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Bones fracture (from
Latin {

x a break in the
continuity of a bone. A
fracture is present when there
is loss of continuity in the
substance of a bone. It is a
soft tissue injury that is
accompanied by a complete or
incomplete break in bone,
resulting usually from trauma
and/or pathological
considerations. A bone
fracture can be the result of
high force impact or stress, or trivial injury as a result of certain medical conditions
that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis
imperfecta, where the fracture is then termed pathological fracture.

When the bone is broken, adjacent structures are also affected, resulting in soft
tissue edema, hemorrhage into the muscles and joints, joint dislocation, ruptured
tendons, severed nerves, and damaged blood vessels. Body organs maybe injured by
the force that cause the fracture or by the fracture fragments.

There are different types of fractures and these include, complete fracture,
incomplete fracture, closed fracture, open fracture and there are also types of
fractures that may also be described according to the anatomic placement of
fragments, particularly if they are displaced or no displaced. Such as greenstick
fracture, depressed fracture, oblique fracture, spiral, comminuted, segmental,
impacted, torus, avulsion, spinal fracture, impacted fracture, transverse fracture and
compression fracture.

  
 
 
Although bone tissue itself contains no nociceptors, bone fracture is very painful
for several reasons:
mc Breaking in the continuity of the periosteum, with or without similar
discontinuity in endosteum, as both contain multiple nociceptors.
mc Edema or swelling of nearby soft tissues caused by bleeding of torn
periosteal blood vessels evokes pressure pain.
mc Muscle spasms trying to hold bone fragments in place.
mc Swelling, Abrasion, Bruising and/or tenderness at the suspected fracture site.
mc Loss of function
mc Bleeding
mc Oedness
mc Yaralysis
mc ematoma
mc Tenderness

 
wc Some fractures can lead to serious complications including a condition known
as compartment syndrome (

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x. If not treated, compartment syndrome can result in amputation of
the affected limb. Other complications may include non-union, where the
fractured bone fails to heal or mal-union, where the fractured bone heals in a
deformed manner.
wc Arterial Damage
wc at Embolism
wc Infection
wc Avascular Necrosis
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Dc [-ray radiographs can be requested to view the bone suspected of being
fractured.
Dc In situations where x-ray alone is insufficient, a computed tomograph (CT scanx
may be performed.
Dc MOI and Ct scan can diagnose early hair-line fracture in small bones and when
plain radiology fails

    
uc Emergency Management:
c It is important to immobilize the body part before the patient is moved.
c If an 
 
     

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     is supported distal and proximal to the fractured site
to prevent rotation as well as angular motion.
c Adequate splinting is essential.
c With an open fracture, the wound is covered with a sterile dressing to
prevent contamination of deeper tissues. Splints are applied for
immobilization.
uc Yain management:
In arm fractures in children, ibuprofen has been found to be equally effective as
the combination of acetaminophen and codeine.
uc Immobilization:
Since bone healing is a natural process which will most often occur; fracture
treatment aims to ensure the best possible function of the injured part after
healing.
A fractured limb is usually immobilized with a plaster or fiberglass cast or
splint which holds the bones in position and immobilizes the joints above and
below the fracture.
When the initial post-fracture edema or swelling goes down, the fracture
may be placed in a removable brace or orthosis.
 Occasionally smaller bones, such as phalanges of the toes and fingers, may
be treated without the cast, by buddy wrapping them, which serves a similar
function to making a cast.

 
Surgical methods of treating fractures have their own risks and benefits, but
usually surgery is done only if conservative treatment has failed or is very likely to
fail. With some fractures such as hip fractures (usually caused by osteoporosis or
osteogenesis Imperfectax, surgery is offered routinely, because the complications of
non-operative treatment include deep vein thrombosis (DVTx and pulmonary
embolism, which are more dangerous than surgery.
When a joint surface is damaged by a fracture, surgery is also commonly
recommended to make an accurate anatomical reduction and restore the smoothness
of the joint.
Infection is especially dangerous in bones, due to their limited blood flow. Bone
tissue is predominantly extracellular matrix, rather than living cells, and the few blood
vessels needed to support this low metabolism are only able to bring a limited number
of immune cells to an injury to fight infection. or this reason, open fractures and
osteotomies call for very careful antiseptic procedures and prophylactic antibiotics.
Occasionally bone grafting is used to treat a fracture. Sometimes bones are
reinforced with metal. These implants must be designed and installed with care.
Stress shielding occurs when plates or screws carry too large of a portion of the
bone's load, causing atrophy. This problem is reduced, but not eliminated, by the use
of low-modulus materials, including titanium and its alloys.
The heat generated by the friction of installing hardware can easily accumulate
and damage bone tissue, reducing the strength of the connections. If dissimilar
metals are installed in contact with one another (i.e., a titanium plate with cobalt-
chromium alloy or stainless steel screwsx galvanic corrosion will result. The metal ions
produced can damage the bone locally and may cause systemic effects as well.
Electrical bone growth stimulation or osteostimulation has been attempted to speed or
improve bone healing. Oesults however do not support its effectiveness.
 Oeduction requires anesthesia to achieve muscle relaxation and pain relief to
return the fractures fragments together. It may be closed or open fixation. Oadiology
may be used to aid procedure

 
c The nurse encourages the patient to return to their usual activities as rapidly
as possible.
c Encouraging the patient to be active within the limits of the fracture
immobilization.
c Teaching exercise to maintain the health of unaffected muscles and to
increase the strength of muscles needed for transferring and for using
assistive devices (e.g. crutches, walker, special utensilsx.
c Ylans are made to help patient modify their home environment as needed and
to secure personal assistance if necessary.
c Yatient teaching includes self-care, medication I information, monitoring for
possible complications, and the need for continuing health care supervision.
c The goal of rehabilitation is to decrease pain and restore full function to the
fracture site.
c Educate patient for utilization of home remedies such as heat and cold can be
used to control pain and edema.
c Oehabilitation emphasizes restoring full range of motion, strength,
proprioception and endurance of all adjacent joints while maintaining
independence in all activities or daily living, if not contraindicated by the
fracture stability.
c ait training using appropriate assistive devices is indicated to promote
independent ambulation. The individual may progress from walker to crutches
to cane based on ability and weight bearing status.
c If casted, range of motion exercises of the adjacent joints may be beneficial
unless contraindicated based on fracture stability.
c Instruct to elevate the fracture if it is in the lower extremities from time to
time to reduce edema.