`

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

M.MUTHU LAKSHMI

I YEAR M. Sc NURSING

MEDICAL SURGICAL NURSING

YEAR 2010 -2011

IKON NURSING COLLEGE, BIDADI

BANGALORE - MYSORE ROAD

RAMANAGARAM TALUKA

BANGALORE – 562109

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1NAME OF THE CANDIDATE AND ADDRESS

M.MUTHU LAKSHMII YEAR M. Sc NURSING IKON NURSING COLLEGENO.32. BEEMANHALLIBIDADI – 562109BANGALORE- MYSORE ROADRAMANAGARAM TALUKA

2 NAME OF THE INSTITUTION IKON NURSING COLLEGE,Bangalore

3 COURSE OF THE STUDY AND SUBJECT

I Year M.Sc NursingMedical Surgical Nursing

4 DATE OF ADMISSION 10:05:2010.

5 TITLE OF THE TOPIC “A study to Assess the Effectiveness of Structured Teaching Programme on Knowledge and skill regarding the life style practices of individual with lower limb fracture in selected hospital”, Bangalore.

1

6 BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION:

The lower leg is the bottom segment of the leg: the part below the knee. The lower leg

contains two long bones. The larger of these two bones is the tibia, the smaller one the fibula.

The tibia is familiarly known as the shinbone. "Tibia" is a Latin word meaning both shinbone

and flute. It is thought that "tibia" refers to both musical instrument because flutes were once

fashioned from the tibia. The fibula runs alongside the tibia. The word "fibula" is a Latin word

that designates a clasp or brooch. The fibula was likened by the ancients to a clasp attaching it

to the tibia to form a brooch.

Lower leg fractures include fractures of the tibia and fibula. Of these two bones,

the tibia is the only weight bearing bone. Fractures of the tibia generally are associated with

fibula fracture, because the force is transmitted along the inter osseous membrane to the

fibula.1

The skin and subcutaneous tissue are very thin over the anterior and medial tibia and

as a result of this,a significant number of fractures to the lower leg are open. Even in closed

fractures, the thin, soft tissue can become compromised. In contrast, the fibula is well covered

by soft tissue over most of its course with the exception of the lateral malleolus.

Drugs used to treat fractures include non steroidal anti-inflammatory agents and

analgesics. In addition, administer proper antibiotics and tetanus prophylaxis for open

fractures.

Mechanisms of injury for tibia-fibula fractures can be divided into 2 categories:

Low-energy injuries such as ground levels falls and athletic injuries

High-energy injuries such as motor vehicle injuries, pedestrians struck by motor

vehicles, and gunshot wounds.

2

Patient may report a history of direct (motor vehicle crash or axial loading) or indirect

(twisting) trauma. Patient may complain of pain, swelling, and inability to ambulate with tibia

fracture. Ambulation is possible with isolated fibula fracture.

When examining a patient for a lower leg fracture one should first examine the patient

for edema, ecchymosis, and point tenderness. Gross deformities should be noted and splinted.

A careful neurovascular assessment should be performed, and an emergent fracture reduction

should be performed if neurovascular deficits are present. A careful examination should be

performed for open wounds. Open fractures require antibiotics and an emergent orthopedic

consultation.The techniques for the stabilisation of these fractures include immobilization in

a cast, external fixators and internal fixation with plates and screws or intramedullary (IM)

nailing. The risks and benefits of each method of fixation are discussed. Wound management

should involve orthopaedic and plastic surgeons.2

Once the patient is stable an assessment of the limb can be made. The wound should

be carefully inspected and a photograph of the wound taken. Gross contamination should be

noted and blistering, contusion, crushed areas of the skin and burns reflect the transfer of large

amounts of energy to the limb (Olson 1996).

