PATHOPHYSIOLOGY OF FRACTURE

Nonmodifiable Personal history of fracture as an adult History of fracture in first degree relative Female sex
Advanced age

TRAUMA

Bone Breakage Death of bone cells Bleeding typically occurs around the site and into the soft tissues surrounding the bone. The soft tissues are usually damaged by the injury. Intense Inflammatory Reaction

Osteoblastic activity is immediately stimulated, both intraosseous and periosteal from osteoproginenitor cell

Modifiable Current cigarette smoking Low body weight Estrogen Deficiency Early menopause (45 years old) or bilateral ovariectomy Prolonged premenstrual amenorrhea Low Calcium Intake Alcoholism Recurrent falls Inadequate physical activity Poor health/Frailty

Disruption in fracture hematoma due to displaced and comminuted bone

Immature new bone or callus is formed Fibrin clot is soon reabsorbed and the new bone cells are slowly remodeled to from true bone True bone replaces callus and is slowly calcified. (Several weeks to few months) Fixation or proper bone alignment is needed to facilitate bone healing

Vasodilation Increased blood flow to the area of injury Leukocytes and mast cells accumulate

Open Reduction Internal Fixation Intramedullary Nailing Interlocking Femur Left, Open Reduction Internal Fixation Wiring Patellar Left

Phagocytosis and removal of dead cell debris A fibrin clot (fracture hematoma) forms at the break and acts as a new network to which new cells can adhere.

Screws, Wires, Rods, Nails or other fixation apparatuses hold both ends of broken bone together Stress on the opposed of the broken bones, which accelerates osteoblastic activity at the break leading to hastened normal bone healing

Impaired skin and tissue integrity related to surgical repair: insertion of fixation apparatuses

Skin and tissue breakage

Maintenance of immobilization to facilitate bone healing

Impaired physical mobility related to musculoskeletal impairment

Risk for Infection related to tissue trauma

Additional inflammation aside from response surrounding the bone Increased nociception

Limited ROM and decreased muscle strength

Self care deficit related to immobility

Risk for Deficient Fluid Volume related to Blood vessel damage secondary to multiple fracture

Risk for Ineffective Tissue Perfusion related to Immobility

Increased Vital Signs, Moaning, Irritable, Guarding Behavior

Risk for Peripheral Neurovascular Dysfunction

Acute Pain related to physical trauma Asks questions about operation and post operative activities

Deficient Knowledge regarding fracture and surgical treatment and care related to lack of exposure

References: Hall, J.E., Guyton A. C. Guyton and Hall Textbook of Medical Physiology 12 th edition (2011) Elsevier (Singapore) Pte Ltd. Pp 960 Black J, Hawks J.H. Medical Surgical Nursing Clinical Management for Positive Outcomes 7th edition (2005) Elsevier (Singapore) Pte Ltd. Pp 619-648