FRX, FX or #

A fracture is any disruptions or
break in the continuity of the
structure of bone.

Mechanical overload of bone
Metabolic bone disease
Eg: Osteoporosis
Direct force.Eg: Moving object strikes
body
Indirect force Eg: Muscle contraction
Stress

 Biologic conditions- Osteopenia
 Neoplasms
 OLD AGE
 Infections
 Post menopausal estrogen loss &
protein energy malnutrition
 High risk recreation or employment related
activity
 Incidence – male are mostly affected at the
age of 15-25 and females at the age of 65 and
more

Fracture
Muscles attached to bone are disrupted
Muscle spasm- Pull fracture fragments out of
position
Proximal portion of bone remains in place, distal
displaced
Fracture fragments displaced sideways or overriding
Periosteum & blood vessels of fractured bone
disrupted

Soft tissue damage
Bleeding from soft tissue & damaged bone
endings
Hematoma between fracture fragments &
beneath periosteum
Bone tissue surrounding fracture site dies
Intense inflammatory response
Vasodilation, edema, pain, loss of function,
Infiltration of WBC

 Fracture can be described and classified
according to type, communication or non
communication with external environment
and location of the fracture
 Stable fractures – some of the periosteum is
intact across the fracture
 Unstable fracture – grossly displaced.

 Open fracture(compound fracture): Break in the
skin over bone injury
Grading of open fracture
 Grade I – the wound is smaller than 1cm,
contamination is minimal
 Grade II- wound is larger than 1cm,
contamination is moderate
 Grade III – wound exceeds 6-8cm, there is
extensive damage to soft tissue, nerve, tendon
and there is high degree of contamination

 Closed facture (simple fracture)
It has intact skin over the site of injury

 Appearance:
1.Burst fracture
- Multiple pieces of bone, mainly in the
vertebra

2. Comminuted fracture
- More than one fracture line, more than 2
bone fragments, Fragments crushed, the
smaller fragments appear to be floating

3.Complete fracture
- Break across entire section of bone, dividing
into distinct fragments

5. Displaced fracture
- Fragments out of normal position at fracture
site

4. Incomplete fracture
- Fracture occurs through only one cortex of
bone, usually nondisplaced

6. Nondisplaced fracture
- -Fragments aligned at fracture site

7. Linear fracture (Longitudinal
fracture)
- Fracture line is intact; Caused by
minor- moderate force
- Periosteum is not torn away from
the bone

8. Oblique fracture
- -Fracture line occurs at 45 degree angle across
longitudinal axis of bone

9. Spiral fracture
- -the line of the fracture extends in a spiral
direction along the shaft of the bone
- Fracture line results from twisting force

10. Stellate fracture
- -Fracture line radiate from one central point

11. Transverse fracture
- -Fracture line occurs at 90 degree angle to
longitudinal axis of bone
12. Inter articular fracture
 Fracture extending to the articular surface of the
bone

1. Avulsion
- Bone fragments are torn away from body of
the bone at the site of attachment of
ligaments or tendon

2. Compression fracture
- Bone cracks as a result of loading force
applied to its longitudinal axis

3. Greenstick fracture
- Incomplete fracture in which one side of the
cortex is broken & the other side is flexed
but intact

4. Impacted fracture
It is a communited fracture in which one fragment
is driven in to other
5. pathologic fracture
It is a spontaneous fracture due to an underlying
pathologic condition

Anatomic Location
1. Colle’s fracture
-Fracture within last inch of distal radius

2. Pott’s fracture
A Pott's fracture is a type of ankle fracture that
is characterized by a break in one or more
bony prominences on the sides of the ankle
known as the malleoli

 3.torus fracture – also known as
buckling fracture, they are
incomplete fractures of the shaft of
long bone which is characterized by
bulging of the cortex.
 4.Transchondral fracture –
separation of cartilaginous joint
surface from main shaft bone

 Self healing of bone occurs in the following
stages
Stage I – hematoma or inflammatory stage
Stage II – granulation tissue formation or
fibro cartilage formation
Stage III – callus formation
Stage IV – ossification
Stage V – consolidation
Stage VI – remodeling