The vascular and neurological status of the limb should be assessed as open fractures

are more commonly associated with neuro-vascular damage. This should include examination

of limb colour and warmth, an examination of the pulses distal to the injury, a measurement of

the capillary refill time (normally <3 seconds) and a record of any active bleeding from the

wound site (Giannoudis 2006). A detailed neurological examination should determine the

sensory and motor function. . The environmental exposure should be recorded. It is important

to document the history and physical findings properly, and to prevent further contamination

the wound should remain covered with sterile dressing, until the is taken to the operation

theatre.3

3

Many studies have looked at the treatment of open fractures with antibiotics and the

benefit of antibiotic therapy (Giannoudis 2006). The current recommendations are a second

generation cephalosporin for 48 to 72 hours for type I fractures. For type II and III fractures a

combination of second-generation cephalosporin with an aminoglycoside offers the best

protection against most Gram positive and Gram negative bacteria. The addition of penicillin

is recommended for fracture.

The treatment of open fractures requires the simultaneous management of both

skeletal and soft tissue injury. Controlling the instability of the bone provides a number of

benefits. Options include immobilisation in a cast, external fixators and internal fixation with

plates and screws or intramedullary (IM) nailing The management of the wound should be

carried out by a Consultant Plastic Surgeon and the management of open tibial fractures

requires cooperation between consultant orthopaedic surgeon and plastic surgeon Optimal

treatment involves appropriate initial evaluation and administration of antibiotics, urgent

operative debridement and skeletal stabilisation (usually by IM nailing or external fixator).

Repeated soft tissue debridement may be required and soft tissue closure or flap coverage.3

6.2. NEED FOR THE STUDY:

. Road traffic crashes (RTCs) are a growing problem worldwide accounting for around

1.2 million deaths and over 50 million injuries annually. It is expected that by the year 2020

they will rank third in the Global Burden of Diseases . To emphasize on the growing

importance of preventing RTCs, World Health Organization had declared "Safe Roads" as the

theme for World Health Day 2004.

India has just 1% of the total vehicles in the world but it contributes to 6% of the global

RTCs Estimates suggest that Delhi has the highest number of road crash fatalities in India.

Data regarding the socio-demographic and injury profile of victims of RTCs in Delhi may

therefore, help policy makers to evolve programmes aimed at prevention of RTCs and

provision of immediate care for victims of RTCs.4

4

In United States Fractures of the tibia are the most common long bone fractures. The

annual incidence of open fractures of long bones is estimated to be 11.5 100,000 persons, with

40% occurring in the lower limb.The most common fracture of the lower limb occurs at the

tibial diaphysis. Limb loss may occur as a result of severe soft-tissue trauma, neurovascular

compromise, popliteal artery injury, compartment syndrome, or infection such as gangrene or

osteomyelitis. Popliteal artery injury is a particularly serious injury that threatens the limb and

is easily over looked.5

Open fractures require debridement and irrigation in operating room. Inpatient

admission may be advised to observe development of compartment syndrome. Continuous

compartment pressure monitoring in asymptomatic patients with tibia fractures is not

recommended. Patient should see primary care physician or be referred to an orthopedic

surgeon within 1week for further evaluation and treatment of isolated fibula fractures.

Reconstruction of osseous and soft tissue defects after high-energy lower extremity

trauma remains a challenge in trauma surgery. . A variety of local, regional, and even free

microvascular flaps are available for acute wound closure in such cases. Staged reconstruction

with initial external fixation and vacuum-assisted wound closure is recommended for severe

contaminated wounds and extended defects with a modern therapeutic strategy limb salvage

with an adequate function after reconstruction of lower extremity fractures with soft tissue

defects can be achieved in the majority of patients.

Open lower extremity fractures with exposed bone and extensive soft tissue defect have

a high incidence of mal-union, infection and non-union. Severe wound contamination is the

main indication of a staged soft tissue reconstruction. In those cases, a primary thorough

debridement and vacuum-assisted sponge closure is preferable in order to decrease the rate of

severe soft tissue complications. The use of vacuum-assisted closure therapy has increased

dramatically within the past few years. Its main advantages are the removal of excessive

edema, the increase in blood flow, the decrease of the amount of bacteria, and the increased

rate of granulation tissue formation.

