FRACTURE is a break in the continuity of the bone ETIOLOGY:

PATHOLOGIC FRACTURE due to local or general bone disease causing

the bone to unduly brittle which predisposes fracture even with minimal traumatic force. Example of bone disease that may cause pathologic fracture; includes new growth, cyst, osteomalacia, osteoporosis, osteomyelitis and pagets disease which results to loss of calcium in the bones.

TRAUMATIC FRACTURE
Violence- the bone is normal but due to maximal force applied, resulted to fracture Direct Violence- fracture occurs on the point of impact by an object or to the ground Indirect Violence these occurs when the force is transmitted to the bone through some parts of the body Muscular Action powerful sudden contraction of muscle that causes fracture of the bone Ex. Patellar Fracture Due to sudden quadriceps muscle contraction

SIGNS AND SYMPTOMS OF FRACTURE

Signs of Local Trauma or Inflammation Pain Swelling Redness Heat Loss of function Bruises or Ecchymosis Presence of deformities Crepitus sound

GENERAL CLASSIFICATION OF FRACTURE Complete fracture involving the entire cross section of the bones Incomplete fracture involving only a portion of a cross section of the bone Open-Compound-Fracture in which there is a communication between fracture site and external air Closed/Simple Bone fracture but there is no communication outside the external air or skin is intact

OTHER TYPES OF FRACTURE CLASSIFICATION ACCORDING TO COMPLETENESS

Incomplete Fracture cortex is broken in the convexity of the curve but the concave surface is intact Transverse fracture surface runs perpendicular to the long axis of the bone Oblique fracture surface runs in slanting line or forms an angle with the axis or shaft of the bone Spiral Fracture coils around the bone due to torsion or twisting motion Comminuted bone breaks into many fragments Impacted Fracture broken bone ends are forced into each other Ex. Greenstick Fracture usually occur in children where in bone is still soft and paliable Fissured consisting of a mere split of the bone without displacement of the fragments Perforating those made by bullets making a hole on the bone Compression usually happen in the vertebrae wherein bones were driven with one another

Fracture

IMMEDIATE COMPLICATION OF FRACTURE

Hemorrhage due to tearing of large vessels Shock is a result to hypovolemia or traumatic shock due to hemorrhage (either internal or external hemorrhage) Ischemia may follow injury of the main artery Nerve injury nerve tissues may be lacerated, destroyed press on by big hemorrhage or deprived blood supply Injury to muscles, tendons and ligaments Fat embolism especially for patients with multiple fractures particularly of the long bones Injury to the skin in compound fractures Adhesions (persistent edema) is brought about by the liberation

LATE COMPLICATIONS
Mal-Union failure to restore back on its original position Delayed Union time of union of bones are longer than usual Non Union failure of the bones to unite together Stiffness of joint or contractures due to synovial adhesions and shrinkage of the capsule

PRINCIPLE IN THE TREATMENT OF FRACTURE (4 RS)

Recognition check the possibility of fracture through physical examination and observation of signs and symptoms Reduction restoration of bone fragments into their proper alignment Closed reduction restoration of proper position of bone fragments by external or manual manipulation Open Reduction restoration of bone fragments by means of direct visualization and surgical operation and putting internal fixation device Retention immobilize the affected part by the use of immobilizing devices such as cast, tractions, braces and splint bandages Rehabilitation restoration to normal function

TRACTION
TRACTION refers to the set of mechanics for straightening broken bones or relieving pressure on the spine and skeletal system.

BASIC TYPES OF TRACTION

1. SKIN TRACTION is the application of a pulling force to the skin from where it is transmitted to the muscles and then to the bones by the use of: Adhesive type material Example: Bryant, Dunlop, Bucks extension Non-adhesive type materials like: canvas, slings, leathers, and straps with buckles and laces Examples: head halter traction, hammock suspension traction, pelvic traction, anklet traction 2. SKELETAL TRACTION- the pulling force is applied directly to the bone using pins and wires such as Kirshners wire, Stainmans pin, Vinkis skull retractor, and crutchfield tongs

PURPOSE OF TRACTION
To regain normal length and alignment of involved bone. To reduce and immobilize a fractured bone. To lessen or eliminate muscle spasms. To relive pressure on nerves, especially spinal. To prevent or reduce skeletal deformities or muscle contractures. In most cases traction is only one part of the treatment plan of a patient needing such therapy. The physicians order will contain: Type of traction Amount of weight to be applied Frequency of neurovascular checks if more frequent than every four (4) hours. Site care of inserted pins, wires, or tongs The site and care of straps, harnesses and halters The inclusion of any other physical restraints/straps or appliances (eg. mouth guard) The discontinuation of traction

PRINCIPLES OF TRACTION
Traction must: 1. Have an opposite pull or countertraction 2. Be free from any friction 3. Follow and establish line of pull that is the line of pull must be in line with the deformity 4. Be a continuous traction 5. Be applied to a patient in a supine position

OBSERVATIONS TO BE MADE IN CARING FOR PATIENT IN TRACTION 1. Patient is free from the following a. Impaired circulation of the extremities b. Hypostatic Pneumonia c. Condition of the skin with emphasis on the ischial, sacral popliteal, schillas tendon, dorsum of foot and heal d. Deformity like footdrop and contracture of joint, muscle atrophy e. Sign of infection f. Bedsore 2. Bone alignment and position of extremity in which the purpose of traction is being accomplished. 3. Patients comfort traction should never be a source of undue discomfort of the patient. Care of skin, mouth, hair, nails, and toes, genitalia must be include in the plan of daily care. 4. Provision of exercises a. ROM exercise of all unaffected joints b. Static quadriceps exercises c. Deep breathing and coughing exercises d. Flexion and extension of the toes, fingers in traction 5. Provision of supportive therapy 6. Check the nutritional status of the patient 7. Every complaint of the patient in traction should be investigated. 8. Check the traction set up for the following: a. Check the apparatus if it is accomplishing each purpose of traction and that the equipments are safe as possible. b. Sash, cords and pulleys should be unobstructed. c. Examine knots, clamps and weights to be certain they are tightened. d. Do not bumps the bed and traction causing the weight to swing. e. Always check the traction apparatus after a patient has moved to make certain that patient is correctly repositioned. 9. Province care to specific type of traction

Skin Traction
1. SIDE ARM TRACTION -supracondylar fracture humerus shoulder 4. HALO FEMORAL TRACTION -severe scoliosis

2. 90-90 LOWER EXTREMITY TRACTION -displaced femoral fracture

5. BRYANT TRACTION -fracture of femur, injuries to the hip among children before 3 y/o; skin traction

3. HALO PELVIC TRACTION -scoliosis

6. HAMMOCK SUSPENSION TRACTION -pelvis region

7. BUCKS EXTENSION TRACTION -affection of femur and hip

10. HEAD HALTER TRACTION - cervical spine affection

8. BOOT TRACTION - ankle metatarsal fracture

11. PELVIC TRACTION -lumbar spine such as HNP, low back syndrome

9. DUNLOP TRACTION -supracondylar fracture humerus

12. HEAD HALTER/PELVIC GIRDLE - non-adhesive lumbar affection - severe cervical sprain, cervical strain, torticollis, mild cervical trauma, potts dse.

Skeletal Traction

Orthopedic bed