 When a fracture occurs, bleeding and edema create a
hematoma, which surrounds the ends of the fragments.
 The hematoma is extravasated blood that changes from
a liquid to a semisolid clot
 Time 1 to 3 days
 The blood forms a clot among the fracture fragments,
providing a small amount of stabilization
 Necrosis of adjacent bone occurs in direct relation to
the loss of blood supply to the affected region and will
extend to the area where collateral circulation begins
 Vascular dilation occurs in response to the accumulation
of dead cells or debris at the fracture site and
exudation of fibrin- rich plasma initiates the migration
of phagocytic cells to the area of injury

 Hematoma
 Liquid to semisolid clot
 Time 1 – 3 days
 Stabilize
 Necrosis due to decrease blood supply
 Collateral circulation begins
 Vascular dilation occurs
 Phagocytic cells migrate to the area

 During this stage, active phagocytosis absorbs the
products of local necrosis.
 The hematoma converts to granulation tissue.
 Granulation tissue (consist of new blood vessels,
fibroblasts(type of cell that synthesizes the extracellular
matrix and collagen) and osteoblasts) produces the basis
for new bone substance called osteoid during 3 to 14
days post injury

 As minerals (calcium, phosphorus and magnesium
and new bone matrix) are deposited in the
osteoid, an unorganized network of bone is
formed that is woven about the fracture parts
 Granulation tissue matrix will convert into callus
 Callus is primarily composed of cartilage,
osteoblasts, calcium and phosphorus
 Duration - 2 to 6 weeks
 Proper alignment is essential during this stage by
traction or cast
 Callus formation can be verified by x-ray

 Bone develops in this stage – osteogenisis
 Ossification of callus occurs from 3 weeks to 6
months after the fracture and continuous until the
fracture has healed.
 Callus ossification is sufficient to prevent movement
at the fracture site when the bones are gently
stressed
 Patient can be converted from skeletal traction to
cast or the cast can be removed to allow limited
mobility.

 As callus continuous to develop, the distance
between bone fragments diminishes and
eventually closes.
 This stage is called consolidation and
ossification continues
 6 to 8 months

 Excess bone tissue is re absorbed in the final
stage of bone healing and union is completed
 Gradual return of the injured bone to its pre
injury structural strength and shape occurs
 Bone remodel in response to physical stress
 Initially stress is provided through exercise
 8 months to 1 year

Favorable factors
 Location – good blood supply at the bone
ends, flat bones
 Minimal damage to soft tissue
 Anatomic reduction possible
 Effective immobilization
 Weight – bearing on long bone
 Proper nutrition
 Hormone functioning – growth hormone,
thyroid, calcitonin and vitamin d

Unfavorable factors
 Fragments widely separated
 Fragments distracted by traction
 Severe communited fracture
 Severe damage to soft tissue
 Bone loss from injury or surgical excision
 Motion/rotation at fracture site as a result of
inadequate fixation
 Infection
 Impaired blood supply to one or more bone
fragments
 Location – decreased blood supply, mid shaft
 Smoking and alcoholism
 Poor nutrition

 Drugs – corticosteroids inhibit the repair
 Age – elderly persons heal more slowly
 Intra articular fracture
 Avascular necrosis
 Metaboilic bone diseases
 Local malignancy

 Deformity – due to loss of bone continuity. Deformity is
the cardinal sign of fracture.
 Edema or Swelling – due to accumulation of serous fluid
at the fracture site and extravasations of blood into the
surrounding tissue
 Bruising ( Ecchymosis) – due to subcutaneous bleeding at
the fracture site
 Muscle spasm can cause limb shortening
 Pain – continuous pain due to spasm, overriding of
fracture fragments or damage to the adjacent structure
 Tenderness

 Loss of function – result from pain and discontinuity.
Paralysis may cause due to nerve damage.
 Neurovascular changes – due to damage to peripheral
nerves or the associated vascular structure. Tingling or
no palpable pulsed distal to the fracture
 Shock – frank and occult hemorrhage can lead to shock
 Crepitation – grating sound occurs if limb is moved
gently. Testing for crepitus can produce further tissue
damage so should minimized as much as possible

 Warmth over injured area resulting from
increased blood flow to the area
 Impairment or loss of sensation or paralysis
in affected area
 Evidence of fracture on x-ray film

