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April 2010, Volume 40 Number 4 , p 24 - 30


  • Michelle D. Smeltzer MSN, RN, CEN


ACCORDING TO THE NATIONAL CENTER for Health Statistics, in 1 year, 1.3 million U.S. patients had fractures requiring hospitalizations and nearly 7,000 of these patients died.1 In the United States, 492,000 tibia, fibula, and ankle fractures occur each year, with tibia fractures being the most common long bone fracture.2This article describes fractures, explains the difference between open and closed fractures, and tells how to care for a patient who's had an open fracture.A fracture, or a break in the continuity of a bone, occurs when a strain or force is applied to it. Fractures can occur anywhere in the bone and are classified by the extent of the break. In a complete fracture, the width of the bone breaks, resulting in two distinct sections of bone. An incomplete fracture doesn't divide the bone into two parts.3Fractures are also described by the amount of associated soft-tissue damage accompanying the injury. Closed fractures (simple) may be associated with an area of ecchymosis and edema in tissue around the fracture, but the skin is intact. Open fractures (compound) are accompanied by a disruption in the skin or mucous membrane in the area over the fracture, resulting in an open wound that lets the fractured bone communicate with the environment.4Most fractures are caused by trauma, such as falls; osteoporosis, which leaves bones thinned and weakened; or repetitive stress, which is associated with athletics.5 Low-velocity injuries include falls from a standing height, athletic injuries, stab wounds, and shotgun injuries. High-velocity injuries are associated with motor vehicle crashes, pedestrian versus automobile injuries, falls from a height, and handgun injuries.3 The higher and faster an object or body moves, the greater the velocity and the more severe the resulting injury.Open fractures usually result from high-energy trauma.6 This article focuses on open fractures because they're always considered contaminated, require complex care in the hospital,

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