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Fractures: Assessment and Stabilization (102.090)

Fractures: Assessment and Stabilization (102.090) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Orthopedics and Movement

102.090

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: FRACTURES: ASSESSMENT AND STABILIZATION

Effective Date: April, 2004 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed April 2005 November 2007 June 2009 October 2011


PURPOSE: To provide guidelines for assisting with the assessment and stabilization of fractures at UWMF
clinics.

DEFINITION: A fracture is a break in the bone or cartilage. It usually is a result of trauma.

BACKGROUND: A fracture can be a result of disease of the bone that leads to weakening, such as
osteoporosis, or osteogenesis, an abnormal formation of the bone from congenital diseases at birth.

Fractures are classified according to their character and location, for example: "spiral fracture of the femur,"
"greenstick fracture of the radius," "impacted fracture of the humerus," "linear fracture of the ulna," "oblique
fracture of the metatarsal," "compression fracture of the vertebrae," and "depressed fracture of the skull."

A "comminuted fracture" is a fracture in which bone is broken into a number of pieces.















The treatment of a fracture depends on the type of fracture, its severity and location, as well as the underlying
condition of the patient. Fractures are treated (per provider’s order) with resting, non-weight bearing, splints,
casting, and surgical procedures.

POLICY: The clinical staff will utilize the following guidelines to assist with the assessment and stabilization a
fracture of a UWMF patient.

SUPPLIES: Splint or cloth, provider’s order, patient’s record, PPE (gloves, gown, goggles, mask) if site is
bleeding





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PROCEDURE:

NOTE The steps in the procedure will depend on the condition, severity and location of the fracture.

1. Identify the patient. Include date of birth and verify allergies.

2. Put on appropriate PPE (personal protective equipment).

3. Obtain the following:
Vital signs including BP, HR, RR, temp, and pulse oximetry (if available)
Brief history (onset, timing, events and symptoms of trauma)

4. If bleeding
 Press directly on the wound with a sterile bandage.
 Apply pressure until the bleeding stops.

4. Assist with immobilizing the affected area.
 Assist in keeping joint(s) above and below fracture immobilized.
 Assist with prescribed splint to
stabilize fracture and prevent
movement. Proper splinting may
reduce pain.
 Remove all jewelry or other
restrictive items near and below
the effected area.

5. Check pulse distal to fracture.
For example: check pedal pulses for
fractures of the femur, tibia or fibula.

5. Assist with neuro assessment (See
Neuro Assessment Policy)
For example: for fractures of the
femur, tibia or fibula have the patient pretend to step on the gas with each foot noting if both feet are
equal. Also have the patient wiggle their effected toes, and note if the task can be completed.

6. Assist with placing splint on the fracture.
Splint should be longer than the affected bone, extending above and below injury.
Pad the splint with gauze wherever possible. Pads make the splint more comfortable and help keep
the bones straight.
Assist with fastening splint to the limb with gauze, strips of cloth or string. Start wrapping from the
extremity and work toward the body.

10. Assist in splinting limb firmly to prevent motion but not stop blood flow.
To splint the lower portion of an arm (forearm):
Wrap sling over shoulder and band around the sling to help keep elbow still.
To splint the lower portion of a leg (shinbone):
Place the entire leg between two splints.
If the thighbone is broken, immobilize the hip joint by gently moving the person onto a rigid surface
such as a CPR/back board.


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11. After the splint is in place, re-check) pulse distally to fracture and neuro status (per provider).

12. Documentation (Vitals sign section and Progress Notes in HealthLink)
Patient education
Patient assessment
Care given (splint/equipment used, application of splint, application of sling (.npsling)
Patient's response to the procedure
Discharge instructions/teachingt

WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support

REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator

REVIEWED BY: Lynn Posick, NP, Ortho/Rehab - Foot/Ankle

REFERENCES:

Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.

Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St. Louis, MO: Mosby
Elsevier.


AUTHORIZATION:



Medical Director Date