Fracture
Mr. B is admitted under your care for fracture
a) Define fracture (2) .
b) Name eight types of fracture (2)
c) State four complications of fracture (2)
d) Mention the pathology of fracture (2)
e) Draw a nursing care plan using nursing process method for Mr.B. (7)
Definition
Fracture may be defined as a break in the continuity of the bone; breaking of the bone into two or more pieces.
Types of fracture
simple or closed fracture
compound or open fracture
comminuted fracture
green stick fracture
complicated fracture
compression fracture
pathological fracture
displaced or undisplaced fracture
transverse fracture
oblique fracture
spiral fracture
wedge compression fracture
Complications of fracture
Early complications
Local:
* Vascular injury causing haemorrhage, internal or external
* Visceral injury causing damage to structures such as brain, lung or bladder
* Damage to surrounding tissue, nerves or skin
* Haemarthrosis
* Compartment syndrome (or Volkmann's ischaemia)
* Wound Infection, more common for open fractures
Systemic:
* Fat embolism
* Shock
* Thromboembolism (pulmonary or venous)
* Exacerbation of underlying diseases such as diabetes or CAD
* Pneumonia
Late Complications
Local:
* Delayed Union
* Non-union
* Malunion
* Joint stiffness
* Contractures
* Myositis ossificans
* Avascular necrosis
* Algodystrophy (or Sudeck's atrophy)
* Osteomyelitis
* Growth disturbance or deformity
Systemic:
* Gangrene, tetanus, septicaemia
* Fear of mobilising
* Osteoarthritis
Pathology of fracture
There are 5 main stages of fracture healing:
" Tissue death and haematoma: Blood vessels rupture and a large haematoma is formed around the fracture
" Inflammation and cellular proliferation: Within 8 hrs of the fracture there is an acute inflammatory reaction and the fragment ends are surrounded by cellular tissue ('bridge formation'). The haematoma breaks down and fine capillaries begin to grow in that area.
" Callus formation: The new blood vessels bring the osteogenic/chrondrogenic cells and osteoclasts to the fracture site. The osteoclasts break down dead bone, and a thick cellular mass is laid down. The laid down bone is cancellous bone, which eventually mineralizes so the fracture units.
" Consolidation: With more osteoblastic and osteoclastic activity the cancellous bone is transformed to compact bone. The bone is made stronger now.
" Bone re-modelling: Over the coming months to years, the bone is remodeled by continuing bone deposition and resorption. This accounts for the various stresses. The medullary cavity is reformed.
Fractures can also heal by direct healing when the fracture is immobile from the start, and bone fragments are well apposed. New bone may be laid down directly across the fracture and callus formation is minimal.
