Overview
Clinical Orientation
A fracture is more than a break seen on an X ray.
A fracture is more than a break seen on an X-ray. Its location, direction, displacement, soft-tissue injury, contamination, and effect on nearby vessels and nerves determine what can deteriorate next. A closed, stable fracture may need protection and analgesia; an open fracture may threaten the patient through infection and blood loss; a tibial fracture in a tight cast may threaten limb perfusion through compartment syndrome. Several classification systems answer different clinical questions. AO/OTA supplies a standardized description of the bony injury. Gustilo-Anderson grades the severity of an open wound. Salter-Harris describes fractures involving a child’s growth plate. The nurse does not use a label as a substitute for assessment: the label predicts risk, while serial pain, swelling, circulation, sensation, movement, vital signs, and respiratory status show whether that risk is becoming real.