A fracture is a complete or partial break in the continuity of bone tissue. When the physical force exerted on a bone is stronger than the bone itself, it cracks or breaks. In clinical practice, this disruption can range from a hairline crack caused by minor stress to a complete shattering of the bone resulting from high-velocity trauma.
Most fractures stem from acute traumatic events such as motor vehicle accidents, falls from a height, or sports injuries. However, pathological fractures occur in bones already weakened by underlying disease processes.
Key risk factors include:
Assessing a fractured extremity requires a systematic approach. Classic signs include immediate localized pain, swelling, bruising, and an obvious deformity of the limb. Patients frequently report an inability to bear weight or use the affected body part. Crepitus, a grating sound or feeling caused by broken bone ends rubbing together, may be present but should never be actively searched for during examination because it can cause further soft tissue damage.
Bone healing is a dynamic physiological regeneration process divided into distinct overlapping phases.
Plain radiography, commonly known as an X-ray, remains the primary diagnostic tool to confirm a fracture, identify its exact location, and classify its pattern. At least two views at right angles to each other are standard practice. Computed tomography (CT) scans may be ordered for complex fractures involving joints or spinal elements. Magnetic resonance imaging (MRI) is exceptionally useful for detecting occult or stress fractures that do not appear on standard X-rays.
Management aims to achieve reduction, immobilization, and rehabilitation. Reduction can be closed through manual manipulation or open via surgical incision. Immobilization is maintained using casts, traction, or internal fixation devices like plates, screws, and intramedullary nails. External fixation frames are frequently utilized for severe open fractures with extensive soft tissue damage.
Comprehensive nursing care centers on frequent neurovascular assessments of the affected limb. The nurse regularly checks capillary refill, skin temperature, peripheral pulses, motor movement, and sensory perception. Pain management and meticulous pin site care for patients with external fixators are vital routine duties. Elevation of the injured limb controls swelling, and early mobilization exercises prevent deep vein thrombosis and muscle atrophy.
Fracture complications can be acute or delayed. Acute complications include compartment syndrome, where excessive pressure within a fascial compartment compromises tissue perfusion, and fat embolism syndrome, often following long bone fractures. Delayed complications feature malunion, where bones heal in a faulty position, and nonunion, where the fracture fails to heal entirely after many months. Infection, particularly osteomyelitis, is a constant threat in open fractures.