5

This 28-year old male suffered from significant soft and bone defects after a

vehicle accident. Primary attempts to reconstruct the bone and soft tissue led to wound

infection resulting in a 15 cm bone loss and significant skin defect . Soft tissue reconstruction

was performed with a latissimus dorsi free flap. The artery and vein were connected to the

distal femoral vessels above the knee joint. The bone defect was closed with segmental bone

transfer using an intramedullary nail in combination with external fixation After 4 months the

bone defect was closed. Full weight bearing could be achieved after another 8months.This 16-

year-old male suffered from a motor vehicle accident. Primary surgical procedures could not

prevent soft tissue infection and loss of 17 cm bone.3

Falls and fall-related injuries, such as fractures, are a growing problem among

older adults, often causing longstanding pain, functional impairments, reduced quality of life

and excess health-care costs and mortality. These problems have led to a variety of single

component or multi component intervention strategies to prevent falls and subsequent injuries.

The most effective physical therapy approach for the prevention of falls and fractures in

community-dwelling older adults is regular multi component exercise; a combination of

balance and strength training has shown the most success.

Home-hazard assessment and modification, as well as assistive devices, such as canes

and walkers, might be useful for older people at a high risk of falls. Hip protectors are

effective in nursing home residents and potentially among other high-risk individuals. In

addition, use of anti-slip shoe devices in icy conditions seems beneficial for older people

walking outdoors. To be effective, multi factorial preventive programs should include an

exercise component accompanied by individually tailored measures focused on high-risk

populations.

In this Review, we focus on evidence-based physical therapy approaches, including

exercise, vibration training and improvements of safety at home and during periods of

6

mobility. Additionally, the benefits of multifaceted interventions, which include risk factor

assessment, dietary supplements, elements of physical therapy and exercise, are addressed.6

A prospective one year outcome study of 64 patients, average age 46years

treated by routine methods showed that about 50% of patients still had functional limitations

due to the fracture and also had reduced quality of life parameters with 42% of patients

experiencing problems with employment and 65% struggling with leisure activities. This

disability was not correlated to specific complications, which were rare.

The frequency of open long bone fractures is approximately 11.5 per 100 000 persons

per year (Court-Brown 1998). The majority of these fractures are open tibial diaphyseal

fractures, of which about 60% are Gustilo type III . If one accepts the British Orthopaedic

Association figure of about 241 000 patients for each District General Hospital in the UK and

that surgeons have a 1:5 on-call rota the average orthopaedic surgeon will see five open long

bone fractures annually, of which two will be of the tibial diaphysis and one will be Gustilo

type IIIb in severity . The leading causes of open fractures of the tibial diaphysis is motor

vehicle accidents followed by falls and accidents on the stairs.7

Nonunion is a fairly common complication of fracture management, with an overall

rate of about 3% for the skeleton as a whole and 9% for the tibia. High-energy injury fractures

have a nonunion rate as high as 75%. Other factors that may lead to nonunion are

inappropriate treatment, infection, and preexisting disease. Plain radiographs and tomograms,

computed tomograms, and contrast imaging may be used to confirm non healing. Radionuclide

imaging can help determine the presence of infection, an impaired blood supply, or impaired

osteogenic activity at the fracture site. The treatment of ununited fractures is based on the

principles of good fracture management: adequate immobilization, asepsis and soft tissue

cover,osteoconduction,osteoinduction,and metabolic well-being.8

So the investigator’s main intension or motive behind this study is that there are clients

with lower limb fracture clients have lack of knowledge and skill regarding life style practices

to manage their all needs by themselves. So the investigator took interest to do some

7

investigation in this side by which she can assess the knowledge and skill of the lower limb

fracture clients.

6.3 STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of structured teaching programme on

knowledge and skill regarding the life style practices of individual with lower limb

fracture in selected hospital,Bangalore.

6.4 OBJECTIVES

To assess the knowledge and skill level of lower limb fracture clients regarding life

style practices.

.

To administer the structured teaching programme for the lower limb fracture clients in

selected hospitals about life style practices.

To evaluate the effectiveness of structured teaching programme on knowledge and skill

regarding life style practices during lower limb fracture.