 History collection
 Physical examination
 x ray
 CT scan

Goals:
 Assessment of injury
 Emergency management
 Reduction and stabilization of fracture
 Monitoring complications
 Eventual remobilization & rehabilitation
 Pharmacological management and nutritional
supplementation

A. Thorough initial assessment:
 Assess the cause of fracture, type of fracture
and the severity of fracture
 Assess early complication: Arterial damage
(Pain, pallor, paresthesia, Absent pulse, Poor
capillary refill, cyanosis)

Neurovascular assessment
 Color and temperature
 cyanotic and cool/cold: arterial insufficiency
 cyanotic and warm: venous insufficiency
 Capillary refill
 Peripheral pulses (↓ indicates vascular insufficiency)
 Check for Edema, Sensation, Motor function, Pain

B. EMERGENCY MANAGEMENT OF FRACTURES
• 1. Immobilize any suspected fracture.
• 2. Support the extremity above and below when
moving. Assess color, warmth, circulation and
movement.
• 3. Suggested temporary splints: hard board, stick,
rolled sheets.

• 4. Apply sling if forearm fracture is suspected or the
suspected fractured arm maybe bandaged to the
chest.
If the fractured extremity is leg bone, the
unaffected extremity can be used as a splint by
bandaging both legs together.
• 5. Open fracture is managed by covering it with
clean/sterile gauze to prevent contamination

 6. DO NOT attempt to straighten or realign or
reduce a fractured extremity. Move the
affected limb as little as necessary
 7.Elevate the injured part to decrease
edema
 8.Apply cold packs to reduce hemorrhage ,
edema and pain

C.FRACTURE REDUCTION/ BONE SETTING:
Reduction - It is refers to restoration of the fracture
fragments to its actual anatomic alignment
a. Closed reduction
b. Open reduction

 it is a non surgical, manual realignment of
bone fragments to their previous anatomic
position
 The extremity is held in the desired position
while the physician applies a cast, splint or
other device
 Traction and counter traction are manually
applied to the bone fragments (to restore
position, length and alignment) for
immobilization and fracture reduction.

 It is usually performed under LA or GA.
 X-ray is obtained to verify that the bone
fragments are correctly aligned.

 The surgeon makes an incision and realigns the
fracture fragments under direct visualization.
 It is treatment of choice for compound fracture
or accompanied by severe neurovascular injury
 Open reduction is usually performed in
combination with internal fixation for femoral
and joint fractures
 Screws, plates, pins, wires, rods or nails may
be used to maintain alignment of fracture
fragments.

 Before the surgery patient will get a course of
prophylactic intravenous antibiotics
 Internal fixation devices are biologically inert metal
devices (stainless steel, vitallium or titanium)
Variety of internal fixation devices are available
 Plates and nails
 Intramedullary rods
 Transfixation screws
 Prosthetic implants ex- femur head, hip prosthesis etc

 External fixation is a metallic device
composed of metal pins that are inserted in
to bone and attached to external rod to
stabilize the fracture while it heals
 It is used for immobilization
 It maintain position for unstable fracture and
for weakened muscles
 Common sites – face and jaw, extremities,
pelvis, ribs, fingers and toes

PLASTER CAST
• Rigid immobilizing device made of plaster of
Paris or fiberglass
• Provides immobilization of the fracture, to
correct a deformity, to apply uniform pressure,
to support and stabilize

Purposes
1. TO immobilize a body part in a specific position.
2. TO exert uniform compression to the tissue.
3. TO provide early mobilization of UNAFFECTED body
part.
4. TO correct deformities.
5. TO stabilize and support unstable joints

Nursing Management
Cast types:
1. Long arm
2. Short arm
3. ARM cylindrical cast and leg cylindrical cast
4. Short leg
5. Long leg
6. Hip Spica
7. Body cast
8. Sugar tong
9. Posterior sling cast

 Short arm cast – extends from below the elbow to the
palmar crease, secured around of the thumb.
 If thumb is included, it is known as a thumb spica or
gauntlet cast.
 Long arm cast – extends from the axillary fold to the
proximal palmar crease. The elbow usually is
immobilized at a right angle.
 Short leg cast – extends from below the knee to the
base of the toes. The foot is flexed at a right angle in a
neutral position
 Long leg cast – extends from the junction of the upper
and middle third of the thigh to the base of the toes.
The knee may be slightly flexed.
 Body cast – it encircles the trunk
 Hip spica cast – encloses the trunk and lower extremity

Casting Materials
• Plaster of Paris
Takes 1-3 days to dry completely..
Material of choice for primary casting.
Moldable, economic, familiar to surgeons.
Easy to reinforce and remove.
Rarely cause skin irritation.
Not water resistant.
Relatively heavy
May break down around a walking heel.
Repairs are difficult.

