Bone Fractures

Key points

1. Fracture pathophysiology

   The underlying pathophysiology of fractures involves stress placed on a bone that results in a break in the bone’s structure.

2. Fracture forces and causes

   Several different forces can result in bone fractures, including direct trauma, twisting movements, and crushing forces. Some of the most common causes of fractures include motor vehicle accidents, sports injuries, and falls.

3. Soft tissue involvement

   Usually when a bone fracture occurs, the soft tissue surrounding the bone is also affected. This can result in edema, hemorrhage, tendon damage, and severed nerves—all collectively referred to as soft tissue injuries.

4. Common clinical manifestations

   The specific clinical manifestations of fractures will vary depending on the anatomic location affected, but there are certain symptoms associated with nearly all fracture types, including pain and tenderness, edema, inability to move the affected body part, bruising or hematoma formation, and deformity of the affected extremity.

5. Definitive fracture diagnosis

   The only definitive way to diagnose a bone fracture is to visualize the break in the bone structure. This can be done with several different types of imaging tests, including x-ray, magnetic resonance imaging (MRI), and computed tomography (CT) scanning.

6. Imaging test selection

   X-rays are typically performed first, as they can quickly and easily visualize bone structure. A CT scan or MRI may be used if there are suspected soft tissue injuries that the provider or surgeon needs to see in more detail.

7. Primary nursing priorities

   Most of the nursing care for patients with fractures focuses on controlling pain and ensuring patient comfort. It is also important for the nurse to assess for and intervene if complications develop such as compartment syndrome, a condition caused by increased pressure within an area of tissue and resulting in muscle and nerve damage (discussed more later in this section).

8. Frequent neurovascular checks

   First, it is important for the nurse to perform frequent neurovascular examinations on the affected extremity.

9. Fat embolism complications

   The fat embolism can travel through the body’s systemic circulation, get lodged in the brain or lungs, and quickly cause a life-threatening ischemic stroke or pulmonary embolism. These clots most commonly develop between 24 and 72 hours after the initial fracture, so the nurse should monitor closely for signs of neurological changes or shortness of breath (Adeyinka Pierre, 2022).

10. Suspected embolism actions

    Priority actions would include notifying the provider, calling a rapid response team if indicated, and applying oxygen as necessary. Additionally, the nurse should carefully follow orders given by the treating provider, such as administering medication or providing other interventions.

11. Cast itching risk

    The skin underneath the cast tends to become dry and itchy, and patients are often tempted to stick items inside to scratch the skin and relieve the itching. This can result in skin breakdown and should be avoided while the cast is in place.

12. Effective treatment signs

    These signs include lack of deformities to the bone or extremity, decreased swelling, improved pain, ability to move distal parts of the affected extremity, normal skin color, and strong pulse distal to the fracture. Additionally, a follow-up x-ray will be performed to evaluate the healing status of the fracture and determine whether further treatment is indicated.

13. Compartment syndrome cues

    Signs and symptoms of compartment syndrome include diminished distal pulses in the affected extremity, swelling and taut skin in the extremity, numbness or “pins and needles” feeling in the extremity, and difficulty moving the extremity. If the nurse suspects that the patient is experiencing compartment syndrome, they must alert the treating provider immediately.