Fracture Nursing Care Plan
Bone injury care from immobilization through healing, watching for compartment syndrome and fat embolism.
Quick answer
A Fracture nursing care plan centers on detect neurovascular compromise and compartment syndrome early; control pain adequately to allow mobility and breathing; maintain immobilization, alignment and traction integrity. Priority nursing diagnoses are Acute pain, Impaired physical mobility, Risk for peripheral neurovascular dysfunction. The plan below gives assessment cues, measurable goals, 6 intervention sets with rationales, and patient teaching.
Overview
A fracture is a break in the continuity of bone, most often from trauma but also from repetitive stress or from pathologic weakening by osteoporosis, malignancy or long-term steroid use. Fractures are described by whether the skin is intact — closed versus open, which carries a far higher infection risk — and by pattern: transverse, oblique, spiral, comminuted with multiple fragments, greenstick in children, impacted, or displaced versus non-displaced.
Healing follows a predictable sequence: hematoma formation within hours, then granulation and fibrocartilage, then a soft callus that becomes bony callus over weeks, then ossification and finally remodeling over months. Immobilization, apposition of fragments, adequate blood supply, protein, calcium and vitamin D all speed the process. Smoking, diabetes, poor nutrition, infection, advanced age and movement at the fracture site all slow or prevent union.
The high-stakes nursing work is complication surveillance. Neurovascular compromise and compartment syndrome can destroy a limb within hours; the cardinal sign is pain out of proportion to injury that is unrelieved by opioids and worsens with passive stretch. Fat embolism syndrome, most common after long bone and pelvic fractures, typically appears within 24 to 72 hours with dyspnea, confusion and petechiae over the chest and axillae. Venous thromboembolism, infection including osteomyelitis, and the complications of immobility follow if prevention lapses.
Key numbers to know
Neurovascular check
The six P's — pain, pallor, pulselessness, paresthesia, paralysis and poikilothermia. Compare with the opposite limb and document every assessment.
Compartment syndrome
Unrelenting pain out of proportion, worsened by passive stretch, with tightness and paresthesia. Do not elevate the limb above heart level and do not apply ice; loosen or split the cast and notify the surgeon immediately — fasciotomy may be required.
Fat embolism
Dyspnea, tachypnea, hypoxemia, confusion and petechiae on the chest, axillae and conjunctivae, typically 24 to 72 hours after long bone fracture. Give oxygen and escalate immediately.
Traction rule
Weights hang freely and are never lifted or removed without an order; ropes stay in the pulley grooves and body alignment is maintained.
Cast care
Handle a wet plaster cast with palms, keep it uncovered to air dry, never insert objects to scratch, and keep it dry.
Nursing priorities
- Detect neurovascular compromise and compartment syndrome early.
- Control pain adequately to allow mobility and breathing.
- Maintain immobilization, alignment and traction integrity.
- Prevent infection, especially with open fractures and external fixation.
- Prevent venous thromboembolism, pneumonia and skin breakdown from immobility.
- Restore mobility and function safely with therapy.
Nursing assessment
Subjective data
- Pain at the fracture site, its quality and what makes it worse
- Pain that keeps increasing despite analgesia — a red flag, not a tolerance issue
- Numbness, tingling, burning or a sensation of tightness distal to the injury
- Inability to move or bear weight on the affected part
- Anxiety about surgery, disability, work and dependence
Objective data
- Deformity, shortening, angulation, swelling and ecchymosis at the site
- Crepitus, guarding, muscle spasm and loss of function
- Open wound with exposed bone, bleeding or contamination
- Distal pulses, capillary refill, color, temperature, sensation and motor function compared bilaterally
- Increasing limb circumference, tense compartments, or pain on passive stretch
- Cast condition: tightness, drainage staining, hot spots, odor or rough edges
- Pin sites for redness, drainage, tenting or loosening
- Respiratory rate, oxygen saturation, mental status and petechiae for fat embolism
- Calf swelling, unilateral edema or new dyspnea suggesting thromboembolism
- Imaging confirmation of fracture type, alignment and healing progress
Related factors
- Interruption of bone continuity with surrounding soft tissue injury
- Muscle spasm, edema and hematoma at the fracture site
- Rising pressure within a closed fascial compartment
- Immobilization by cast, splint, traction or external fixation
- Disruption of skin integrity in open fractures and surgical incisions
- Reduced mobility, weight-bearing restrictions and pain
- Osteoporosis, malnutrition, smoking and chronic disease impairing healing
Key nursing diagnoses
Goals and expected outcomes
- Neurovascular status distal to the injury remains intact at every assessment.
