Fractures: Nursing process (ADPIE)

Malaya Tanglao is a 15-year-old female who presented to the ED with her father, Ulan, after being unable to bear weight on her left lower extremity following a skiing accident.

X-ray confirms that she sustained a closed transverse midshaft fracture to her left tibia that is displaced with resulting soft tissue injury. Malaya is now being admitted to the pediatric orthopedic unit for pain management and preparation for surgical intervention.

A fracture is defined as a complete or partial break in a bone, which occurs when the physical force applied to the bone is stronger than the bone itself. Most often, this occurs due to trauma associated with a fall, sports injury, or motor vehicle crash.

Fractures may also result from overuse during repetitive activities, such as running or jumping. Finally, some conditions, such as osteoporosis or cancer, can weaken the bones and cause spontaneous fractures. There are some factors that can put an individual at risk for fractures.

Modifiable risk factors that may weaken the bones include low vitamin D, smoking, alcohol, and glucocorticoid use; while nonmodifiable risk factors include increasing age, as well as congenital disorders like osteogenesis imperfecta, and malabsorption problems that may impair the ability to absorb important nutrients for bone health, like calcium and vitamin D.

Now, most commonly, we talk about closed or simple fractures, which occur when the bone breaks, but the overlying skin remains intact. On the other hand, open or compound fractures occur when the fractured ends pierce through the overlying skin.

There are many different types of fractures, such as greenstick fractures, which occur when one side of the bone breaks, while the other side of the bone bends. Impacted fractures occur when a piece of one bone gets wedged into another bone.

Comminuted fractures are where the bone breaks into multiple fragments. Finally, in spiral fractures, the fracture line follows the projection of a strong, twisting force that is applied to the bone.