FRACTURE

A bone fracture is a break in the

continuity of a bone. A significant
percentage of bone fractures occur
because of high force impact or stress.
However, a fracture may also be the
result of some medical conditions that
weaken the bones. These
include osteoporosis and some types
of cancer. The medical term for these is
a pathological fracture.
A bone fracture is a full or partial break
in the continuity of bone tissue.
Fractures can occur in any bone in the body. There are several different ways in which a bone
can fracture. For example, a closed fracture is a break to the bone that does not damage
surrounding tissue or tear through the skin. By contrast, a compound fracture is one that damages
surrounding tissue and penetrates the skin. Compound fractures are generally more serious than
simple fractures due to the risk of infection.

Types of Fracture

There are a number of other fracture types, including:

 Avulsion fracture: A muscle or ligament pulls on the bone, fracturing it.

 Comminuted fracture: An impact shatters the bone into many pieces.

 Compression, or crush, fracture: This generally occurs in the spongy bone in the spine.
For example, the front portion of a vertebra in the spine may collapse due to osteoporosis.

 Fracture dislocation: This occurs when a joint dislocates, and one of the bones of the
joint fractures.

 Greenstick fracture: The bone partly fractures on one side but does not break
completely, because the rest of the bone can bend.

 Hairline fracture: This is a thin, partial fracture of the bone.

  Impacted fracture: When a bone fractures, a piece of the bone may impact another
bone.

 Intra-articular fracture: This occurs when a fracture extends into the surface of a joint.

 Longitudinal fracture: This is when the fracture extends along the length of the bone.

 Oblique fracture: An oblique fracture is one that occurs opposite to a bone’s long axis.

 Pathological fracture: This occurs when an underlying condition weakens the bone and
causes a fracture.

 Spiral fracture: Here, at least one part of the bone twists during a break.

 Stress fracture: Repeated stress and strain can fracture a bone. This is common Trusted

Source among athletes.

 Transverse fracture: This is a straight break across the bone.

CAUSES

Healthy bones are extremely resilient and can withstand surprisingly powerful impacts.
However, under enough force, they may crack or break.

 Trauma. A fall, motor vehicle accident, or tackle during a football game can all result in
fractures.
 Osteoporosis. This disorder weakens bones and makes them more likely to break.
 Overuse. Repetitive motion can tire muscles and place more force on bone.

RISK FACTORS

 Smoking. Smoking is a risk factor for fracture because of its impact on hormone levels.
Women who smoke generally go through menopause at an earlier age. 
 Alcohol. Drinking alcohol in excess can influence bone structure and mass. Research
published by the National Institute on Alcohol Abuse and Alcoholism indicates that
chronic heavy drinking during a person’s earlier years can compromise bone quality and
 may increase the risk of bone loss—and potential fractures—even after drinking has
stopped.
 Steroids. Steroids (corticosteroids) are often prescribed to treat chronic inflammatory
conditions, such as rheumatoid arthritis, inflammatory bowel disease and chronic
obstructive pulmonary disease (COPD). Unfortunately, the need to use them at increased
doses can frequently cause bone loss and fractures. These unwanted side effects are dose-
dependent and are directly related to the ability of steroids to hinder the formation of
bone, curtail absorption of calcium in the gastrointestinal tract, and increase the loss of
calcium through the urine. In fact, bone loss occurs more rapidly with steroid use.
 Rheumatoid Arthritis. In this debilitating autoimmune disease—which strikes two to
three times more women than men—the body attacks healthy cells and tissues around the
joints, resulting in severe joint and bone loss. Steroids, such as Prednisone, may make life
easier, but they can also trigger bone loss as discussed under “steroids”. And, adding to
the complexity, the pain and poor joint function reduce activity levels, further
accelerating bone loss and fracture risk.
 Other Chronic Disorders. Celiac disease. Crohn’s disease, and ulcerative colitis, are
often linked to bone loss which can be accelerated by their frequent and necessary
treatment with steroids. A common factor in all these conditions is the gastrointestinal
tract’s reduced ability to absorb enough calcium to create and maintain strong bones. The
Crohn’s and Colitis Foundation of America notes that 30 to 60 percent of people with
inflammatory bowel disease may also have low bone density.
 Diabetes. Diabetes patients with Type 1 diabetes often have low bone density, though
researchers are not sure why. Typical onset of Type 1 diabetes is in childhood when bone
mass is building, and some sufferers also have celiac disease. The vision problems and
nerve damage that frequently accompany diabetes can contribute to falls and related
fractures. In Type 2 diabetes, typically with onset later in life, poor vision, nerve damage,
and inactivity can lead to falls; although bone density is typically greater than with Type
1 diabetes, bone quality may be adversely affected by metabolic changes due to high
blood sugar levels.
 Previous Fracture. Previous Low Impact Fractures doubles the risk of having another
fracture. Spine (vertebral) fractures are strong predictors of more spine fractures to come,
but these fractures often occur so slowly that there is no painful “event”. Women should
 ask for accurate height measurements at their annual medical examinations, since loss of
height more than an 1½ inches could indicate the presence of spine fractures.
 Family History. Family history of hip fracture increases the risk of hip fractures in their
children.
Pathophysiology

