of bone Disruption of muscle and blood vessels attached to the ends of the bone Soft tissue damage Bleeding

Hematoma forms in medullary canal Bone tissue surround the fractured site dies Inflammatory response Emergency Management 1. Unless there is an immediate danger, do not move the person especially in the case of suspected fracture of the skull, spine, ribs, pelvis, or upper leg. 2. Attend to any bleeding wounds first. Stop the bleeding by pressing firmly on the site with a clean dressing. If a bone is protruding, apply pressure around the edges of thye wound 3. If bleeding has been controlled, keep the wound covered with a clean dressing 4. Do not attempt to straighten broken bone. 5. For limb fractures, provide support and comfort such as pillow under the lower leg or forearm. However, do not cause further pain or make an unnecessary movement of the broken bone. 6. Apply slint to support the limb. 7. Immobilize a fractured arm by applying a sling. Immobilize a fractured leg by trying it together above and below the fractured area. 8. If possible, elevate the fractured area and apply a cold pack to reduce swelling and pain. 9. Do not eat or drink anything until seen by a doctor, in case surgery is required. Management Process
1. Reduction setting the bone; refers to restoration of the fructure fragments into anatomic

position and alignment. 2. Immobilization- maintaining reduction until bone healing occurs. 3. Rehabilitation- regaining normal function of the affected part. Nursing Responsibilities 1. 2. 3. 4. Enhance comfort Ensure edequate oxygenation of tissues Take measures toward restring the function of the fructured bones. Maintain total body mobility while keeping the injured part at rest. 5. Protect against infection in the absence of an intact fist line of defense against infection 6. Provide adequate nutrition for healing 7. Prevent constipation

8. Promote urinary elimination 9. Prevent additional trauma to soft tissues 10. Assist in allaying anxiety 11. Assist patient to attain optimal level of independence 12. Help prevent boredom 13. Provide care to patients in cast, traction, externalfixation, brace and ambulatory device. 14. Provide care to patients for surgery Diagnostic Evaluation 1. Bone fractures are diagnosed with x-rays. CT and MRI scans may also be used. 2. Broken bones heal by themeselves- the aim of medical treatment is to make sure the two peices are lined up correctly. Subsequent x-rays are taken to monitor the bones healing process. 3. Depending on the site of tyhe fracture and the severity of the injury, treatment options may include: Arthroscopy to detect joint movement Angiography, if associated with blood vessel injury Nerve conduction and electromyogram studies to detect nerve injury 4. Blood studies (complete blood count, electrolytes), if there is blood loss and extensive muscle damage, to show if there is decresaed hemoglobin and hematocrit. Nursing Diagnosis 1. Acute pain related to fracture, soft tissue damage, muscle spasm, and surgery 2. Impaired physical mobility related to musculoskeletal impairment (fracture) 3. Risk for infection related to surgical incision 4. Risk for trauma