Urcia, Arianna B.

Worksheet NCM 104

BSN III
Classifications of Fractures Definition
Avulsion Fracture of the bone resulting from the
strong pulling effect of tendons or
ligaments at the bone attachment
Comminuted (Unstable fx) Fracture of two or more fragments. The
smaller fragments appear to be floating
Displaced/Overriding Includes a displaced fracture fragment
that is overriding the other bone
fragment. The periosteum is disrupted
on both sides
Greenstick (Stable fx) An incomplete fracture with one side
splintered & the other is bent
Impacted A comminuted fracture in which more
than two fragments are driven to each
other
Interarticular Fracture that extends to articular joint
surface of the bone
Longitudinal An incomplete fracture in which the
fracture line runs along the longitudinal
axis of the bone. The periosteum is not
torn away from the bone
Oblique (Unstable fx) Fracture in which the line of fracture
extends in an oblique position
Pathologic A spontaneous fracture at the site of the
bone disease
Spiral (Stable fx) Fracture in which the line of fracture
extends in a spiral direction along the
shaft of the bone
Stress Fracture that is subject to repeated
stress, such as from jogging to running
Transverse (Stable fx) Fracture in which the line of fracture
extends across the bone shaft at a right
angle to the longitudinal axis

Treatment:

Fracture Reduction

Closed Reduction Open Reduction Traction

Nonsurgical realignment Surgical realignment of Application of pulling force
of bone fragments to bone fragments to their to an injured extremity or
their previous anatomic previous anatomic part of the body while
position. Traction & position. It includes countertraction pulls in the
countertraction are internal fixators. opposite direction to attain
manually applied to the Development of infection is realignment. This reduces
Urcia, Arianna B.
Worksheet NCM 104
BSN III
bone fragments to a chief disadvantage. If
restore position, length & ORIF is used for
alignment. It is usually intrarticular fractures (inv.
performed while on Joint surfaces), early
general/local anesthesia. initiation of ROM is
indicated. ORIF facilitates
early ambulation to
decrease the risk of
complications such as
immobility & promotes
fracture healing with
gradually increasing
increments of stress placed
on the affected joint & soft
tissues.
Fracture Immobilization
Cast Internal Fixator
Temporary Devices such as pins,
circumferential plates, IMR, metal &
immobilization device, a bioabsorbable screws are
common tx following surgically inserted at the
closed reduction. time of realignment.
Nursing Responsibilities
On Traction
Inspect exposed skin areas regularly
Observe skeletal traction pin sites for signs of infection & Provide pin site care
pain/muscle pain,
immobilize, reduce fracture
& treat pathologic joint
condition. It is indicated to
provide immobilization to
prevent soft tissue
damage, promote active &
passive exercise, expand a
joint space during
arthroscopic procedures &
expand joint space before
major joint reconstruction.
Skin traction is for
short0term treatment (48-
72 hrs) until skeletal
traction or surgery is
possible. Skeletal traction
place in for longer periods.
External Fixator
Metallic devices composed
of metal pins that are
inserted into the bone &
attached to external rods
to stabilize the fx while it
heals. It is indicated in
simple, complex fractures
with extensive soft tissue
damage, correction of bony
defects (congenital),
psedoarthritis, non-union
or malunion & limb
lengthening
Urcia, Arianna B.
Worksheet NCM 104
BSN III
Correct position when external rotation of the hip (lower ext traction) occurs
by placing pillow, sandbag or rolled-up sheet along the great trochanteric
region of the femur
Encourage simple exercise regimen based on activity restriction
Encourage frequent position changes, ROM of unaffected joints, deep
breathing exercises, isometric exercises & use of trapeze bar to raise body off
the bed
Encourage frequent exercises of the trunk & ext to stimulate deep breathing

On Cast

Perform frequent neurovascular assessments of immobilized ext

Encourage/instruct to elevate ext above the level of heart to promote venous
return & application of ice to control/prevent edema during the initial phase
Discourage pulling out cast padding, scratching or placing foreign objects
For itching, hair dryer set on a cool setting can be directed under cast