(Subject: Traumatology and Orthopedic Nursing.
3rd year B.Sc nursing).
Definition: A fracture is a structural break in continuity of a bone. (Ref: Lippincott). OR, a fracture is a partial or complete disruption of the normal continuity of bone. OR, Fracture is a break in the surface of a bone, either across its cortex or through its articular surface. (Ref: John Ebenezar).
Classification or Type:
- According to the communication with exterior fracture has two type they are- (a). Simple fracture or close fracture. (b). compound fracture or open fracture.
- Fracture may be occurring without penetration of skin and muscle.
- Fracture may be occurring with penetration of skin and muscle and communicate with exterior.
- According to the site of extension: (a). Incomplete fracture. (It involves only one surface or cortex of the bone). (b). Complete fracture. (Here the fracture involves the entire bone. A complete fracture could be displaced or displace. Displace fracture pose challenge in the treatment.
- According to displacement: (a). Undisplacement fracture.(b).Displacement fracture.
- According to fracture configuration: a. Spiral fracture- by twisting force. (b). Transvers fracture- by angulations force. (An angle <30 with horizontal line). (c) Oblique fracture– by twisting force. (An angle >30 with horizontal line). (d). Comminuted fracture- Here the fracture fragment are more than two in number. (E). Segmental fracture- A fracture can break into segments and the segment could be two level, three level, a longitudinal splint or comminuted.
- Load barring- (a).Low stress fracture. (b). High stress fracture.
Clinical feature of fracture:
- Symptom: Pain. 2. Swelling-(due to soft tissue injury, medullary bleeding and reactionary hemorrhage). 3. Deformity. 4.inabity to use affected part.
- Symptom: Tenderness, Swelling, Deformity, Abnormal mobility between two fragments, Loss of transmitted movement, crepitus, Temperature rise in fracture area.
Common fracture in children and adult: Common fracture of children are- 1. Green stick fracture. 2. Clavicle fracture. 3. Epiphyseal fracture. 4. Supracondylar fracture. 5. Buckle fracture. 6. Hair line fracture. 7. Incomplete fracture.
Common fracture of adult are-
Complication of fracture: the complication of fracture are given in the below –
Immediate complication: Skin laceration, bleeding in the injury area, injury to- muscle, tendon, vessels, soft tissue and viscera. Shock, multiple organ system failure.
Early complication: Skin infection, joint infection, bone infection at fracture area, acute compartment syndrome, tetanus, pneumonia, pulmonary embolism, fat embolism.
Late complication: 1. Bone- (Nonunion, mal union, Delayed union), Growth retardation, Chronic osteomyelitis, Osteoarthritis, Joint stiffness, Deformity, Neurosis, Tardy nerve palsy.
Treatment of fracture:
Fracture treatment depend on – 1. Age of patients. 2. Age of the fracture. 3. Socioeconomic condition. 4. Patient demand.
- Early age: (Fracture within 2 weeks):
(A). in case of undisplacement fracture: Fix by cancellers, cannulated hip screw under (C-arm) meaching.
- In case of displacement fracture– Cloze reduction under general anesthesia and fix by cancellers, cannulated hip screw under C-arm meaching.
- Late case: (more than 2 weeks): a. If patients age less than 50 years, we can go for surgery hemiarthroplasty bipolar prosthesis. (b) if the patient age more than 50 years , we can go for surgery hemiarthroplasty by unipolar Austin more prosthesis.
- Basic treatment of fracture: (4R)
R- Resuscitation of the patient.