Fracture: Types, Traction, treatment, and Nursing Management

What is a fracture?

• Fracture is defined as breaking the continuity of bones due to excessive pressure on bones.
• Fracture is characterized by the separation of bone into two or more pieces resulting from direct or indirect force.

Causes of Fracture

• Accident
• Fall from a height
• Direct and indirect blow
• Domestic and occupational injury
• Sports injury
• Repetitive force
• Pathology condition and malnutrition
• Prolonged stress
• Aging process.

Types of Fractures  

1. Open fracture

• Open fracture is also called compound and complex fracture.
• Open fracture includes open skin bound.
• In open fracture, the bone comes out of the skin.

2. Close fracture  

• Closed fracture also called simple fracture.
• Closed fracture does not involve break skin.
• In a closed fracture, bone breaks but does not come out of the skin.

3. Complete Fracture –

• Complete bone fracture includes the complete break of the bone into two divided parts.

4. Incomplete Fracture

• Incomplete bone fracture also called greenstick fracture.
• In these fractures, bon breaks but incompletely.

5. Impacted Fracture

• In the impacted fracture, the bone breaks and penetrates into each other.

6. Pathologic Fracture

• Pathological fractures occur due to any bone disease and inflammation.

Eg. – Osteoporosis.

Pattern of Fracture 

1. Transverse fracture – fracture straight across the bone.
2. Oblique fracture – fracture at an angle across the bone.
3. Greenstick fracture – The Bone breaks from one side and bent to the other side.
4. Spiral fracture – Twists around the shaft of bone.

Clinical Manifestation –

• Acute pain
• Tenderness, swelling
• Hematoma
• Loss of function
• Swelling and bruising
• Short extremities
• Bleeding from an open wound
• Ecchymosis
• Numbness
• Crepitation ( abnormal mobility )
• Injured blood vessels
• Localized edema.

Diagnostic Examination of Fracture

• History collection and physical examination.
• Bone x-ray.
• CT scan and MRI.

Medical Management of Fracture

• Monitor patient ABC (Airway, Breathing and Circulation).
• Administer analgesic and TT injection.
• Assess fracture type and bleeding intensity.
• Immobilize the patient.
• Apply Ice to reduce pain and swelling.
• Administer oxygen and IV line.
• Pressure bandage applied to prevent bleeding.
• Fracture Management procedure –

1. Reduction
2. Fixation
3. Traction
4. Cast application.

5. Reduction

• Reduction is done to make fracture bone in the appropriate alignment.
• Reduction is the first stage of the healing process.
• Reduction process helps to reduce the space between fracture bones.
• Reduction helps to keep the bone straight.
• Reduction divided into –

1. Open reduction
2. Closed reduction.

• In open reduction, exposing the skin inside and break bone arrange in proper alignment.
• In closed reduction, the bone is pulled and brought into the natural alignment.

2. Fiction

• Fixation helps to fix reduction and        fix in proper alignment.
• Fixation divided into internal fixation and external fixation.
• Internal fixation is performed by exposing the skin by – screw, plates, wires, pins and roads.
• External fixation fixes the alignment from outside with the help of a frame.

3. Traction

• Traction applies the pulling force on the break bone so that the break bone returns into its normal alignment.
• Traction –

1. Skin traction ( pulling force on skin )
2. Skeletal traction (pulling force on bone).

• Indication of traction – maintain proper alignment

• Reduce spasm
• Reduce pain
• Reduce neurological injury.

      4.  Cast application for fracture

• Cast is a material that hardens by drying and provides support to fracture bones.
• The most cast applied on the fracture part which becomes hard after drying and keeps the alignment for a long time.

• Two type cast is –

1. POP ( plaster of Paris )
2. Synthetic fibre glass

• POP takes 48 to 72 hours to dry and synthetic fibre glass takes 20 – 30 minute to dry.

Nursing Management of fracture 

• Nurse monitors the patient’s Airway, breathing, circulation (ABC) and vital signs.
• Monitor type of fracture, site and intensity of pain.
• Assess bleeding and apply pressure bandages to prevent bleeding.
• Assess level of consciousness by Glasgow Coma scale.
• Administer oxygen therapy and IV therapy.
• Nurses maintain patients in immobilization positions.
• Provide all emergency treatment and prescribed medication.
• Conduct radiological procedure to identify fracture.
• Nurses conduct reduction procedures and maintain fracture bones into natural alignment.
• Nurses apply traction, to prevent immobilization of the fracture part.
• Nurse monitors the traction site and applies normal dressing.
• In traction, required weight apply and traction must not touch the ground.
• Nurses apply moist cast on fracture areas to maintain fix alignment.
• Fracture part after cast application, elevated to reduce swelling.
• Nurses use only a cool mode of air dryer to dry the cast.
• Nurses observe any complication of fracture.
• Provided psychological and emotional support.
• Provide health education during discharge planning.
• Provide rehabilitation programs.
• Education about crutch walking.

Complication of Fracture

1. Compartment syndrome
2. Fat embolism
3. Infection
4. Osteomyelitis
5. Pulmonary embolism
6. Loss of muscle strength
7. Muscles atrophy

• Fat embolism is the most common complication of fracture.
• In the condition of fat embolism, fat is released from the fractured part and goes into circulation.
• Fat embolism converts into pulmonary embolism and causes life-threatening conditions.
• Compartment syndrome is a painful and dangerous condition due to build-up pressure from internal bleeding and swelling.
• Generally, compartment syndrome is associated with closed fractures.
• Osteomyelitis is a disorder of bone and muscles characterized by an infection in the bone and muscles
• Muscle atrophy is a muscle wasting disorder that causes loss of muscle tissue.

FAQ.