To find out the association between knowledge and skill regarding life style practices

during lower limb fracture among the clients with selected socio demographic

variables.

6.5 OPERATIONAL DEFINITIONS

Assessment:

8

It is to assess the level of knowledge and skill regarding life style practices.

Effectiveness:

It refers to the extent to which the structured teaching programme on life style

practices achieved. The desired effect in improving the knowledge and practices of

lower limb fracture clients as evident from gain in the knowledge and change in the

practice.

Structured Teaching Programme:

It refers to systematically developed instruction designed to provide

information regarding life style practices of lower limb fracture clients.

Life style adaptations:

Life style adaptation means adopting activities that control the fracture

complications, improving clients knowledge and of lower limb fracture clients self care

practices.

.

Lower limb fracture:

Fracture is a distruption or break in the continuity of the structure of bone.

Based on anatomic location of fracture in the involved bone, lower limb fracture

indicates the fracture occurred in lower limb bones.

6.6 ASSUMPTIONS OF THE STUDY

1. Fracture clients may have limited knowledge and practice related to life style

modifications. 9

2. Lower limb fracture client’s knowledge and practice can be modified through

structured teaching programme.

3. The level of lower limb fracture client’s knowledge and practice can be measured by

using a structured interview schedule.

6.7 HYPOTHESIS

H1: There will be significant difference between pretest and post test knowledge score

regarding life style practices during lower limb fracture.

H2: There will be significant association between the knowledge of the lower limb

fracture clients with selected demographic variables regarding life style practices .

6.8 REVIEW OF LITERATURE

The literature review involves the systematic identification, location,

scrutiny and summary of written material that contains information or the

research problem. The investigator followed these steps in review of related

research and non research literature to broaden the understanding and to gain a

better insight into the selected problem under study.

Literature review done for the study is presented under the following heading:

1. Studies related to general information regarding the orthopedic trauma.

2. Studies related to risk factors and nutritional needs for lower limb fractures.

3. Studies related to knowledge regarding treatment modalities for lower limb fracture.

10

1. Studies related to general information regarding the orthopedic trauma:

Some recent studies have suggested that certain types of orthopedic trauma result in

ongoing disability and that factors other than injury severity or location may influence

outcome. This study aimed to evaluate outcome 12 months and 2 years after severe orthopedic

trauma, as measured on the Short Form-36 Health Survey, relative to a control group, to

examine change over time and to examine which demographic data, injury- related and

psychological factors are associated with persisting disability. Results indicated presence of

significant ongoing disability in all SF-36 physical and mental health domains, significant

ongoing psychologic adjustment problems, including post traumatic disorder symptoms, and

pain, with little or no improvement between 1 or 2 years post injury, although those with lower

limb fractures had greater pain and poorer physical outcomes that those with fractures in other

locations.9

A study was conducted to estimate the incidence of lower limb fractures in the

United Kingdom and assess the relative importance of various risk factors for lower limb

fractures. Individuals registered with these general practices who were at risk for a first time

lower limb fracture from 1 January1990 to 31 December 2001. Overall, the risk of lower limb

fracture was 17% higher in women than in men. Within age groups, men and women had

generally similar proportions of fractures at specific sites in the lower limb. Among the risk

factors evaluated, road collisions were associated with the highest relative risk for lower limb

fracture, but only accounted for 3.1% or less of the population attributable risk for specific

fracture types in any age group. The relative risk for lower limb fracture associated with a

diagnosis of dementia was 2.3 (95% confidence interval 2.0 to 2.6), while relative risk

estimates for other medical diagnoses were less than 2. Fracture risk was increased among

current users of corticosteroids, antipsychotics, antidepressants, and hypnotic/sedatives, but the

population attributable risks for each of these drug classes within fracture and age specific

strata were only 3.0% or less.10

11

A study concentrated on analysis of the arterial/venous relationship on the most distal

vessels on the medial aspect of the lower limbs (the vascular basis for the commonly used

distally based fasciocutaneous flap). The researchers found that 25 of these arteries were

accompanied by one perforating vein whereas 12 were accompanied by two or more veins.

