Fracture Management

Fracture Management

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

Mechanism of Fracture

• 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.

Classification of Fracture

• 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.

Causes of Fracture

• 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.

Clinical Manifestations of Fracture

• 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.

Assessment and Diagnostic Findings

• 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.

Medical Management of Fracture

• 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.