nursing care of child with fracture

1. Care of the child with fractures, traction,
kyphosis, scoliosis & lordosis
Instructor
Asif Shah Khan
Mph, BscN

2. Fractures
Bone fractures occur when the resistance of
bone against the stress being exerted yields
to the stress force.
• Fortunately, fractures also heal faster in
children.
• Newborns: 2-3 weeks
• Early childhood: 4 weeks
• Later childhood: 6 – 8 weeks
• Adolescence: 8 – 12 weeks

3. Causes:
o Accidents
o Every day activities
o Physical abuse

4. Cont..
• A partial or complete break in a bone.
– Bone is the only tissue in the human body other
than liver that heals by regeneration instead of by
scarring.
– For regeneration to occur the bone must be
immobilized to allow uninterrupted formation of
new bone.

5. Types of fractures
•Transverse:
crosswise, at
right angles to
the long axis of
the bone

6. Types of fractures cont’d
Oblique: slanting
but straight,
between a
horizontal
and perpendicular
direction

7. Cont..
•Spiral: slanting
and circular,
twisting around
the bone shaft

8. Green stick fractures
It occurs when a bone
is angulated beyond
the limits of bending.
The compressed side
bends causing an
incomplete fracture

9. Types of fractures cont’d
• Closed or simple fracture: If the fracture does
not produce a break in the skin, it is simple, or
closed fracture
• Open or compound fracture: Are those with
an open wound through which the bone is
protruded.
• Complicated fracture: Bone fragments cause
damage to the other organs

10. Clinical manifestations of a fracture
• Generalized swelling
• Pain or tenderness
• Diminished functional use of affected part
 May be
• Bruising
• Severe muscular rigidity
• Crepitus

11. Diagnostic Evaluation
• History
• X-Rays
• Computed tomography (CT) and magnetic
resonance imaging (MRI)
• Physical examination

12. Therapeutic management
The goals of the therapeutic management are
the following
 To regain alignment
 To restore function to the injured parts
 To prevent further injury

13. Nursing consideration
• Assess the extent of injury
• Determine the mechanism of injury
• Move the injured part as little as possible
• Cover open wounds with a sterile or clean
dressing
• Immobilize the limb
• Assess neurovascular status
• Apply cold compressions to the injured
area

14. Long Bone Fractures
• Fractures of the femur, humerus, tibia/fibula
• Blunt and penetrating trauma
• Requires high energy to break bone, therefore
look for other injuries.
• Bone has a generous blood supply.
• Does patient have associated bleeding
disorder?

15. Long Bone Fracture

16. Management
• ABC’s
• Neurovascular exam (vascular +/- nerve injury)
• Splint involved extremity
– Reduction decreases pain, bleeding
• Orthopedic consultation for definitive
management
• Complications:
– Blood loss

17. Treatment
• fractures require immediate attention
• pain and loss of function for the person
• after emergency treatment
• immobilization with
• casts or traction, or fixation with surgery.

18. Cast care
• Before the cast is applied, the extremities
are checked for any abrasions, cuts in the
skin.
• Protect the cast with a large plastic bag
during bathing
• Skin care
• Circulation check

19. • Don’t put toys or bits of food down a cast.
• Clear paths for crutch-walking
• Quiet activities and rest.
• Home care

20. Fracture Complications
• Vascular Injuries
– Most commonly occur in open fracture and
dislocations, or widely displaced fracture and at
sites where the vessels lie in close proximity to the
bone or at sites where the vessels are held in a
relatively fixed position.
• Classic signs:
• The 5 P’s: Pain, Pallor, Pulselessness (or diminished
pulse), Paresthesia, decrease sensation) and Paralysis.

21. Fracture Complications
• Nerve Injuries
– Occur more frequently than vascular injuries
– Nerves are at increased risk of injury when they
are superficial to the skin, lie close to the bone, or
span a joint, making them susceptible to stretch
injury.

22. Pulmonary Embolism
• Pulmonary Embolism:
• Pulmonary embolism is the sudden blocking
of a lung artery by an embolus, nearly always
resulting from a blood clot that can travel to
the lungs, especially from the deep veins of
the leg

23. Traction
• Traction refers to the set of mechanisms for
straightening broken bones or relieving pressure on
the spine and skeletal system.
Purposes
• To regain normal length and alignment of involved
bone.
• To reduce and immobilize a fractured bone.
• To lessen or eliminate muscle spasms.
• To relieve pressure on nerves, especially spinal.
• To prevent or reduce skeletal deformities or muscle
contractures.

25. Types of traction
• Manual traction
• Skin traction
• Skeletal traction
• Cervical traction

26. Nursing considerations
• Check pin site frequently.
• Clean pin sites as ordered
• Apply topical antiseptic as ordered
• Check pin screw
• Cover ends of pin with padding
• Prevent skin breakdown
• Prevent complications.
• Check pulse in affected area, compare with counter
lateral site.

27. cont,…
• Assess circular dressing for excessive tightness
• Encourage deep breathing exercise.
• Note any neurovascular changes
• Active passive exercise of uninvolved joints
and muscle
• Applying foot board to prevent foot drop.

28. Kyphosis
• Kyphosis also called round back, is a common
condition of a curvature of the upper back.
Abnormally increased convex angukation in
the curvature of the thoracic spine.
Types of kyphosis
• Postural kyphosis (common)
• Scheuermann’s kyphosis
• Congenital kyphosis

30. Treatment option
• This include exercise (weight lifting, dancing &
swimming)
• Braces may be prescribed by a doctor.
• Surgical fusion.

32. Scoliosis
• Is an abnormal lateral curvature of the spine,
causing the spinal column to bend to the left
or right. It make the spine look more like an
“S” or “C” than a straight “I”. The one
shoulder, scapula or hip appears higher than
the other.
• Can run in the families
• Can occur at any age.

34. Types of scoliosis
• Congenital scoliosis (infantile), juvenile.
• Idiopathic scoliosis occurs without known
cause.
Diagnostic evaluation
• Physical examination
• X-rays.

35. Post operative care
• Close monitoring in ICU
• Skin caring
• Assessment of wound, circulation & vital sign.
• Neurological status of the extremities.
• N/G tube care and bowel assessment.
• I/O measurement
• Pain management
• Physiotherapy
• Ambulation
• Family involvement.

36. Lordosis
• Is a disorder defined by an excessive inward
curve of the spine (lumbar curvature). Severe
lordosis is accompanied by pain.
• It can be caused by trauma, contracture of the
hip, scolosis & obesity.

38. Treatment
• Analgesic & anti-inflammatory medication
• Physical therapy
• Bracing
• Reduction of body weight
• Correction of deformities.