V. Medical Management
The principles of fracture treatment include reduction, immobilization and regaining of normal function and strength through rehabilitation.
• The fracture is reduced “setting” the bone using a closed method (manipulation and manual traction (e.g. splint or cast) or an open method (surgical placement of internal fixation devices like pins, wires, screws, plates and nails) to restore the fracture fragments to anatomic alignment and rotation. The specific method depends on the nature of the fracture.
• After the fracture has been reduced, immobilization holds the bone in correct position and alignment until union occurs. Immobilization is accomplished by external or internal fixation.
• Function is maintained and restored by controlling swelling by elevating the injured extremity and applying ice as prescribed.
• Restlessness, anxiety, and discomfort are controlled using a variety of approaches (e.g. reassurance, position changes, pain relief strategies, including analgesic agents).
• Isometric and muscle-setting exercises are done to minimize disuse atrophy and to promote circulation.
• With internal fixation, the surgeon determines the amount of movement and weight-bearing stress the extremity can withstand and prescribed the level of activity.
VI. Nursing Diagnosis
• Pain related to fracture, soft tissue damage, muscle spasm, and surgery
• Impaired physical mobility related to fractured hip
• Impaired skin integrity related to surgical incision
• Risk for impaired urinary elimination related to immobility
• Risk for disturbed thought process related to age, stress of trauma, unfamiliar surroundings, and drug therapy
• Risk for ineffective coping related to injury, anticipated surgery, and dependence
• Risk for impaired home maintenance related to fractured hip and impaired mobility
VII. Nursing Management
Prevent infection
- Cover any breaks in the skin with clean or sterile dressing.
Provide care during client transfer.
- Immobilize a fractured extremity with splint in the position of the deformity before moving the client; avoid strengthening the injured body part if a joint is involved.
- Support the affected body part above and below fracture site when moving the client.
Provide client and family teaching.
- Explain prescribed activity restrictions and necessary lifestyle modification because of impaired mobility.
-Teach the proper use of assistive devices, as indicated.
Administer prescribed medications, which may include opioid or nonopioid analgesics and prophylactic antibiotics for an open fracture.
Prevent and manage potential complications.
- Observe for symptoms of life-threatening fat embolus, which may include personality change, restlessness, dyspnea, crackles, white sputum, and petechaie over the chest and buccal membranes. Assist with respiratory support, which must be instituted early.
- Observe for symptoms of compartment syndrome, which include deep, unrelenting pain; hard edematous muscle; and decreased tissue perfusion with impaired neurovascular assessment findings.
- Monitor closely for signs and symptoms of other complications.
Patient education regarding different factors that affect fracture healing
Factors that enhance fracture healing
• Immobilization of fracture fragments
• Maximum bone fragment contact
• Sufficient blood supply
• Proper nutrition
• Exercise: weight bearing for long bones
• Hormones: growth hormone, thyroid, calcitonin, vitamin D, anabolic steroids
Factors that inhibit fracture healing
• Extensive local trauma
• Bone loss
• Inadequate immobilization
• Space or tissue between bone fragments
• Infection
• Local malignancy
• Metabolic bone disease (Paget’s disease)
• Irradiated bone (radiation necrosis)
• Avascular necrosis
• Intra-articular fracture (synovial fluid contains fibrolysins, which lyse the initial clot and retard clot formation)
• Age (elderly persons heal more slowly)
• Corticosteroids (inhibit the repair rate)