Fractures Nursing Care Plan & Management

Definition

A fracture is a traumatic injury interrupting bone continuity.

TYPES:

Closed simple, uncomplicated fractures – do not cause a break in the skin.
Open compound, complicated fractures – involve trauma to surrounding tissue and break in the skin.
Incomplete fractures– are partial cross-sectional breaks with incomplete bone disruption.
Complete fractures – are complete cross-sectional breaks severing the periosteum.
Comminuted fractures – produce several breaks of the bone, producing splinters and fragments.
Greenstick fractures – break one side of a bone and bend the other.
Spiral (torsion) fractures – involve a fracture twisting around the shaft of the bone.
Transverse fractures – occur straight across the bone.
Oblique fractures – occur at an angle across the bone (less than a transverse)

From crushing force or direct blow
Sudden twisting motion; persons with osteoporosis are at a particular risk
Extremely forceful muscle contraction can cause fractures
Pathological fractures result from a weakness in bone tissue, which may be caused by neoplasm or a malignant growth

Fracture occurs when stress placed on a bone exceeds the bone’s ability to absorb it.

Stages of normal fracture healing include:

Potential complications of fracture include:

Life-threatening systemic fat embolus, which most commonly develops within 24 to 72 hours after fracture.
Compartment syndrome, which is a condition involving increased pressure and constriction of nerves and vessels within an atomic compartment.
Nonunion of the fracture side
Arterial damage during treatment
Infection and possibly sepsis
Hemorrhage, possibly leading to shock

Radiographs and other imaging studies may identify the site and type of fracture.

The principles of fracture treatment include reduction, immobilization and regaining of normal function and strength through rehabilitation.

The fracture is reduced “setting” the bone using a closed method (manipulation and manual traction (e.g. splint or cast) or an open method (surgical placement of internal fixation devices like pins, wires, screws, plates and nails) to restore the fracture fragments to anatomic alignment and rotation. The specific method depends on the nature of the fracture.
After the fracture has been reduced, immobilization holds the bone in correct position and alignment until union occurs. Immobilization is accomplished by external or internal fixation.
Function is maintained and restored by controlling swelling by elevating the injured extremity and applying ice as prescribed.
Restlessness, anxiety, and discomfort are controlled using a variety of approaches (e.g. reassurance, position changes, pain relief strategies, including analgesic agents).
Isometric and muscle-setting exercises are done to minimize disuse atrophy and to promote circulation.
With internal fixation, the surgeon determines the amount of movement and weight-bearing stress the extremity can withstand and prescribed the level of activity.

Pain related to fracture, soft tissue damage, muscle spasm, and surgery
Impaired physical mobility related to fractured hip
Impaired skin integrity related to surgical incision
Risk for impaired urinary elimination related to immobility
Risk for disturbed thought process related to age, stress of trauma, unfamiliar surroundings, and drug therapy
Risk for ineffective coping related to injury, anticipated surgery, and dependence
Risk for impaired home maintenance related to fractured hip and impaired mobility