# Fracture Nursing Care > Fracture nursing care: the five Ps neurovascular check, healing stages from haematoma to remodelling, fat embolism red flags and immobilisation priorities. - Canonical URL: https://prepelephant.com/topics/allied/nursing/fracture-nursing-care - Exam / course: Allied Health · Subject: Nursing - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Fracture Nursing Care", PrepElephant, https://prepelephant.com/topics/allied/nursing/fracture-nursing-care ## Direct answer The five Ps — pain, pallor, pulselessness, paraesthesia, paralysis — anchor fracture nursing: they detect the compromised limb early and the deteriorating one continuously. Fractures are closed (skin intact) or open or compound (skin breached, contamination and infection risk, tetanus and antibiotic cover mandatory), and heal through a fixed sequence: haematoma, soft (fibrocartilaginous) callus, bony callus, and remodelling over months to years. The danger window every exam loves is 24-72 hours after a long-bone fracture, when fat embolism syndrome strikes — hypoxia and respiratory distress, confusion and restlessness, and a petechial rash over the chest, axillae and conjunctivae. Nursing care circles immobilisation, neurovascular observation, analgesia, and the prevention of immobility's complications. ## What you must remember - **Classification that changes management:** closed versus open (compound); also comminuted, transverse, spiral, impacted, greenstick (children's bending fracture), stress and pathological (through diseased bone — osteoporosis, tumour). - **Healing stages in order:** haematoma and granulation (first days) → soft or fibrocartilaginous callus (about 1-2 weeks) → bony callus by ossification (from about 2-3 weeks to 2-3 months) → remodelling (months to years, Wolff's law). - **Five Ps checks:** pain, pallor, pulselessness, paraesthesia, paralysis distal to the injury — performed before and after splinting, casting, or traction, every shift thereafter. - **Fat embolism syndrome:** classically 24-72 hours after long-bone (especially femoral) fractures; triad of respiratory distress with hypoxaemia, cerebral signs (confusion, restlessness, drowsiness) and a petechial rash on chest, axillae and conjunctivae; often with thrombocytopenia — give oxygen, notify urgently, and anticipate intensive care. - **Haemorrhage awareness:** a femoral shaft fracture can lose 1000-1500 mL of blood, a pelvic fracture substantially more — shock in a trauma patient is haemorrhage until proven otherwise. - **Open fracture first nursing care:** cover the wound with a sterile saline-soaked dressing (do not probe or irrigate deeply), immobilise, tetanus prophylaxis and antibiotics as prescribed, and document the time and appearance. - **Other complications:** compartment syndrome, nerve injury (humeral shaft and radial nerve; foot drop from common peroneal pressure), avascular necrosis (scaphoid, femoral neck), infection, malunion, delayed union and non-union, DVT, and pressure ulcers from immobilisation. - **Rehabilitation begins day one:** isometric exercises of immobilised muscles, active movement of uninvolved joints, early ambulation when allowed, and honest analgesia so movement happens. ## Day two on a femoral shaft fracture: the confused young man A twenty-year-old with a femoral shaft fracture managed with traction was stable yesterday. On day two the night nurse finds him restless, oddly vague about where he is, and breathing fast; the rash is easy to miss — pinprick petechiae across the chest and in the axillary folds and conjunctivae, fading within hours. The pulse oximeter reads in the high eighties. This is fat embolism syndrome until excluded: the nurse escalates immediately — oxygen, physician notification, positioning, monitoring of saturation and urine output, and transfer to intensive care if worsening, because the syndrome can slide into ARDS within hours. The teaching point is why it is caught at all: not because of a scan, but because the night nurse knew the 24-72 hour window, examined the chest and axillae in a confused trauma patient, and treated confusion after long-bone fracture as a respiratory emergency in disguise. ## The Indian trauma context India's fracture burden is road traffic injury — two-wheeler riders, pedestrians and, in rural wards, children falling from trees presenting with classic greenstick fractures. First contact is often a PHC or a casual emergency room, so the nurse's basic moves carry disproportionate weight: splint before shifting (immobilisation reduces pain, bleeding and secondary injury), sterile cover for open wounds, and never sending an open fracture home without tetanus cover. Stacked government wards make the immobility-complication list the daily work — pressure care, chest exercises, DVT prevention, bowel and bladder routines. INC and nursing exam questions orbit the same fixed points year after year: the five Ps, the healing sequence with time frames, the fat embolism triad with its timing, and the blood-loss figure for femoral fractures. ## Frequently asked questions ### What are the five Ps of fracture neurovascular assessment? Pain, pallor, pulselessness, paraesthesia and paralysis distal to the injury site — checked before and after immobilisation and every shift while the limb is at risk. ### When does fat embolism occur and what is its triad? Classically 24-72 hours after long-bone fractures, presenting with hypoxaemic respiratory distress, cerebral dysfunction such as confusion or restlessness, and petechiae over chest, axillae and conjunctivae. ### Why do children get greenstick fractures? A child's softer, more porous bone bends and cracks on one cortex like a green twig instead of breaking cleanly across, so the periosteum and one cortex remain intact. ### How much blood can a femoral shaft fracture lose? About 1000-1500 mL into the thigh compartment, so the nurse assesses for hypovolaemic shock from the time of admission, not only after surgery. ### What is the immediate nursing care of an open fracture? Cover the wound with a sterile saline-soaked dressing without probing it, immobilise the limb, ensure tetanus prophylaxis and antibiotics are given, and document the wound's appearance and time.