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.

Stress on the opposed of the broken bones, which accelerates osteoblastic activity at the break leading to hastened normal bone healing

Screws, Wires, Rods, Nails or other fixation apparatuses hold both ends of broken bone together

PATHOPHYSIOLOGY OF FRACTURE

NonmodifiablePersonal history of fracture as an adultHistory of fracture in first degree relativeFemale sexAdvanced age

ModifiableCurrent cigarette smokingLow body weightEstrogen DeficiencyEarly menopause (45 years old) or bilateral ovariectomyProlonged premenstrual amenorrheaLow Calcium IntakeAlcoholismRecurrent fallsInadequate physical activityPoor health/Frailty

TRAUMA

Leukocytes and mast cells accumulate

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

cell

Increased blood flow to the area of injury

Intense Inflammatory Reaction

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

the injury.

Death of bone cells

Bone Breakage

VasodilationFibrin clot is soon reabsorbed and the new

bone cells are slowly remodeled to from true bone

Immature new bone or callus is formed

Fixation or proper bone alignment is needed to facilitate bone healing

Disruption in fracture hematoma due to displaced and comminuted bone

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

Open Reduction Internal Fixation Intramedullary Nailing Interlocking Femur

Left, Open Reduction Internal Fixation Wiring Patellar Left

Impaired skin and tissue integrity related to surgical repair:

insertion of fixation apparatuses

Acute Pain related to physical trauma

Risk for Deficient Fluid Volume related to Blood vessel damage secondary to multiple fractureIncreased Vital Signs, Moaning, Irritable, Guarding Behavior

References:

Hall, J.E., Guyton A. C. Guyton and Hall Textbook of Medical Physiology 12th 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

Additional inflammation aside from response surrounding the bone

Maintenance of immobilization to facilitate bone healing

Increased nociception

Skin and tissue breakage

Risk for Infection related to tissue trauma

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

exposure

Limited ROM and decreased muscle strength

Asks questions about operation and post operative

activities

Impaired physical mobility related to musculoskeletal impairment

Risk for Ineffective Tissue Perfusion related to Immobility

Risk for Peripheral Neurovascular Dysfunction

Self care deficit related to immobility