A fracture is the medical term for a broken bone. They occur when the physical force exerted on the bone is stronger than the bone itself. They commonly happen because of car accidents, falls or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Fracture is sometimes abbreviated FRX or Fx, Fx, or #.
Types of Fracture
There are many types of fractures, but the main categories are complete, incomplete, open, closed and pathological. Five major types are as follows:
- Incomplete: Fracture involves only a portion of the cross-section of the bone. One side breaks; the other usually just bends (greenstick).
- Complete: Fracture line involves entire cross-section of the bone, and bone fragments are usually displaced.
- Closed: The fracture does not extend through the skin.
- Open: Bone fragments extend through the muscle and skin, which is potentially infected.
- Pathological: Fracture occurs in diseased bone (such as cancer, osteoporosis), with no or only minimal trauma.
Nursing Care Plans
- Prevent further bone/tissue injury.
- Alleviate pain.
- Prevent complications.
- Provide information about condition/prognosis and treatment needs.
- Fracture stabilized.
- Pain controlled.
- Complications prevented/minimized.
- Condition, prognosis, and therapeutic regimen understood.
- Plan in place to meet needs after discharge.
Diagnostic Studies for Fracture
- X-ray examinations: Determines location and extent of fractures/trauma, may reveal preexisting and yet undiagnosed fracture(s).
- Bone scans, tomograms, computed tomography (CT)/magnetic resonance imaging (MRI) scans: Visualizes fractures, bleeding, and soft-tissue damage; differentiates between stress/trauma fractures and bone neoplasms.
- Arteriograms: May be done when occult vascular damage is suspected.
- Complete blood count (CBC): Hematocrit (Hct) may be increased (hemoconcentration) or decreased (signifying hemorrhage at the fracture site or at distant organs in multiple trauma). Increased white blood cell (WBC) count is a normal stress response after trauma.
- Urine creatinine (Cr) clearance: Muscle trauma increases load of Cr for renal clearance.
- Coagulation profile: Alterations may occur because of blood loss, multiple transfusions, or liver injury.
Here are 8 nursing care plans for fracture.
1. Risk for Trauma
- Risk for Trauma
Risk factors may include
- Loss of skeletal integrity (fractures)/movement of bone fragments
- Getting up without assistance
- Maintain stabilization and alignment of fracture(s).
- Display callus formation/beginning union at fracture site as appropriate.
- Demonstrate body mechanics that promote stability at fracture site.
|Maintain bed rest or limb rest as indicated. Provide support of joints above and below fracture site, especially when moving and turning.||Provides stability, reducing possibility of disturbing alignment and muscle spasms, which enhances healing.|
|Secure a bedboard under the mattress or place patient on orthopedic bed.||Soft or sagging mattress may deform a wet (green) plaster cast, crack a dry cast, or interfere with pull of traction.|
|Support fracture site with pillows or folded blankets. Maintain neutral position of affected part with sandbags, splints, trochanter roll, footboard.||Prevents unnecessary movement and disruption of alignment. Proper placement of pillows also can prevent pressure deformities in the drying cast.|
|Use sufficient personnel for turning. Avoid using abduction bar for turning patient with spica cast.||Hip, body or multiple casts can be extremely heavy and cumbersome. Failure to properly support limbs in casts may cause the cast to break.|
|Observe and evaluate splinted extremity for resolution of edema.||Coaptation splint (Jones-Sugar tong) may be used to provide immobilization of fracture while excessive tissue swelling is present. As edema subsides, readjustment of splint or application of plaster or fiberglass cast may be required for continued alignment of fracture.|
|Maintain position or integrity of traction.||Traction permits pull on the long axis of the fractured bone and overcomes muscle tension or shortening to facilitate alignment and union. Skeletal traction (pins, wires, tongs) permits use of greater weight for traction pull than can be applied to skin tissues.|
|Ascertain that all clamps are functional. Lubricate pulleys and check ropes for fraying. Secure and wrap knots with adhesive tape.||Ensures that traction setup is functioning properly to avoid interruption of fracture approximation.|
|Keep ropes unobstructed with weights hanging free; avoid lifting or releasing weights.||Optimal amount of traction weight is maintained. Note: Ensuring free movement of weights during repositioning of patient avoids sudden excess pull on fracture with associated pain and muscle spasm.|
|Assist with placement of lifts under bed wheels if indicated.||Helps maintain proper patient position and function of traction by providing counterbalance.|
|Position patient so that appropriate pull is maintained on the long axis of the bone.||Promotes bone alignment and reduces risk of complications (delayed healing and nonunion).|
|Review restrictions imposed by therapy such as not bending at waist and sitting up with Buck traction or not turning below the waist with Russell traction.||Maintains integrity of pull of traction.|
|Assess integrity of external fixation device.||Hoffman traction provides stabilization and rigid support for fractured bone without use of ropes, pulleys, or weights, thus allowing for greater patient mobility, comfort and facilitating wound care. Loose or excessively tightened clamps or nuts can alter the compression of the frame, causing misalignment.|
|Review follow-up and serial x-rays.||Provides visual evidence of proper alignment or beginning callus formation and healing process to determine level of activity and need for changes in or additional therapy.|
|Administer alendronate (Fosamax) as indicated.||Acts as a specific inhibitor of osteoclast-mediated bone resorption, allowing bone formation to progress at a higher ratio, promoting healing of fractures and decreasing rate of bone turnover in presence of osteoporosis.|
|Initiate or maintain electrical stimulation if used.||May be indicated to promote bone growth in presence of delayed healing or nonunion.|
2. Acute Pain
- Acute Pain
May be related to
- Muscle spasms
- Movement of bone fragments, edema, and injury to the soft tissue
- Traction/immobility device
- Stress, anxiety
Possibly evidenced by
- Reports of pain
- Distraction; self-focusing/narrowed focus; facial mask of pain
- Guarding, protective behavior; alteration in muscle tone; autonomic responses
- Verbalize relief of pain.
