Fracture Management

Study Notes

A fracture is a complete or incomplete disruption in the continuity of the bone structure.

Fractures occur when the bone is subjected to stress greater than it can absorb.
When a bone is broken, adjacent structures are affected, resulting in soft tissue edema, hemorrhage into muscles and joints, joint dislocations, ruptured tendons, severed nerves, and damaged blood vessels.

Complete fracture: a break across the entire cross-section of the bone and is frequently displaced.
Incomplete fracture: a break through only part of the cross-section of the bone.
Comminuted fracture: produces several bone fragments.
Closed fracture: does not cause a break in the skin.
Open fracture: the skin or mucous membrane wound extends to the fractured bone.

Direct blows: being hit directly by a great force.
Crushing forces: forces that come into contact with the bones and crush them.
Sudden twisting motions: twisting the joints in a sudden motion.
Extreme muscle contractions: when the muscles have reached their limit in contraction.

Edema and swelling: disruption and penetration of bone through skin or soft tissues, or bleeding into surrounding tissues.
Pain and tenderness: muscle spasm as a result of involuntary reflex action of muscle, direct tissue trauma, increased pressure on nerves, movement of fracture parts.
Muscle spasm: caused by irritation of tissues and protective response to injury and fracture.
Deformity: abnormal position of extremity or part as a result of original forces of injury and action of muscles pulling fragment into abnormal position.
Ecchymosis, contusion: discoloration of skin as a result of extravasation of blood in subcutaneous tissues.
Loss of function: disruption of bone or joint, preventing functional use of limb or part.
Crepitus: grating or crunching together of bony fragments, producing palpable or audible crunching or popping sensation.

X-ray examinations: determines location and extent of fractures/trauma, may reveal preexisting and yet undiagnosed fracture(s).
Bone scans, tomograms, computed tomography (CT)/magnetic resonance imaging (MRI) scans: visualize fractures, bleeding, and soft-tissue damage; differentiate between stress/trauma fractures and bone neoplasms.
Arteriograms: may be done when occult vascular damage is suspected.
Complete blood count (CBC): muscle trauma increases load of creatinine for renal clearance.
Coagulation profile: alterations may occur because of blood loss, multiple transfusions, or liver injury.
Hematocrit (Hct) may be increased (hemoconcentration) or decreased (signifying hemorrhage at the fracture site or at distant organs in multiple trauma).
Increased white blood cell (WBC) count: a normal stress response after trauma.

Immediately after injury, if a fracture is suspected, it is important to immobilize the body part before the patient is moved.
Adequate splinting is essential to prevent further injury.