• Fiberglass
 Lighter in weight
 dries in 20-30 minutes.
 Water resistant
 Stronger & more
durable than plaster
cast
 Easy to apply.
 No need to remove during
radiographic procedures.
 More expensive in cost
per roll.
 Considered less moldable
than plaster.
 Can’t be reheated and
remolded.
 Patient may be allergic to
material

Thermoplastics
 Comfortable, lightweight, strong,
durable.
 Easy to remove
 Water-resistant and permeable.
 Can be reheated for additional
molding.
 Don’t require padding.
 Not as comfortable as plaster or
fiberglass.
 cost is higher.

Procedure
 Preparation for casting
 Explanation of procedure
 Skin preparation
 Apply stockinette over padding
 Casting material submerged in water
 Squeeze excess water, apply on injured part
 It is composed of unhydro calcium sulfate embedded in
gauze.
 As the cast dries a thermo chemical reaction occurs in
which the calcium sulfate recrystallizes and hardens with
in 15 min
 Finger tips should not pressed into cast
 A fresh cast should never cover with blanket because air
cannot circulate and heat builds up in the cast

Nursing Management
• 1. Allow the cast to air dry (usually 24-72
hours)
• 2. Handle a wet cast with the PALMS not
the fingertips to avoid dents.

Nursing Management
• 3. Keep the casted extremity
ELEVATED using a pillow to reduce
swelling.
• 4. Turn the extremity for equal
drying. DO NOT USE DRYER for plaster
cast
– Encourage mobility and range of motion
exercises

Nursing Management
• 5. Petal the
edges of the
cast to prevent
crumbling of
the edges.
• 6. Examine the
skin for
pressure areas
and Regularly
check the
pulses and
skin color.

Nursing Management
• 7. Instruct the patient not to place sticks or
small objects inside the cast.
• 8. Monitor for the following: pain, swelling,
discoloration, coolness, tingling or lack of
sensation and diminished pulses.
• 9.Hot spots (progressively painful areas)
occurring along the cast may indicate
infection under the cast

Windowing or Bivalving a cast
 Cutting the cast along both sides & splitting
to decrease pressure
 To visualize wounds under cast/remove drain
 Allow pulse assessment
 For wound care: Remove half of the cast
Neuro vascular assessment:
 Extremity: color, warmth, pulse distal to
cast, capillary refill( Circulatory function)
 Movement of distal finger/toes, light touch,
sensation ( Nerve function)
 N.V assessment every 30mts for 4hrs.after
cast application

 Cast material water resistance varies:
- Plaster casts are not water resistant.
- Synthetic casts are but undercast material
in not.
- Thermoplastic casts are and have no
undercast material.

 Application of a pulling force to an injured
body part or extremity while a counter traction
pulls in the opposite direction
Purpose:
 Reduce, realign & promote healing of fracture
 Decrease muscle spasm
 Prevent soft tissue damage
 Prevent or treat deformity
 Rest an inflamed or painful joint
 Reduce & treat dislocation
 Prevent contracture

Based on principle
Fixed traction
Sliding traction

 Traction is applied to the leg against a fixed
point of counter pressure.

 When the weight of all or part of the body,
acting under the influence of gravity, is
utilized to provide counter-traction.