- The patient reports pain at or below the agreed acceptable level and can participate in therapy.
- No compartment syndrome, fat embolism, thromboembolism or infection develops.
- Skin, cast and pin sites remain clean, dry and intact.
- The patient demonstrates correct crutch, walker or cane use and adheres to weight-bearing limits.
- Radiographic healing progresses and the patient regains the expected range of motion and strength.
Nursing interventions and rationales
Perform neurovascular assessment relentlessly
- Check the six P's distal to the injury at least every hour for the first 24 hours or per protocol, and always compare with the unaffected limb.
- Take escalating pain seriously; pain unrelieved by opioids and worsened by passive stretch is compartment syndrome until proven otherwise.
- If compartment syndrome is suspected, keep the limb at heart level rather than elevated, remove ice, bivalve or loosen constrictive dressings and casts as permitted, and notify the surgeon immediately.
- Document each assessment with specific findings rather than a global 'neurovascular intact.'
Control pain and muscle spasm
- Give multimodal analgesia on a schedule during the acute phase, adding muscle relaxants as ordered for spasm.
- Elevate the injured extremity above heart level and apply ice for the first 24 to 48 hours to limit swelling — but not if compartment syndrome is suspected.
- Support the limb above and below the fracture during all movement and repositioning.
- Premedicate before therapy, dressing changes and transfers, and reassess effectiveness after each dose.
- Add non-drug measures: repositioning, distraction, relaxation and appropriate immobilization.
Maintain immobilization devices
- Support a fresh plaster cast on pillows using the palms, leave it uncovered to dry, and never rest it on a hard edge that could dent it.
- Assess for hot spots, drainage, odor and cast tightness; mark and date any drainage to track progression.
- Teach the patient never to insert coat hangers, pencils or other objects under the cast, and to use cool air for itching.
- For traction, keep weights hanging free and off the floor, ropes in the pulleys, and the patient in correct alignment with counter-traction maintained; never remove weights without an order.
- Provide pin site care per protocol and assess for signs of infection, loosening or tenting of skin.
Prevent complications of immobility
- Encourage deep breathing and incentive spirometry every hour while awake to prevent atelectasis and pneumonia.
- Apply sequential compression devices and give prescribed anticoagulants, and assess daily for calf pain, unilateral swelling or new dyspnea.
- Reposition every two hours, inspect skin under and around devices, and pad bony prominences and cast edges.
- Promote ankle pumps, quadriceps and gluteal setting, and range of motion of all unaffected joints.
- Maintain a bowel regimen with fluids, fiber and stool softeners, since opioids and immobility together cause constipation quickly.
- Monitor for fat embolism in the first 72 hours after long bone or pelvic fracture and report dyspnea, confusion or petechiae immediately.
Prevent infection and support healing
- Treat open fractures as surgical emergencies: cover with a sterile dressing, control bleeding, verify tetanus status and give antibiotics as ordered.
- Use aseptic technique for wound and pin care and monitor temperature, white count and wound appearance.
- Report persistent localized pain, fever, drainage or a wound that will not close as possible osteomyelitis.
- Encourage a diet high in protein, calcium, vitamin D and vitamin C, with adequate calories and fluids.
- Counsel smoking cessation directly; nicotine constricts vessels and significantly delays or prevents union.
Restore mobility and prepare for discharge
- Coordinate with physical and occupational therapy for early, safe mobilization within the prescribed weight-bearing limits.
- Teach and verify correct use of crutches, walker or cane, including stairs and transfers, before discharge.
- Explain the healing timeline realistically and the reason for continued restrictions after the cast comes off.
- Arrange home equipment, safety modifications and help with activities of daily living.
- Address osteoporosis evaluation and fall prevention in older adults, since a fragility fracture predicts the next one.
Patient and family teaching
- Call immediately for pain that keeps getting worse, numbness, tingling, coldness, or inability to move your fingers or toes.
- Keep the injured limb elevated and use ice as instructed for the first day or two.
