C - fractures

Question 1

What’s a fracture?

Answer 1

Complete or partial break in a bone, which occurs when the physical force applied to the bone is stronger than the bone itself.

Question 2

Causes of fractures? (3)

Answer 2

• trauma associated with a fall, sports injury, or motor vehicle crash
• overuse during repetitive activities (eg. running / jumping)
• conditions — osteoporosis or cancer, can weaken the bones and cause spontaneous fractures

Question 3

Modifiable & non-modifiable risk factors of fractures? (3,3)

Answer 3

Modifiable:
1. Decreased vitamin D
2. Smoking, alcohol
3. Glucocorticoid use

Non-modifiable
1. increased age
2. congenital disorders like osteogenesis imperfecta (brittle bone disease)
3. malabsorption problems of calcium & vit d

Question 4

What are the types of fractures? (6)

Answer 4

Closed (simple)
○ bone breaks, but the overlying skin remains intact

● Open (compound)
○ fractured ends pierce through the overlying skin

● Greenstick
○ one side of the bone breaks, while the other side of the bone bends

● Impacted
○ a piece of one bone gets wedged into another bone

● Comminuted
○ bone breaks into multiple fragments

● Spiral
○ fracture line follows the projection of a strong, twisting force that is applied to the bone
○ most commonly seen in non-accidental traumas (eg. physical abuse)
○ broken bone typically requires several weeks to months to heal.

Question 5

What are the recovery phases of a fracture? (3)

Answer 5

1. Inflammatory phase
   a. body responds to the trauma by sending immune cells to the location of the fracture
   b. Immune cells remove dead and damaged tissue
2. Reparative phase
   a. body activates osteoblasts to form a callus (new bone tissue that connects the fractured ends)
3. Remodelling phase
   a. callus replaced by regular bone, and healing process is completed!!!

• Fractures typically present with signs and symptoms like localised pain, especially when trying to move + swelling & bruising.

Answer 6

Complications (immediate)
- Broken ends of the bone may damage surrounding structures
■ Blood vessels → bleeding
■ Nearby nerves → altered sensation
■ Muscles and tendons → tears

○ Compartment syndrome
■ bleeding or edema from the fracture leads to increased pressure inside the section of the limb that contains muscles, nerves, and blood vessels -> decreased blood supply -> tissue necrosis

○ Fracture of long bones
■ fat embolism → a piece of fat breaks off from the fractured bone and then travels through bloodstream & gets lodged within a blood vessel in organs like the heart, lungs, or brain, obstructing blood flow

Complications (long term)
○ Healing abnormalities → bone deformity
■ Malunion → occurs when the fractured ends are not adequately aligned
■ Delayed union → bone requires more time to complete the healing process
■ Nonunion → occurs when a bone completely fails to connect broken ends of the bone

● Mobility complications
○ Joint stiffness / instability
○ Rare → contractures (muscles and tendons get shortened and the range of motion gets limited)

● Pressure injuries → when immobilised patients spend too much time in bed
○ typically occurs over bony prominences like the sacrum or heels
○ Also at risk of DVT (typically in deep veins of lower extremities)
■ blood clot can break off and travel all the way to the lungs, ultimately causing a pulmonary embolism

Question 7

What is the treatment for fractures?

Answer 7

1. Rest and immobilisation of the affected limb + use of removable splints, or casts, to allow the bone to heal.
2. Displaced fractures require reduction = alignment of fractured ends into their proper position.
   ○ Closed reduction = alignment without surgical intervention
   ○ Open reduction = surgery.
3. Once aligned, bones can be held in place using internal and external fixation.
   ○ Internal fixation uses metal devices, such as nails, pins, screws, and plates within the skin to hold fractured ends in place.
   ○ External fixation, pins, screws, and wires are inserted into the fractured bone and held in place by a bar or ring outside of the skin.

Question 8

Whats the nursing diagnosis? (3)

Answer 8

• Acute pain related to fracture
• Risk for peripheral neurovascular dysfunction related to disrupted bone and soft tissue integrity
• Impaired physical mobility

Question 9

Whats the nursing goals? (3)

Answer 9

• Pain level managed at her stated tolerable level of 3/10 or less
• Continue to have adequate circulation and full sensation to affected area
• Able to safely mobilise on crutches before discharge

Question 10

Whats the nursing management? (5)

Answer 10

• Administering the ordered IV analgesic
• Teach child and caregiver about non-pharmacological ways to relieve pain such as: ice packs, pursed-lip breathing, & listening to music
• Affected area properly immobilised & elevated on pillows to increase peripheral
  circulation and decrease edema.
• Perform a CMS check every 2 hours to monitor for signs and symptoms of neurovascular compromise.
• Teach the proper use of crutches & importance of being non-weight bearing on affected limb.