 Exact weight required is determined by trial.
 For the fracture of femoral shaft an initial
weight of 10% of body weight
 Foot end is elevated so that the body slides
in opposite direction.
 1 inch (2.5 cm) for each 1 lb (0.46 kg) of
traction weight

Skin traction
Skeletal Traction

 Traction force is applied over a large area of
skin
 Applied over limb distal to fracture site
 Used for Short term treatment (48 to 72 hrs)
 Tapes, boots or splints are applied directly to
the skin and maintain alignment, assist in
reduction and to help diminish muscle spasm
in the injured extremity
 Traction weight – 5-10 Ib (2.3 – 4.5KG)

 Buck’s Traction
 Hamilton Russel Traction
 Gallow’s or Brayant’s Traction
 Modified Brayan’s Traction
 Pelvic Traction
 Dunlop Traction

 A foam boot is applied to
client’s affected limb &
attached to weight that is
suspended off the foot of the
bed. Used for fracture femur,
knee or back.
 Can be used unilaterally or
bilaterally.
 Check every 4th hourly for
decreased peripheral
vascular flow, peroneal nerve
deficit, pressure necrosis and
allergic reaction towards
adhesive material

 Used for fracture of hip or femur
 A broad soft sling is placed under the knee

 the treatment of fracture shaft femur in
children up to age of 2 yrs.
 Weight of child should be less than 15- 18 kg

 Sometimes used as a initial management
of developmental dysplasia of hip (1 YR)
 After 5 days of Bryant’s traction,
abduction of both hips is begun
increased by about 10 degree alternate
days.
 By three weeks hips should be fully
abducted.

 Used for conservative management of IVDP
 The amount by which foot end should be
elevated depends upon patient’s weight ,
more heavy the patient, more should be
elevation.

 USED IN fracture of humerus
 Useful when flexion of elbow causes
circulatory embarrassment with loss of radial
pulse
 Apply skin traction to forearm
 Abduct shoulder about 45 degree
 the elbow is flexed 45 degree.

COMPLICATIONS
 Allergic reactions to adhesives.
 Excoriation of skin.
 Pressure sores over bony prominences.
 Common nerve palsy.

 Using pin or wire
 7-15 pounds/ 2.3-20.4 kg
 more frequently used in lower limb fractures
 Should be used for those cases in which skin
traction is insufficient.
 Generally used when more weight is needed
to give traction.
 To treat fractures conservatively.

SITES
 Upper tibial
 Lower femoral
 Lower tibial
 Calcaneus
 Olecrenon
 Metacarpel

 Lateral or Upper Femoral Traction
 Nintey / Nintey traction
 Olecrenone traction
 Perkin’s Traction

For the management of central
fracture dislocation of the hip
Attach weight upto 9 kgs
Traction to continued for about
4-6 wks

 Used for fracture proximal third of the shaft
of the femur
 Traction is given through lower femoral pin,
which is more efficient, or by upper tibial
pin.

COMPLICATIONS
 Infection
 Distraction at fracture site
 Physical damage
 Nerve Injury

 Used for the fracture of tibia or femur.
 Skeletal traction is usually applied, but
skin traction can be given b/k.

 SKIN TRACTION Head Halter traction
 SKELETAL TRACTION
Crutchfield tongs
Cone or Barton tongs

 Simple type cervical
traction
 Management of neck
pain
 Weight should not
exceed 3 kg initially
 Can only be used a few
hours at a time
 Head end should be
elevated to give counter
traction

 Must incise skin and
drill cortex to place
 Rotate metal traction
loop so touches skull in
midsagittal plane
 Place at the line
connecting tips of
mastoid processes on
both sides.

Nursing Management
• 1. ALWAYS ensure that the weights hang freely and
do not touch the floor.
• 2. NEVER remove the weights without doctors order
• 3. Maintain proper body alignment.
• 4. Ensure that the pulleys and ropes are properly
functioning and fastened by tying square knot.

• 5. Observe and prevent foot drop
– Provide foot plate
• 6. Observe for DVT, skin irritation & breakdown.
• 7. Provide pin site care for clients in skeletal
traction- use of chlorhexidine is the most
effective, normal saline can be used also.

