NCP Fractures

A fracture is a discontinuity or break in a bone. There are more than 150 fracture classifications. Five major ones are as follow:

1. Incomplete: Fracture involves only a portion of the cross-section of the bone. One side breaks; the other usually just bends (greenstick).

2. Complete: Fracture line involves entire cross-section of the bone, and bone fragments are usually displaced.

3. Closed: The fracture does not extend through the skin.

4. Open: Bone fragments extend through the muscle and skin, which is potentially infected.

5. Pathological: Fracture occurs in diseased bone (such as cancer, osteoporosis), with no or only minimal trauma.

Stable fractures are usually treated with casting. Unstable fractures that are unlikely to reduce may require surgical fixation.


Most fractures are managed at the community level. Although a number of the interventions listed here are appropriate for this population, this plan of care addresses more complicated injuries encountered on an inpatient acute medicalsurgical unit.


Craniocerebral trauma (acute rehabilitative phase)

Pneumonia: microbial

Psychosocial aspects of care

Renal failure: acute

Spinal cord injury (acute rehabilitative phase)

Surgical intervention

Thrombophlebitis: deep vein thrombosis

Patient Assessment Database

Symptoms of fracture depend on the site, severity, type, and amount of damage to other structures.


May report: Weakness, fatigue

Gait and/or mobility problems

May exhibit: Restricted/loss of function of affected part (may be immediate, because of the fracture, or develop secondarily from tissue swelling, pain)

Weakness (e.g., affected extremity or generalized)


May exhibit: Hypertension (occasionally seen as a response to acute pain/anxiety) or hypotension (severe blood loss)

Tachycardia (stress response, hypovolemia)

Pulse diminished/absent distal to injury in extremity

Delayed capillary refill, pallor of affected part

Tissue swelling, bruising, or hematoma mass at site of injury


May exhibit: Hematuria, sediment in urine, changes in output, acute renal failure (ARF) (with major skeletal muscle damage)


May report: Loss of/impaired motion or sensation

Muscle spasms, worsening over time

Numbness/tingling (paresthesias)

May exhibit: Local musculoskeletal deformities, e.g., abnormal angulation, posture changes, shortening of limbs, rotation, crepitation (grating sound with movement or touch), muscle spasms, visible weakness/loss of function

Giving way/collapse or locking of joints; dislocations

Agitation (may be related to pain/anxiety or other trauma)

Range-of-motion (ROM) deficits


May report: Sudden severe pain at the time of injury (may be localized to the area of tissue/skeletal damage and then become more diffuse; can diminish on immobilization); absence of pain suggests nerve damage

Muscle aching pain, spasms/cramping (after immobilization)

May exhibit: Guarding/distraction behaviors, restlessness



May report: Circumstances of incident that do not support type of injury incurred (suggestive of abuse)

May exhibit: Skin lacerations, tissue avulsion, bleeding, color changes

Localized swelling (may increase gradually or suddenly)

Use of alcohol or other drugs

Presence of fall-risk factors, e.g., age, osteoporosis, dementia, arthritis, other chronic conditions; preexisting (unrecognized) fracture


May report: Use of multiple medications (prescribed and over-the-counter [OTC]) with interactive effects

Discharge plan

DRG projected mean length of inpatient stay: femur 9.0 days; hip/pelvis, 6.7 days; all other, 2.5–5.0 if hospitalization required

May require temporary assistance with transportation, self-care activities, and homemaker/maintenance tasks

May require additional therapy/rehabilitation post discharge, or possible placement in assisted-living/extended-care facility for a period of time

Refer to section at end of plan for postdischarge considerations.


X-ray examinations: Determines location and extent of fractures/trauma, may reveal preexisting and yet undiagnosed fracture(s).

Bone scans, tomograms, computed tomography (CT)/magnetic resonance imaging (MRI) scans: Visualizes fractures, bleeding, and soft-tissue damage; differentiates between stress/trauma fractures and bone neoplasms.

Arteriograms: May be done when occult vascular damage is suspected.

Complete blood count (CBC): Hematocrit (Hct) may be increased (hemoconcentration) or decreased (signifying hemorrhage at the fracture site or at distant organs in multiple trauma). Increased white blood cell (WBC) count is a normal stress response after trauma.

Urine creatinine (Cr) clearance: Muscle trauma increases load of Cr for renal clearance.

Coagulation profile: Alterations may occur because of blood loss, multiple transfusions, or liver injury.


1. Prevent further bone/tissue injury.

2. Alleviate pain.

3. Prevent complications.

4. Provide information about condition/prognosis and treatment needs.


1. Fracture stabilized.

2. Pain controlled.

3. Complications prevented/minimized.

4. Condition, prognosis, and therapeutic regimen understood.

5. Plan in place to meet needs after discharge.