It is not surprising if a bone breaks but what is surprising is the fact that bone does not break more often considering the amount of forces it is subjected to everyday by muscle action ,load transmission, etc. bone has devised its own mechanism to ward off the unnatural forces and keep itself intact. But only when the force is to large and occurs suddenly or the force is chronic and repetitive or when the natural resistance of bone is eroded by diseases process that a bone succumbs to the insult and break.

1. MR. ABHIJIT P. BHOYAR
M SC NURSING

2. INTRODUCTION
•It is not surprising if a bone breaks but what is surprising
is the fact that bone does not break more often considering
the amount of forces it is subjected to everyday by muscle
action ,load transmission, etc. bone has devised its own
mechanism to ward off the unnatural forces and keep
itself intact.

3. DEFINITION
A fracture is a break in the continuity
of bone.
A fracture occurs when the stress
placed on a bone is greater than the
bone can absorb.
Muscles, blood vessels, nerves,
tendons, joints, and other organs may
be injured when fracture occurs.

4. ETIOLOGY
1. Blunt Trauma
 Motor vehicle collision
 Pedestrian event
 Falls
 Direct blows
 Forced flexion and
hyperextension
 Twisting forces

5. Penetrating
Gunshot
Blast
Others
Pathological conditions
Violent muscle contraction
Crush injury

6. PATHOPHYSIOLOGY
Due to etiological factors
Broken the body immediately begins to repair for adult
Within 48-72 hours after the injury of hematoma
(blood clot) forms at fracture site because bone has
rich blood supply
In about week or so a non-body union called callus develop
and can be seen on x-ray examination

7. As healing continuous (osteoclast) bone destroying cell
resorb any necrotic bone, and (osteoblast) bone
building cells make new bone as replacement
This process sometimes referred as remolding
young healthy adult bone completely heals within 6
weeks
It can take a year for process of remolding to
complete.

8. TYPES OF FRACTURE
Complete fractures are fractures where
the parts of the bone that have
been fractured are completely separated
from each other
A minor fracture is also known as
an incomplete fracture. When this
happens, your bone doesn't break
completely.
Complete fracture
Incomplete fracture

9. Types- Based on extent of fracture line
A closed fracture is when the bone
breaks but there is no puncture or
open wound in the skin..
Open fracture is one in which the
bone breaks through the skin; it
may then recede back into the
wound and not be visible through
the skin

10. Pathological fracture
.
A pathologic fracture is a broken bone
that's caused by a disease, rather than an
injury.
A Some conditions weaken your bones,
which makes them more likely to break
Everyday things, such as coughing,
stepping out of a car, or bending over
can fracture a bone that's been weakened
by an illness.

11. Based on fracture
patterns
Linear fracture: Where the fracture is one thin line with no additional lines
splintering from it and no compression or distortion of the bones.
A comminuted fracture is a break or
splinter of the bone into more than two
fragments. Since considerable force and
energy is required to fragment
bone, fractures of this degree occur after
high-impact trauma such as in vehicular
accidents.
Segmental fracture is
a fracture composed of at least
two fracture lines that together isolate
a segment of bone, usually a portion of
the diaphysis of a long bone
Bone loss can lead to low bone
density (osteopenia), weakness of
the bone, and eventually osteoporosis.
This can lead to bone fractures
(broken bones), even with minimal
trauma. Osteoporosis (or porous bone)
is a disease in which bones become
weak and fragile.

13. Atypical fractures
Greenstick fracture
Impacted fracture
Stress or fatigue fracture
Hairline or crack fracture
Torus fracture

15. CLINICAL MANIFESTATIONS
Pain
Swelling
Deformity
Inability
Tenderness
Abnormal mobility
Loss of shortening moments
Crepitus
Shortening

16. DIAGNOSTIC EVALUATION
History collection
Blood studies

17. X-rays
Bone Scan

18. Bone Densitometry
Magnetic Resonance Imaging
Arthrogram
Myelogram

19. Diskogram
Arthrocentesis
 Arthroscopy
Nerve studies

20. MANAGEMENT
Management of simple fractures
Management of open fractures
Surgical Management
Drug therapy
Nutritional therapy
Nursing management

21. MANAGEMENT OF SIMPLE
FRACTURES
Cuff and collar sling for upper limb fracture.
Strapping for fracture clavicle, fracture ribs etc.
plaster slabs plaster of Paris slab can be used to
support the injured limb
Rest and non steroidal anti-inflammatory drugs
K- Wire implant

22. Intramedullary nails
Plate and screws

23. INTERLOCKING NAILS
HIP IMPLANTS

24. Casts
Types of casts

25. FULL BODY CAST
SPICA CAST

26. MANAGEMENT OF OPEN
FRACTURES
Types of Traction
Running Traction
Balanced suspension

27. Skin traction
SKELETAL TRACTION

28. CRUTCH WALKING

29. AMBULATION
WITH WALKER
AMBULATION
WITH CANE

30. SURGICAL
MANAGEMENT
 Arthroplasty
 Total joint replacement
 Total hip replacement

31. Total joint arthroplasty
External fixation

32. Amputation
Other surgeries
• Bone graft
• Meniscectomy
• Tendon transfer movement
• Fasciotomy

33. DRUG THERAPY
MUSCLE RELAXANT
ANALGESICS
ANTIBIOTICS

34. NUTRITIONAL THERAPY
PROTEIN
VITAMIN B,C AND D
CALSIUM
PHOSPHORUS
MAGNESIUM
ADEQUATE FLUIDE
HIGH FIBER DIET

35. NURSING MANAGEMENT
Acute Pain related to surgical intervention
Risk for Deficient Fluid Volume related to
hemorrhage
Ineffective Breathing Pattern related to effects of
anesthesia, analgesics, and immobility
Risk for Peripheral Neurovascular Dysfunction
related to swelling

36. Risk for Infection related to surgical
intervention
Impaired Physical Mobility related to
immobilization therapy and pain
Imbalanced Nutrition: Less Than Body
Requirements related to blood loss and the
demands of healing

37. COMPLICATIONS
Muscle atrophy
Loss of ROM
Pressure Sores
Venous stasis
Shock
Pulmonary emboli
Fat emboli syndrome
Bone union problems

38. ASSIGNMENTS
A child of 12 year old fell from bicycle, child had
pain in the pain and swelling in the legs. Identify
the condition and prepare a care plan for the
condition.