Which is a most common complication of fracture in first 24 hours?

NORCET 3 - 2022 (Shift-2)

Medical Surgical Nursing

Medium

Appeared in: NORCET 3 - 2022 (Shift-2)

Explanation

Hypovolemia, or low blood volume, is the correct answer because fractures, especially of large bones, cause significant bleeding into surrounding tissues.
The bone itself and adjacent blood vessels are torn at the time of injury, leading to immediate and ongoing hemorrhage.
This blood loss is the most acute and life-threatening complication in the initial 0-24 hour period, potentially leading to hypovolemic shock.
A femur fracture can result in 1-1.5 liters of blood loss, and a pelvic fracture can cause even more significant hemorrhage.

Option A: Infection is a significant risk, especially with open fractures, but it is not an immediate complication. It takes time for bacteria to colonize and cause clinical signs, which typically appear after 48 hours.
Option B: Fat embolism syndrome (FES) is a classic complication of long bone fractures, but its clinical manifestation is delayed. The syndrome typically appears 24 to 72 hours after the initial injury.
Option C: Bone necrosis (avascular necrosis) is a long-term complication. It results from the disruption of blood supply to the bone, leading to bone death over weeks, months, or even years.

Visual 1: Infographic: A timeline chart showing the typical onset periods for immediate (Hemorrhage/Hypovolemia), early (Fat Embolism, DVT), and late (Infection, Avascular Necrosis, Non-union) complications of fractures.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Timeline and prioritization of complications following a bone fracture as background academic context rather than a clinical decision trigger.
A nurse's primary responsibility in the immediate post-fracture period is to monitor for and prevent hypovolemic shock. This involves frequent assessment of vital signs, mental status, and peripheral perfusion.
Prompt initiation of large-bore IV access is critical for rapid fluid or blood product administration if signs of shock appear.
What if the fracture was in a small bone like a phalanx (finger bone)? The risk of significant hypovolemia would be negligible. In that case, the primary immediate concern would be pain management and neurovascular assessment of the digit.

How to Approach the Question

First, identify the key parameters of the question: 'most common complication' and 'first 24 hours'.
Consider the pathophysiology of a fracture. A broken bone immediately results in torn tissue and blood vessels.
Evaluate each option based on its typical time of onset.
Hemorrhage is an immediate result of the trauma. Therefore, hypovolemia is the most immediate risk.
Systemic responses like Fat Embolism Syndrome, or biological processes like infection and bone death (necrosis), require more time to develop.
Prioritize the complications: immediate life threats (bleeding) come before delayed systemic responses.

Concept Tested & Keywords

Concept Tested: Timeline and prioritization of complications following a bone fracture.
Stem keywords: fracture, complication, first 24 hours
Lead-in keywords: most common

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