8. Promote skin integrity
– Use special mattress if possible
– Provide frequent skin care
– Assess pin entrance and cleanse the pin with
chlorhexidine solution
– Turn and reposition within the limits of traction

Care of Client in Traction
Temperature
extremity
infection
Ropes hang freely
Alignment
Circulation Checks
Type & location of Fx
Increase fluid intake
Overhead Trapeze
No weights on bed or floor

1. Patient education:
 Explain procedure of traction, purpose
 Explain amount of movement permitted
 Explain how to maintain correct body positioning
2. Instructions to maintain traction:
 Check traction equipment every shift and as needed:
- Traction codes aligned in each pulley
- Cords not stretched
- Knots tied tightly & secured with tape
- Cords hanging free of bed & floor
- Weights hanging free of bed & floor
- Correct number of weights hanging
- Overhead frame & bars are intact
- Bed linen not interfering with the line of traction
 Maintain correct body alignment & proper bed
position for counter traction, if indicated

 Do not lift weights without a specific order
 Check weights after position change
 Assess client for secondary complications of
immobility such as thrombophlebitis,
constipation, atelectasis, skin breakdown,
urinary problems
 Inspect pin entry/ exit sites for redness,
swelling, odour, bleeding, discharge
 Perform pinsite care twice a day as ordered
 Assess neurovascular comprise, pain, skin
breakdown, nutrition deficit, signs of infection

 Dietary supplements according to nutritional
status
 Small, frequent meals
 Fracture bedpan, provide privacy
 Stool softners & laxatives
 Exercise unaffected joints regularly
 If slings are used, inspect skin area regularly
 Avoid wrinkling of bed sheets

 Pin site care:
 Regular removal of exudates with hydrogen
peroxide
 Rinse pin site with saline
 Dry with sterile gauze
 Deep breathing exercises
3. Maintain skin integrity:
 Turn slightly from side to side
 Prevent friction & strain over skin
 Inspect skin for contusion

4. Drug Therapy
 Central & peripheral muscle relaxants
Eg: Cyclobenzaprine
 Open fracture: Tetanus & Diptheria toxoid/
Tetanus immunoglobulin
 Bone penetrating antibiotics. Eg:
Cephalosporin
5. Nutritional Therapy
 Diet:
Protein: 1g/kg body wt.
Vitamins B,C,D
Calcium,phosphorous,magnesium
Fluids, Fiber

1. Nerve injury
2. Infection
3. Compartment syndrome
4. Volkmann’s contracture
5. Fat embolism syndrome (FES)
6. Deep vein thrombosis and pulmonary
embolism
7. Cast syndrome
8. Traumatic or hypovolemic shock

 Bone fragments and tissue edema associated
with injury can cause nerve damage
Check for:-
 pallor and coolness of the affected
extremity
 changes in the client's ability to move the
digits or the extremity,
 paresthesia or complaints of increased pain.

 Open fracture and soft tissue injuries have a high
incidence of infection
 Devitalized and contaminated tissue is an ideal medium
for many common pathogens.
 Management – open fracture requires aggressive surgical
debridement, wound irrigation and mechanical removal
of contaminants.
 Closed suction drainage and skin grafting may be
needed
 Some time irrigation with antibiotic solution
 Antibiotic impregnated beads may be placed in the
surgical site
 IV ANTIBIOTICS for 3-7 days.

COMPARTMENT SYNDROME:
 It is a Condition in which elevated intra
compartmental pressure within a confined
myofascial compartment and compromises the
neuro vascular function of tissues within that
space.
 Causes
 Decreased compartment size: restrictive dressing,
splints, cast, excess traction
 Increased compartment content: bleeding,
edema, IV infiltration

 Due to soft tissue injury
 Edema occurs
 Elevate compartment pressure
 This will obstruct circulation and cause venous occlusion
 Ischemia
 Muscle and nerve cells are destroyed overtime
 Fibrotic tissue replacement
 Contractures, disability and loss of function

C/m:
 6 p’s
 PARESTHESIA
 PAIN
 PRESSURE RISES
 PALLOR
 PARALYSIS
 PULSE – DIMINISHED

Diagnosis:
 Neurovascular assessment
 Myoglobinurea – dark reddish brown urine –
myoglobin released from damaged muscle cells
can be trapped in renal tubules because of its
high molecular weight
 Treatment:
 Prevention and early recognition
 Do not apply cold application
 Remove constrictive bandage
 Reduce weight in traction

 Bivalve the cast
 Shouldn’t elevate the extremity above heart
level: Increase venous pressure, Decrease
blood flow
 Hydration
 Pain management
 Surgical decompression - Fasciotomy: Incision
through skin into muscle compartment

VOLKMAN’S CONTRACTURE:
 Limb deformity resulting from unrelieved
compartment syndrome
 pressure- muscle replaced by fibrous tissue
 Deformed foot, stiff claw like deformity

 Prolonged pressure causes ischemia
 Muscle is gradually replaced by fibrous tissue that traps
tendon and nerves
 Result in contracture, disability and loss of function
 Commonly occurs after fracture of the elbow and forearm
or after crushing injuries of the forearm or it is caused by
tight bandage or casts
 Contractures can be avoided through prompt recognition
of manifestation of compartment syndrome followed by
limb splinting and compartment decompression.

