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Fractures | 마이메르시 MyMerci
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Fractures

NCLEX Review Guide: Fractures

Fracture Classifications and Assessment

Types of Fractures

  • Closed (simple) fractures have intact skin over the fracture site, while open (compound) fractures have broken skin with bone exposure to the environment.
  • Complete fractures involve the entire bone width, whereas incomplete fractures (like greenstick fractures in children) only partially break through the bone.
  • Comminuted fractures have multiple bone fragments, making them more complex to treat and heal.
  • Pathologic fractures occur through diseased bone (osteoporosis, cancer) with minimal trauma.

Fracture Types Comparison

TypeCharacteristicsHealing TimeComplications
Simple/ClosedSkin intact6-8 weeksLower infection risk
Compound/OpenSkin broken8-12+ weeksHigh infection risk
ComminutedMultiple fragments12+ weeksDelayed union

Key Points

  • Open fractures require immediate surgical intervention and antibiotic therapy
  • Always assess neurovascular status distal to fracture site
  • Document the 5 P's: Pain, Pallor, Paresthesia, Pulselessness, Paralysis

Emergency Management and Complications

Immediate Assessment and Interventions

Clinical Scenario

A 45-year-old construction worker presents with a deformed, painful right forearm after falling from scaffolding. The skin is intact, but his fingers are cool and pale with decreased sensation.

  1. Assess ABCs first - ensure airway, breathing, and circulation are stable
  2. Perform neurovascular assessment using the 5 P's method
  3. Immobilize the fracture site above and below the injury
  4. Apply ice to reduce swelling (20 minutes on, 20 minutes off)
  5. Elevate the extremity if possible to reduce edema
  6. Administer pain medication as ordered

Memory Aid: 5 P's Assessment

Pain - increasing, unrelieved by medication
Pallor - pale, cool skin
Paresthesia - numbness, tingling
Pulselessness - absent/weak pulses
Paralysis - inability to move

Life-Threatening Complications

  • Compartment syndrome occurs when pressure within muscle compartments compromises circulation, requiring emergency fasciotomy.
  • Fat embolism syndrome can develop 24-72 hours post-fracture, especially with long bone fractures, presenting with respiratory distress, confusion, and petechial rash.
  • Infection risk is highest with open fractures and requires immediate antibiotic prophylaxis and surgical debridement.

Key Points

  • Compartment syndrome is a surgical emergency - notify physician immediately for unrelieved pain
  • Fat embolism presents with classic triad: respiratory, neurologic, and skin changes
  • Open fractures require tetanus prophylaxis and broad-spectrum antibiotics

Treatment Modalities and Nursing Care

Fracture Management Options

  • Closed reduction involves manual manipulation of bone fragments back into alignment without surgery.
  • Open reduction with internal fixation (ORIF) requires surgical exposure of the fracture site with hardware placement for stabilization.
  • External fixation uses pins or wires through bone connected to an external frame, often used for complex or infected fractures.
  • Traction applies pulling force to maintain bone alignment and reduce muscle spasms.

Cast Care and Patient Education

  1. Assess cast for proper fit - should allow one finger width between cast and skin
  2. Monitor for signs of cast syndrome: increased pain, swelling, numbness
  3. Keep cast dry and clean - cover during bathing
  4. Elevate casted extremity above heart level when possible
  5. Teach patient to report foul odor, increased pain, or drainage

Memory Aid: Cast Care "RICE"

Rest the injured area
Ice for first 24-48 hours
Compression with proper cast fit
Elevation above heart level

Key Points

  • Never insert objects into cast to scratch - can cause skin breakdown
  • Wet casts lose structural integrity and must be replaced
  • Fiberglass casts dry quickly (30 minutes) vs plaster casts (24-48 hours)

Common Pitfalls and Study Tips

Frequently Confused Concepts

Compartment Syndrome vs. Deep Vein Thrombosis

AssessmentCompartment SyndromeDVT
PainSevere, unrelieved by medicationCramping, aching
PulsesMay be present initiallyUsually present
SkinTense, shinyWarm, red
TreatmentEmergency fasciotomyAnticoagulation

Study Tip: Fracture Healing Stages

Hematoma formation (immediate)
Inflammatory phase (1-3 days)
Callus formation (3 days-2 weeks)
Consolidation (weeks to months)
Remodeling (months to years)

Common Pitfalls

  • Don't assume intact pulses rule out compartment syndrome
  • Remember that pain with passive stretching is an early sign of compartment syndrome
  • Open fractures always require surgical intervention, not just antibiotics

Quick Check Questions

Can you list the 5 P's of neurovascular assessment?
Do you know the difference between open and closed reduction?
Can you identify signs of compartment syndrome?
Do you understand proper cast care instructions?

Key Points

  • Always prioritize neurovascular assessment over pain management
  • Compartment syndrome can occur even with intact pulses
  • Patient education prevents complications and promotes healing

Remember: You've got this! Fracture care is about systematic assessment, early recognition of complications, and patient advocacy. Trust your nursing judgment and prioritize patient safety. Every question you master brings you closer to becoming the nurse your patients need!

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