Chapter 70 Nursing Care for Patients with Bone Fracture Fujian Health College Surgical Nursing Department

What is Fracture? A fracture is a break in the continuity of the bone caused by trauma, twisting as a result of muscle spasm or indirect loss of leverage, or bone decalcification and disease that result in osteopenia. Types of fractures Closed or simple: skin over the fractured area remains intact. comminuted: the bone is splintered or crushed., with three or more fragments. Complete: The bone is separated completely by a break into two parts. Compression: a fractured bone is compressed by other bone. Depressed: Bone fragments are driven inward.

Greenstick: one side of the bone is broken and the other is bent, these fractures occur most commonly in children. Impacted: A part of the fractured bone is driven into another bone. Incomplete: the bone is partially broken. Oblique: The break extends in an oblique direction. Open or compound: the bone is exposed to air through a break in the skin, and soft tissue injury and infection are common. Pathological: The fracture results from weakening of the bone structure by pathological processes such as neoplasia or osteomalacia. Also called spontaneous fracture. Spiral: The break partially encircles bone. Transverse: The bone is fractured straight across.

Signs and Symptoms Pain or tenderness over the involved area. Loss of function Obvious deformity Crepitation Erythema, edema, ecchymosis Muscle spasm and impaired sensation

Initial care of a fracture of an extremity 1. Immobilize affected extremity 2. If a compound (open) fracture exists, splint the extremity and cover the wound with a sterile dressing. Nursing Care Reduction- Restores the bone to proper alignment 1. Closed Reduction a. Closed reduction is performed by manual manipulation. b. Closed reduction may be performed under local or general anesthesia. c. A cast may be applied following reduction.

2. Open Reduction a. Open reduction involves a surgical intervention. b. Fractured may be treated with internal fixation devices. c. The client may be placed in traction or a cast following the procedures Fixation 1. Internal Fixation a. Internal fixation follows open reduction b. Internal fixation involves the application of screws, plates, pins or nails, to hold the fragments in alignment. c. Internal fixation may involve the removal of damaged bone and replacement with a prosthesis. d. Internal fixation provides immediate bone strength. e. Risk of infection is associated with the procedure.

2. External fixation a. An external frame is used with multiple pins applied through the bone. b. External fixation provides more freedom of movement than with traction. Traction a. Traction is the exertion of a pulling force applied into two directions to reduce and immobilize a fracture. b. Traction provides proper bone alignment and reduces muscle spasm. Interventions a. Maintain proper body alignment. b. Ensure that the weights hang freely and do not touch the floor. c. Do not remove or lift the weights without a physician’s order. d. Ensure that pulleys are not obstructed and that ropes in the pulleys move freely. e. Place knots in the ropes to prevent slipping.

Casts – Casts are made of plaster or fiberglass to provide immobilization of bone and joints after a fracture or injury. Nursing Care a. Keep the cast and the extremity elevated. b. Allow a wet cast 24 to 48 hours to dry (synthetic cast dry in 20 minutes) c. Handle the wet cast with the palms of the hands until dry. d. Turn the extremity unless contraindicated so that all sides of the wet cast will dry e. Cool setting on hair dryer can be used to dry a plaster cast (heat cannot be used on a plaster cast because the cast heats up and burns the skin). f. The cast will change from a dull to a shiny substance when dry.

g. Examine the skin and cast for pressure areas. h g. Examine the skin and cast for pressure areas. h. Monitor the extremity for circulatory impairment such as pain, swelling, discoloration, tingling, numbness, coolness, or diminished pulse. i. Notify the physician immediately if circulatory compromise occurs. j. Prepare for bivalving or cutting the cast if circulatory impairment occurs. k. Petal the cast; maintain smooth edges around the cast to prevent crumbling of the cast material. l. Monitor client’s temperature. m. Monitor for the presence

n. Monitor drainage and circle the area of drainage on the cast. o n. Monitor drainage and circle the area of drainage on the cast. o. Monitor for warmth on the cast p. Monitor for wet spots, which may indicate a need for drying or the presence of drainage under the cast. q. If open draining area exists on the affected extremity, the physician will make a cut-out portion of the cast or a window. r. Instruct the client to keep the cast clean and dry. t. Instruct the client in isometric exercises to prevent muscle atrophy.