FAT EMBOLISM SYNDROME:
 Presence of fat globules in tissues & organs
 Occur in fracture long bones, ribs, pelvis, joint
replacement etc.

Mechanical theory
 Fat is released from the marrow of injured
bone
 Travel to pulmonary capillaries
 Enter to the systemic circulation
 Embolization to other organs

Biochemical theory
 Catecholamines released at the time of trauma
 Mobilize free fatty acids from the adipose tissue
 Causing loss of chylomicron emulsion stability
 Chylomicrons form large fat globules
 Lodges in the tissues of lungs, brain, heart and
kidney

 C/f:
12-72 hrs after injury
 lungs: s/s of ARDS:
chest pain, tachypnoea, tachycardia,
dyspnoea, restlessnes, confusion
Changes in mental status
Memory loss, restlessness, confusion, elevated
temperature and headache, Changes in level
of consciousness

 Diagnosis: Blood, urine, sputum, pao2 < 60
mm of Hg, ST changes, X-ray chest
 Treatment: Immobilization of a long bone
fracture, splint, symptom related, fluid
resuscitation, Oxygen, intubation, blood
transfusion

DEEP VEIN THROMBOSIS & PULMONARY EMBOLISM
 Stasis of blood flow in veins, increased
coagulability & injury to vessels
 Prolonged immobility/bed rest- stasis
 Prevention: Oral anticoagulant, SC low molecular
weight heparin, Elastic stockings

CAST SYNDROME/
SUPERIOR MESENTERIC
ARTERY SYNDROME:
 Occur in body spica cast
 Duodenum is compressed
between superior
mesenteric artery &
aorta and vertebral
bodies causing decreased
blood supply leads to
hemorrhage & necrosis of
bowel
 Develop days- weeks
after immobilization

 s/s – dilated stomach, severe abdominal
pain, severe back pain, persistent vomiting

1. Joint stiffness or post traumatic arthritis
2. Avascular necrosis (AVN)
3. Nonfunctional union
 Delayed union
 Non union
 Fibrous union
 Malunion
4. Complex regional pain syndrome and disuse

LONG TERM COMPLICATIONS OF FRACTURE:
1. Joint stiffness/ traumatic arthritis:
 Occur after injury/prolong immobilization
 Leads to joint contracture
 Need active & passive ROM
 NSAID

2. Avascular necrosis:
 Due to local circulatory compromise
 Usually seen on femoral head
 Need replacement of femoral head with
prosthesis

3. Nonfunctional union:
Malunion:
 Results when fracture fragments heal in improper
alignment
 Occur if client bears weight on affected
extremity
 Corrected with adjustment of traction or surgical
correction
Nonunion:
 Occurs when fracture healing not occurred 4-6
months after injury
 Cause: Insufficient blood supply, stress, excess
traction, infection, inadequate immobilization

 X-ray: Gap between fracture fragments
 Treatment: Bone grafting, internal/external fixation,
electronic bone stimulation.

Delayed union:
 Occurs when healing is slowed but not
completely stopped
 c/f: Increase in bone pain & tenderness
Fibrous union:
 Fibrous tissue interposed in wide gap
between fracture fragments
 Cause – loss of bone through surgery or injury
 Need additional surgical fixation

4. Complex regional Pain Syndrome(CRPS):
 Painful dysfunction characterized by abnormal
pain & swelling of affected extremity
 Disorder of central/peripheral nervous system
 Treatment: Steroids, analgesics, muscle
relaxants, physical therapy, rom exercises,
avoid taking blood pressure or performing
venipuncture in the affected extremity

 Risk for peripheral neurovascular dysfunction
 Acute pain
 Risk for infection

 Risk for impaired skin integrity
 Impaired physical mobility
 Ineffective therapeutic regimen management