A fracture is a break or disruption in the continuity of a bone. In Nigerian clinical settings, nurses encounter fractures resulting from road traffic accidents, falls, and pathological conditions like osteoporosis or osteomyelitis. Bones possess a remarkable capacity for self-repair, but proper initial classification dictates the entire treatment trajectory.
When a bone breaks, the body reacts immediately with local tissue trauma, bleeding, and nerve irritation. Nurses must perform a rapid, systematic assessment to identify injury severity and prevent further neurovascular compromise.
Neurovascular compromise is a surgical emergency following a fracture. Swelling, tight casts, or displaced bone ends can compress arteries and nerves, cutting off blood supply and sensation to distal tissues. Nurses utilize the 5 Ps framework during every shift assessment:
Failure to recognize these signs early can lead to permanent muscle and nerve damage, or necessitate amputation.
Fracture management aims to achieve reduction (setting the bone), immobilization to maintain alignment, and restoration of function. Medical management relies on closed reduction and external immobilization, whereas severe or unstable fractures require surgical intervention.
| Treatment Type | Description | Common Indication |
|---|---|---|
| Closed Reduction | Manual manipulation of bone fragments back into alignment without surgery | Simple, stable fractures |
| traction | Application of a pulling force to align an extremity and reduce muscle spasms | Pre-operative stabilization of femoral fractures |
| Open Reduction Internal Fixation (ORIF) | Surgical incision to align bone using plates, screws, or rods | Complex, displaced, or intra-articular fractures |
| External Fixation | Insertion of metal pins through skin into bone attached to an external frame | Open fractures with severe soft tissue damage |
Casts and traction devices require meticulous nursing maintenance to prevent skin breakdown, infection, and mechanical failure. Plaster casts take up to 48 hours to dry completely; during this time, nurses handle them with open palms rather than fingertips to avoid indentations that can press against the skin and cause pressure ulcers.
For patients in skeletal traction, the nurse must ensure weights hang freely at all times and never rest on the floor or bed frame. Ropes must remain in the center of pulley grooves. Pin sites require sterile cleaning protocols to prevent osteomyelitis. Any foul odor, purulent drainage, or warmth around a pin site must be reported immediately to the medical team.
Promoting safe mobility while protecting the healing bone is a central nursing duty. Patients learning to use crutches, walkers, or canes require thorough instruction to prevent falls and secondary fractures. When fitting crutches, there should be a two-to-three finger-width space between the top of the crutch and the patient's axilla to prevent pressure on the brachial plexus nerves.
When teaching stairs with crutches, a helpful clinical reminder is that the good leg goes up first, followed by the crutches and the affected leg. Conversely, when going down stairs, the crutches and bad leg go down first, followed by the good leg. Weight-bearing status—ranging from non-weight-bearing to full weight-bearing—must be strictly followed according to surgeon prescriptions.
Bone healing is a high-energy metabolic process requiring specific dietary components. Nurses educate patients and their families about the importance of balanced nutrition to accelerate osteogenesis and tissue repair.
Fractures carry systemic risks that can become life-threatening if ignored. Nurses must monitor for major complications throughout the recovery period.