- Never stick anything inside your cast, and keep it clean and completely dry.
- Report a cast that feels too tight, has a bad smell, drains, or develops a warm spot.
- Wiggle your fingers or toes and do the exercises you were taught to keep circulation moving.
- Follow your weight-bearing instructions exactly, even if the limb feels fine.
- Eat protein, calcium and vitamin D rich foods and stop smoking — bone will not heal well otherwise.
- Go to the emergency department for sudden shortness of breath, chest pain, confusion or a pinpoint rash on your chest.
How to build this plan
- 1Assess the patient. Collect subjective and objective data through interview, physical assessment, labs and chart review. Complete, accurate data is the foundation of every later step.
- 2Analyze and cluster the data. Group related cues, compare them with normal findings, and identify patterns that point to actual or potential problems.
- 3Formulate nursing diagnoses. Write the problem statement using a recognized diagnostic label plus related factors and evidence (problem related to cause as evidenced by signs).
- 4Set priorities. Rank diagnoses as high, medium or low using ABCs, Maslow's hierarchy and the patient's own stated priorities. Life-threatening problems come first.
- 5Establish goals and outcomes. Write SMART, patient-centered outcomes: specific, measurable, attainable, realistic and time-bound (short-term and long-term).
- 6Select nursing interventions. Choose independent, dependent and collaborative actions that are safe, evidence-based and matched to the outcome.
- 7Provide rationales. State the scientific reason each intervention works. Rationales are what turn a task list into clinical reasoning.
- 8Evaluate the plan. Compare the patient's actual response with the expected outcome: met, partially met or not met — then continue, revise or discontinue.
- 9Document and communicate. Record the plan and the patient's response in the health record so the whole team works from the same information.
Summarized for study use. Always follow your school's or facility's approved care plan format and current clinical policy.
Practice Fracture questions
These concepts are tested on the ATI proctored exams below — every set has answers and rationales.
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Common questions
What are the nursing diagnoses for Fracture?
Priority nursing diagnoses for Fracture: Acute pain; Impaired physical mobility; Risk for peripheral neurovascular dysfunction.
What are the nursing interventions for Fracture?
Check the six P's distal to the injury at least every hour for the first 24 hours or per protocol, and always compare with the unaffected limb. Take escalating pain seriously; pain unrelieved by opioids and worsened by passive stretch is compartment syndrome until proven otherwise. If compartment syndrome is suspected, keep the limb at heart level rather than elevated, remove ice, bivalve or loosen constrictive dressings and casts as permitted, and notify the surgeon immediately. Document each assessment with specific findings rather than a global 'neurovascular intact.' Give multimodal analgesia on a schedule during the acute phase, adding muscle relaxants as ordered for spasm. Elevate the injured extremity above heart level and apply ice for the first 24 to 48 hours to limit swelling — but not if compartment syndrome is suspected.
What are the nursing care goals for Fracture?
Neurovascular status distal to the injury remains intact at every assessment. The patient reports pain at or below the agreed acceptable level and can participate in therapy. No compartment syndrome, fat embolism, thromboembolism or infection develops. Skin, cast and pin sites remain clean, dry and intact. The patient demonstrates correct crutch, walker or cane use and adheres to weight-bearing limits. Radiographic healing progresses and the patient regains the expected range of motion and strength.
What should you assess in a patient with Fracture?
Pain at the fracture site, its quality and what makes it worse; Pain that keeps increasing despite analgesia — a red flag, not a tolerance issue; Numbness, tingling, burning or a sensation of tightness distal to the injury; Inability to move or bear weight on the affected part; Anxiety about surgery, disability, work and dependence; Deformity, shortening, angulation, swelling and ecchymosis at the site; Crepitus, guarding, muscle spasm and loss of function; Open wound with exposed bone, bleeding or contamination; Distal pulses, capillary refill, color, temperature, sensation and motor function compared bilaterally; Increasing limb circumference, tense compartments, or pain on passive stretch; Cast condition: tightness, drainage staining, hot spots, odor or rough edges; Pin sites for redness, drainage, tenting or loosening; Respiratory rate, oxygen saturation, mental status and petechiae for fat embolism; Calf swelling, unilateral edema or new dyspnea suggesting thromboembolism; Imaging confirmation of fracture type, alignment and healing progress
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