SIGNS & SYMPTOMS

Symptoms of a fracture vary depending on its location, a person’s age and general health, and the
severity of the injury.

However, people with a bone fracture will typically experience some of the following:

 pain
 swelling
 bruising
 discolored skin around the affected area
 protrusion of the affected area at an unusual angle
 inability to put weight on the injured area
 inability to move the affected area
 a grating sensation in the affected bone or joint
 bleeding if it is an open fracture

In more severe cases, a person may experience:

 dizziness
 faintness or lightheadedness
 nausea

DIAGNOSIS/LABORATORY TEST
To diagnose a broken bone, your healthcare provider will examine the injury. You will also
likely have one or more imaging tests. These tests can include:
 X-rays: This tool produces a two-dimensional picture of the break. Healthcare providers
often turn to this imaging first.
 Bone scan: Healthcare providers use a bone scan to find fractures that don’t show up on
an X-ray. This scan takes longer — usually two visits four hours apart — but it can help
find some fractures.
 CT scan: A CT scan uses computers and X-rays to create detailed slices or cross-sections
of the bone.
 MRI: A MRI creates very detailed images using strong magnetic fields. MRI is often
used to diagnose a stress fracture.

MEDICAL MANAGEMENT
A healthcare provider can usually treat a broken bone with a cast or splint. Casts wrap the break
with hard protection, while splints protect just one side. Both supports keep the bone
immobilized (no movement) and straighten it. The bone grows back together and heals.
With smaller bones such as fingers and toes, you won’t get a cast. Your healthcare provider
might wrap the injury before using a splint.
Occasionally, your healthcare provider might need to put you in traction. This treatment uses
pulleys and weights to stretch the muscles and tendons around the broken bone. Traction aligns
the bone to promote healing.
For some breaks, your healthcare provider may recommend surgery. Your treatment may use
stainless-steel screws, plates and fixators, or frames that hold the bone steady.

NURSING INTERVENTIONS
Nursing care of a patient with fracture include:
The nurse should instruct the patient regarding proper methods to control edema and
pain.
It is important to teach exercises to maintain the health of the unaffected muscles and to
increase the strength of muscles needed for transferring and for using assistive devices.
Plans are made to help the patients modify the home environment to promote safety such
as removing any obstruction in the walking paths around the house.
Wound management. Wound irrigation and debridement are initiated as soon as
possible.
Elevate extremity. The affected extremity is elevated to minimize edema.
Signs of infection. The patient must be assessed for presence of signs and symptoms of
infection.

COMPLICATIONS
As with many injuries, a fractured bone can lead to complications. These can include:
 Blood clots: Blockage of a blood vessel that can break free and move through the body.
 Cast-wearing complications: Can include pressure ulcers (sores) and joint stiffness.
 Compartment syndrome: Bleeding or swelling within the muscles surrounding the
fracture.
 Hemarthrosis: Bleeding into the joint, causing it to swell.