Fractures incapacitate - patient, care givers all will be in chaos... lets know about fractures

2. Fractures
By: Ms . S.Peter

4. Fractures
• The fracture occur when the bone is
subjected to stress greater than it can absorb
Like----
• Trauma –(Fall from a height , accidents )
• Direct blow , sudden twisting motion
• Repetitive forces
• Extreme muscle contraction
• Pathology

5. When bone is fractured………..
Adjacent structures affect, body organs injures
• The blood vessels across the break are ruptured.
Blood clots around the site of the fracture and
forms a fracture hematoma.
Because of the disrupted blood supply, many of the
bone cells in the fracture site die.

6. Signs and Symptoms
 Swelling or tenderness
 pain
 Numbness
 Bleeding
 Broken skin with bone protruding
 Limitation or unwillingness to move a limb
• Shortening—long bone # -- due to contraction of
muscles attached Fragments may overlap 2-5 cm
• Crepitus-- examine by hand--- crepitus – due to
rubbing of fragments
• Swelling & Discoloration : Localized—trauma –may
not develop for several hrs or days after injury

7. Closed fracture(Simple) fracture is one where the fracture
does not communicate outside.
No break in skin
Open fracture:Compound/complex) ( This is one where
the fracture communicates with the outside through an open
wound.
1. Traumatic
Fracture Types
Open Fracture :
Grade I : Clean wound – less than 1 cm long
Grade II : Larger wound without extensive soft tissue damage
Grade III: Highly contaminated, extensive soft tissue damage, most
severe

8. • Complete fracture :
Break across the entire cross section of bone
(often move from normal position)
• Incomplete Fracture /green stick
Break occurs only through part of the cross
section

9. Transverse Fracture
A fracture in which the
# line is perpendicular
to the long axis of the
bone .
Oblique Fracture
A fracture in which the #
line is at oblique angle to
the long axis of the bone.
According to the Path of the fracture Line
Fracture Types…..

10. Spiral Fracture
A severe form of oblique
fracture in which the #
plane rotates along the long
axis of the bone. These #s
occur secondary to
rotational force.
Longitudinal Fracture
A fracture in which the #
line runs nearly parallel to
the long axis of the bone.
A longitudinal fracture
can be considered a long
oblique fracture.
According to the Path of the Fracture Line
Fracture Types……

11. Anatomical classification of fractures
Fracture Types ……………
Comminuted Fracture :
The bone is broken into
more than two fragments.
Stellate fracture:
This # occurs in the flat
bones of the skull and in
the patella, where the
fracture lines run in
various directions from
one point.

12. Anatomical classification of fractures
Impacted fracture:
The bone fragment is driven
into another bone fragment
Fracture Types………….
Depressed fracture:
This # occurs in the skull where a
segment of bone gets depressed
into the cranium.

13. Avulsion fracture:
Pulling away of a fragment of bone or tendon and its attachment
Eg:
1. The supra spinatus muscle avulsing the
greater tuberosity of the humerus.
2. Avulsion fracture of the tibial tuberosity
Fracture Types…..
Anatomical classification of fractures

14. Compression fracture

15. Pathological
It is a fracture occurring spontaneously in a bone
weakened by some pathological lesion.
This lesion may be –
• Localized disorder (e.g. secondary malignant
deposit- bone tumors,
• Generalized disorder-eg. Osteoporosis, multiple
myeloma, osteomyelitis ….
Fracture Types….

16. Birth fracture:
• It is a fracture in the new born
children due to injury during delivery.
Stress fracture :
• It is a fracture occurring at a site in
the bone subject to repeated minor
• stresses over a period of time. Tiny crack in a
bone---- caused by the repetitive application of force,
often by over use-------
Eg. repeatedly jumping up and down if
running a long distance. Stress # cause
also due to osteoporosis

17. Stress #s
Common in weight bearing bones- of foot , lower
leg—athletes—dancers are of higher risk
• Reason---muscles over tires – and transfer stress
to bone – common site is 2, 3 rd metatarsal ,
heel , fibula and navicular --- on the top of the
mid foot
• Recovery----------- -- rest
• High impact activity--- Frequency – how often,
duration(how long) intensity(level of exercise)
• Osteoporosis – bone insufficiency
• Too much too soon

19. Fracture Types-summary
Simple little or no bone displacement
Compound fracture ruptures the skin & bone protrudes
Green stick mostly in children- bones have not calcified or hardened
Transverse crack perpendicular to long axis of the bone ?displacement
Oblique diagonal crack across the long axis of the bone
Spiral diagonal crack -a "twisting" of the bone - the longitudinal axis
Comminuted "crushing" fracture - more common in elderly
Impacted one end of bone is driven up into the other
Depressed broken bone is pressed inward (skull fracture)
Avulsion fragment of bone is pulled away by tendon

20. FRACTURES DISPLACEMENT
• After a complete fracture the fragments usually
displaced:
– partly by the force of injury
– partly by gravity
– partly by the pull of muscles attached to them.
• 4 types:
– Translation/Shift
– Alignment/Angulation
– Rotation/Twist
– Altered length

21. Other Terms used in describing fracture
Greenstick- incomplete
is the fracture in the young bone of children where the break
is incomplete, leaving one cortex intact .
Plastic - Bowing fracture in children without disruption of cortex.
Distraction Is a separation of fragments that have been pulled
apart.
Greenstick #
Distraction #

22. 1.Position –
changed or unchanged
Terms used in fracture Follow-up
2. Healing -central or
peripheral bony bridging

23. Delayed union - the healing process is slower than
normal.
Non-union - the healing stopped before union
occurred.
Malunion - the fracture healed in unacceptable
position
Terms used in fracture follow-up

25. A. FAT EMBOLISM
Embolism originating in the Bone marrow after #
• Long bone has great risk, occurs within 48 hrs
after #
Assessment: restlessness, change in mental
status, Tachycardia, tachypnea, hypotension,
dyspnea, petechial rash over the chest/neck
Implementation: notify, treat symptoms to
prevent resp. failure and death

26. B. Compartment syndrome .
Increased pressure within one or more
compartments causing massive compromise of
circulation in an area.
• Leads to decreased circulation and anoxia
• After 4-6 of onset-- irreversible neuromuscular
damage occurs
Assessment : increased pain, swelling, pain on
passive motion, inability to move joints, loss of
sensation, pulselessness
Implementation: notify immediately

27. C. Infection and osteomyelitis-
due to interruption of integrity of skin, -- infection
invades tissue
Assessment: fever, pain, erythema around the # site,
tachycardia, elevated WBC
Implementation: notify, prepare for aggressive I.V
antibiotic therapy
==========================================
D. Avascular Necrosis :
Interruption of blood supply to bony tissue—leads to
death of the bone
Assessment : Pain, decreased sensation,
Implementation: notify if pain and paresthesia,
prepare pt for removal of necrotic tissue which will
lead to infection.

28. D. Pulm Embolism :
caused by immobility caused by #
Assessment: restlessness, apprehension,
dyspnea, diaphoresis , ABG changes
Implementation: notify if signs present, prepare
for anticoagulant therapy

29. END OF THIS SESSION