Review of Bone Fractures

Introduction

• Review part of the NCLEX review series on the musculoskeletal system.
• Definition: Break or crack in a bone.
• Importance: Key concepts discussed, quiz available at the end.

Causes of Bone Fractures

1. Trauma
   • Falls, accidents (e.g., car accidents), sports injuries, and child abuse (twisting fractures in pediatrics).
2. Disease
   • Conditions like bone cancer, osteoporosis.

Healing and Complications

• Children vs. Adults: Children heal faster due to stronger, thicker, and more flexible periosteum.
• Healing Time: 3-12 weeks, varies with age and health.
• Complications:
  • Infection: Osteomyelitis
  • Compartment Syndrome
  • Fat Embolism
  • Nerve and Vessel Damage

Types of Bone Fractures

1. Based on Skin Penetration
   • Open (Compound) Fracture: Bone breaks through the skin.
   • Closed (Simple) Fracture: Bone does not penetrate skin.
2. Based on Completeness
   • Complete Fracture: Bone completely breaks into two.
   • Incomplete Fracture: Bone partially breaks.
3. Patterns of Fracture
   • Greenstick Fracture: One side bent, other side broken (common in pediatrics).
   • Comminuted Fracture: Bone broken into multiple fragments.
   • Transverse Fracture: Fracture across bone shaft.
   • Oblique Fracture: Slanted fracture across bone shaft.
   • Spiral Fracture: Bone twists around the shaft.

Signs and Symptoms

• Diagnosed with x-ray.
• BROKEN Acronym:
  • B: Bruising with pain and swelling.
  • R: Reduced movement.
  • O: Odd appearance.
  • K: Crackling sound (crepitus).
  • E: Edema and erythema.
  • N: Neurovascular impairment (Six P's: Pain, Pallor, Paralysis, Paresthesia, Pulselessness, Poikilothermia).

Nursing Interventions

1. Immediate Actions
   • Ensure safety and immobilize the fracture.
2. Stop Bleeding
   • Apply pressure with a clean cloth.
3. Open Fractures
   • Cover with a sterile dressing to prevent infection.
4. Elevate Extremity
   • Reduce swelling with elevation and ice.
5. NPO Status
   • Keep patient nothing by mouth (NPO) until evaluated.
6. Pain Management
   • Administer medication and monitor for effectiveness.
7. Frequent Neurovascular Assessments
   • Monitor for signs of compartment syndrome.

Compartment Syndrome

• Definition: Increased pressure within fascial compartments that can cut off nerve and blood supply.
• Signs to Monitor:
  • Pain unrelieved by medication.
  • Paresthesia, Pallor, Paralysis, Pulselessness, and Poikilothermia.
  • Compare affected and unaffected extremities.
• Interventions:
  • Notify physician, keep extremity at heart level, loosen restrictive clothing.
  • Possible fasciotomy: Surgical opening of fascia to relieve pressure.

Treatments for Bone Fractures

1. Bone Reduction: Aligning bone back to original state for natural healing.
   • Closed Reduction: Manual, often under general anesthesia.
   • Open Reduction: Surgical, using fixation devices (internal or external).
2. Cast Care
   • Watch for six P's, infection, and maintain skin integrity.
   • Elevate newly placed cast, handle with palms, avoid getting wet.
3. Traction
   • Aligns bone with steady pull, ensure weights hang freely.

Conclusion

• Review of key points on bone fractures.
• Reminder to take the quiz and subscribe for more videos.