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Urcia, Arianna B.

Worksheet NCM 104

Classifications of Fractures Definition
Avulsion Fracture of the bone resulting from the
strong pulling effect of tendons or
ligaments at the bone attachment
Comminuted (Unstable fx) Fracture of two or more fragments. The
smaller fragments appear to be floating
Displaced/Overriding Includes a displaced fracture fragment
that is overriding the other bone
fragment. The periosteum is disrupted
on both sides
Greenstick (Stable fx) An incomplete fracture with one side
splintered & the other is bent
Impacted A comminuted fracture in which more
than two fragments are driven to each
Interarticular Fracture that extends to articular joint
surface of the bone
Longitudinal An incomplete fracture in which the
fracture line runs along the longitudinal
axis of the bone. The periosteum is not
torn away from the bone
Oblique (Unstable fx) Fracture in which the line of fracture
extends in an oblique position
Pathologic A spontaneous fracture at the site of the
bone disease
Spiral (Stable fx) Fracture in which the line of fracture
extends in a spiral direction along the
shaft of the bone
Stress Fracture that is subject to repeated
stress, such as from jogging to running
Transverse (Stable fx) Fracture in which the line of fracture
extends across the bone shaft at a right
angle to the longitudinal axis


Fracture Reduction

Closed Reduction Open Reduction Traction

Nonsurgical realignment Surgical realignment of Application of pulling force
of bone fragments to bone fragments to their to an injured extremity or
their previous anatomic previous anatomic part of the body while
position. Traction & position. It includes countertraction pulls in the
countertraction are internal fixators. opposite direction to attain
manually applied to the Development of infection is realignment. This reduces
Urcia, Arianna B.
Worksheet NCM 104
bone fragments to a chief disadvantage. If pain/muscle pain,
restore position, length & ORIF is used for immobilize, reduce fracture
alignment. It is usually intrarticular fractures (inv. & treat pathologic joint
performed while on Joint surfaces), early condition. It is indicated to
general/local anesthesia. initiation of ROM is provide immobilization to
indicated. ORIF facilitates prevent soft tissue
early ambulation to damage, promote active &
decrease the risk of passive exercise, expand a
complications such as joint space during
immobility & promotes arthroscopic procedures &
fracture healing with expand joint space before
gradually increasing major joint reconstruction.
increments of stress placed Skin traction is for
on the affected joint & soft short0term treatment (48-
tissues. 72 hrs) until skeletal
traction or surgery is
possible. Skeletal traction
place in for longer periods.

Fracture Immobilization

Cast Internal Fixator External Fixator

Temporary Devices such as pins, Metallic devices composed
circumferential plates, IMR, metal & of metal pins that are
immobilization device, a bioabsorbable screws are inserted into the bone &
common tx following surgically inserted at the attached to external rods
closed reduction. time of realignment. to stabilize the fx while it
heals. It is indicated in
simple, complex fractures
with extensive soft tissue
damage, correction of bony
defects (congenital),
psedoarthritis, non-union
or malunion & limb

Nursing Responsibilities

On Traction

Inspect exposed skin areas regularly

Observe skeletal traction pin sites for signs of infection & Provide pin site care
Urcia, Arianna B.
Worksheet NCM 104
Correct position when external rotation of the hip (lower ext traction) occurs
by placing pillow, sandbag or rolled-up sheet along the great trochanteric
region of the femur
Encourage simple exercise regimen based on activity restriction
Encourage frequent position changes, ROM of unaffected joints, deep
breathing exercises, isometric exercises & use of trapeze bar to raise body off
the bed
Encourage frequent exercises of the trunk & ext to stimulate deep breathing

On Cast

Perform frequent neurovascular assessments of immobilized ext

Encourage/instruct to elevate ext above the level of heart to promote venous
return & application of ice to control/prevent edema during the initial phase
Discourage pulling out cast padding, scratching or placing foreign objects
For itching, hair dryer set on a cool setting can be directed under cast