- Display relaxed manner; able to participate in activities, sleep/rest appropriately.
- Demonstrate use of relaxation skills and diversional activities as indicated for individual situation.
|Maintain immobilization of affected part by means of bed rest, cast, splint, traction.||Relieves pain and prevents bone displacement and extension of tissue injury.|
|Elevate and support injured extremity.||Promotes venous return, decreases edema, and may reduce pain.|
|Avoid use of plastic sheets and pillows under limbs in cast.||Can increase discomfort by enhancing heat production in the drying cast.|
|Elevate bed covers; keep linens off toes.||Maintains body warmth without discomfort due to pressure of bedclothes on affected parts.|
|Evaluate and document reports of pain or discomfort, noting location and characteristics, including intensity (0–10 scale), relieving and aggravating factors. Note nonverbal pain cues (changes in vital signs, emotions and behavior). Listen to reports of family members or SO regarding patient’s pain.||Influences effectiveness of interventions. Many factors, including level of anxiety, may affect perception of pain. Note: Absence of pain expression does not necessarily mean lack of pain.|
|Encourage patient to discuss problems related to injury.||Helps alleviate anxiety. Patient may feel need to relive the accident experience.|
|Explain procedures before beginning them.||Allows patient to prepare mentally for activity and to participate in controlling level of discomfort.|
|Medicate before care activities. Let patient know it is important to request medication before pain becomes severe.||Promotes muscle relaxation and enhances participation.|
|Perform and supervise active and passive ROM exercises.||Maintains strength and mobility of unaffected muscles and facilitates resolution of inflammation in injured tissues.|
|Provide alternative comfort measures (massage, backrub, position changes).||Improves general circulation; reduces areas of local pressure and muscle fatigue.|
|Provide emotional support and encourage use of stress management techniques (progressive relaxation, deep-breathing exercises, visualization or guided imagery); provide Therapeutic Touch.||Refocuses attention, promotes sense of control, and may enhance coping abilities in the management of the stress of traumatic injury and pain, which is likely to persist for an extended period.|
|Identify diversional activities appropriate for patient age, physical abilities, and personal preferences.||Prevents boredom, reduces muscle tension, and can increase muscle strength; may enhance coping abilities.|
|Investigate any reports of unusual or sudden pain or deep, progressive, and poorly localized pain unrelieved by analgesics.||May signal developing complications (infection, tissue ischemia, compartmental syndrome).|
|Apply cold or ice pack first 24–72 hr and as necessary.||Reduces edema and hematoma formation, decreases pain sensation. Note: Length of application depends on degree of patient comfort and as long as the skin is carefully protected.|
|Administer medications as indicated:|
|Narcotic and nonnarcotic analgesics: morphine, meperidine (Demerol), hydrocodone (Vicodin); injectable and oral nonsteroidal anti-inflammatory drugs (NSAIDs): ketorolac (Toradol), ibuprofen (Motrin); muscle relaxants: cyclobenzaprine (Flexeril), carisoprodol (Soma), diazepam (Valium). Administer analgesics around the clock for 3–5 days.||Given to reduce pain or muscle spasms. Studies of ketorolac (Toradol) have proved it to be effective in alleviating bone pain, with longer action and fewer side effects than narcotic agents.|
|Maintain and monitor IV patient-controlled analgesia (PCA) using peripheral, epidural, or intrathecal routes of administration. Maintain safe and effective infusions and equipment.||Routinely administered or PCA maintains adequate blood level of analgesia, preventing fluctuations in pain relief with associated muscle tension and spasms.|