Pathophysiology of Fracture

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

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

Bleeding typically occurs around the site and into the soft tissues surrounding the bone. The soft tissues are usually damaged by the injury.

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 Intense Inflammatory Reaction Fibrin clot is soon reabsorbed and the new bone cells are slowly remodeled to from true bone

Vasodilation Increased blood flow to the area of injury

True bone replaces callus and is slowly calcified. (Several weeks to few months)

Leukocytes and mast cells accumulate

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.

Fixation or proper bone alignment is needed to facilitate bone healing

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

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

Risk for Infection related to tissue trauma

Skin and tissue breakage

Additional inflammation aside from response surrounding the bone

Maintenance of immobilization to facilitate bone healing

Impaired physical mobility related to musculoskeletal impairment

Limited ROM and decreased muscle strength

Self care deficit related to immobility

Increased nociception 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