GOOD MORNING

FRACTURES

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A fracture is a break or disruption in the continuity of the bone.Fractures in children differ from those in adults

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ETIOLOGY Most fractures in children are as a result of low velocity trauma such as a fall Upto age 2,most fractures are sustained as a result of child abuse. Abuse should be suspected in this age group Fractures in newborns and often the result of child abuse

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PATHOPHYSIOLOGY A bone fractures when the force applied to it exceeds the amount the bone can absorb. Childrens long bone are almost resilent then those of adults.they are able to withstand greater deflection without fracturing Childrens long bone also have thick periosteum

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Unique to fractures in children is the involvement of growth plates.The plate is weaker than the surrounding ligaments and tendons and joint capsules and is disrupted before these tissues are injured. Epiphyseal or physeal injuries The weakest point of long bones is the cartilage growth or epiphyseal plate.

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Types of fracture Complete( Bone fragments are separated) Incomplete( fragments remain attached

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The fracture line can be any of the following Transverse- cross wise at right angle to the long axis of the bone Oblique- slanting but straight between a horizontal and a perpendicular direction Spiral- slanting or circular, twisting around the bone shaft

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Simple or closed fracture Open or compound fracture Complicated fracture Communited fracture

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TYPES OF FRACTURE IN CHILDREN Bend (bent 45 degrees n more.mostly ulna and fibula) Buckle or torus (compression of
porus bone raised or bulging projection)

Green stick fracture (occurs when a bon eis angulated beyond the limits of bending)

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BONE HEALING AND REMODELLING Neonatal period 2 to 3 weeks Early childhood- 4 weeks Later childhood- 6 to 8 weeks Adolescence- 8 to 12 weeks

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Clinical manifestations Generalized swelling,pain or tenderness,deformity,diminishe d functional use of affected part Diagnostic evaluationhistory and radiographic examination

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Therapeutic management Goal To regain allignment and length of the body fragments To retain allignment and length To restore function to the injured parts to prevent further injury

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Therapeutic management Realignment by traction Closed manipulation Casting Weight bearing on lower extremities

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Nursing considerations Initial assessment Reassuring the parent and the child Reduction of pain Care of child in a cast Care of child in a traction

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Nursing alerts
Pain Pallor Pulselessness Paresthesia paralysis

The child in a cast

Four major categories Upper extremeties
to immobilise wrist or elbow

Lower extremity
to immobilise ankle or knee

Spinal or cervical
immobilisation of the spine

Spica casts
to immobilise the hip and knee

Upper extremity cast

Lower extremity cast

Spinal or cervical cast

Spica casts

Sunthetic cats

Water resistant casts

The child in traction

Purposes To provide rest for an extremity To help prevent or improve contracture deformity To correct a deformity To treat a dislocation To provide poistioning and allignment To reduce muscle spasm

Types of traction
Upper extremity traction
Overhead suspension traction Dunlop traction

Lower extremity traction

Bryant traction Buck traction Russel traction Balance suspension traction

Cervical traction

Over head suspension

The arm bent at the elbow is suspended vertically by skin or skeletal attachment and traction is applied to the distal end of the humerus

DUNLOP TRACTION The arm is suspended horizontally using skin or skeletal attachment

BRYANT TRACTION
It is a type of running traction in which the pull is in only one direction.legs are flexed at 90 degree of the hips

Bryant traction

Bucks traction
Type of traction in which the legs are in extended position Used for short term immobilisation

Bucks traction

Rusell traction
Uses skin traction on the lower leg and a padded sling under the knee.two lines of pull one along the longitudinal line and the other perpensdicular to the leg

Balanced suspension traction

Balance suspension traction

A thomas splint from the groin to above the foot Pearson attachment to support the lower leg

Cervical traction

Thank you