(^266) Medical-Surgical Nursing Demystified
Fractures
WHAT WENT WRONG?
Excess stress or direct trauma is placed on a bone, causing a break. This results in
damage to surrounding muscles and tissue, leading to hemorrhage, edema, and local
tissue damage. Initially after the fracture, bleeding in the area leads to hematoma
formation at the site. Inflammatory cells enter the area. Granulation tissue replaces
the hematoma. Cellular changes continue and a non-bony union known as a callus
develops. Osteoblasts continue to enter the area. Fibrous tissue in the fractured
area changes to bone.
The fracture site may be just a crack in the bone, without displacing any of the
bone itself. A fracture that does not go all the way through the bone is considered
an incomplete fracture. The fracture may also go all the way through a bone, break-
ing it into two (or more) pieces, which is referred to as a complete fracture. The
surrounding muscle tissue that attaches above and below the fracture area in a limb
will continue to create tension on their attachment points to the bone and pull the
pieces further out of alignment. Some fractured bone pieces may penetrate through
the skin; this is known as an open or compound fracture. Those that do not pene-
trate the skin are considered closed or simple fractures.PROGNOSIS
The area of fracture needs to be identified (via an x-ray) and properly treated in
order to heal. The fractured area typically needs to be realigned and then immobi-
lized to allow for proper healing. During this time of immobilization, the bone
cells come into the area to rebuild new bone to repair the damaged area. The period
of immobilization typically lasts for 6 to 8 weeks, depending on the site and degree
of damage. The full structural strength is not typically restored until months after
the break, depending on the size and location of the fracture. Time for full healing
varies from 6 weeks in young healthy adults with simple fractures to a couple of
months in older patients with other health problems. Older patients have a signif-
icant increase in both morbidity and mortality following a hip fracture.
Complications following fractures include compartment syndrome, fat embo-
lism, deep vein thrombosis (DVT), delayed union, nonunion, or misalignment.
Compartment syndrome occurs when excess pressure builds up within a muscle
compartment sheath. The pressure may be coming from internal or external
sources of pressure. This is most common with fractures involving the lower leg2