When there was a single vein this was usually larger than the artery in external diameter and

lay inferior to the artery 76% of the time. When there were two veins or more, there was an

interconnection between the two around the artery in over half of the samples (7/12).

Surprisingly, three vessels did not have any accompanying vein. This study sheds some light

on the variation in venous drainage important to the initial survival of these flap transfers.11

2. Studies related to risk factors and nutritional needs for lower limb fracture:

A study was conducted regarding improving lower limb salvage following fractures

with vascular injury. Lower limb fractures with vascular injuries are associated with a high

rate of secondary amputation. Reducing ischaemic time for limb salvage. A total of 101 cases

described in 10 publications [median age:31 ;range:2.5-76]were suitable for analysis. The

mean MESS was 4.2.The limb-salvage rate with an ischemic time of less than 6h was 87%,

falling to 61% when ischaemic time exceeded 6h.The rate of re-vascularisation within 6h

improved from 46% to 90% with the use of a shunt, with a mean ischaemic time of 3.8h.The

amputation rate of 27% was reduced to 13% by using shunts. Early recognition of vascular

injury is vital. A vascular shunt can significantly reduce ischaemic time,enabling unhurried

assessment of the feasibility of limb salvage, debridement of demonstrably non-variable tissue

and safe skeletal fixation prior to definitive vascular and soft-tissue repair.12

A study was conducted regarding physiological responses to exercise in patients

folowing fracture of the lower limb.25 patients with healed fractures of the lower limb and 9

control subjects were measured anthropometrically and during maximal and sub maximal one-

and two leg exercise. Oxygen intake at a given sub maximal work level of 450 kmp min-1 and

cardiac frequency at an oxygen intake of 1.51 min-1 were significantly higher in the injured

compared with the uninjured limbs of the patients and normal subjects. The maximum aerobic

power of the injured and uninjured limbs of the patients were 18.8% and 25.6% respectively

12

lower than the right and left legs of the control subjects. The corresponding value for 2-leg

work was 17.6%.The deterioration in 1-leg performance of the patients was associated with a

concomitant decrease in leg muscle volume.13

A cross-sectional and longituidinal study was conducted in a population-based sample

of 1077 women aged 75y. At baseline, protein consumption was measured with a food-

frequency questionnaire, and bone mass and structure were measured by using quantitative

ultrasound of the heel. One year later, bone mineral density [BMD] was measured by using

dual-energy X-ray absorptiometry. Subjects consumed a mean of 80.5g to 108.3g protein per

day. Regression analysis showed a positive correlation between protein intake and bone

mineral density after adjustment for age, body mass index, and other nutrients.14

A study was conducted to provide a detailed evaluation of adherence to nutrition

supplements by patients with a lower limb fracture.These descriptive data are from 49

nutritionally “at-risk” patients aged 70+ years admitted to the hospital after a fall-related lower

limb fracture and allocated to receive supplementation as part of a randomized, controlled trial.

Supplementation commenced on day 7 and continued for 42 days. Prescribed volumes aimed

to meet 45% of individually estimated theoretical energy requirements to meet the shortfall

between literature estimates of energy intake and requirements. Median daily percent of the

supplement consumed averaged over the 42 days was 67%. There was no difference in

adherence for gender, accommodation, cognition, or whether the supplement was self-

administered or supervised. Twenty-three participants took some supplement every day, and a

further 12 missed <5 days. For these 35 “nonrefusers,” adherence was 82% (IQR, 65–93), and

they lost on average 0.7% (SD, 4.0%) of baseline weight over the 6 weeks of supplementation

compared with a loss of 5.5% (SD, 5.4%) in the “refusers” (n = 14, 29%), p = .003.15

A study was conducted to examine factors influencing return to work (RTW) following

severe fracture to a lower extremity. This prospective cohort study followed 312 individuals

treated for a lower extremity fracture at 3 level-1 trauma centers. After accounting for the

extent of impairment, characteristics of the patient that correlated with higher rates of RTW

included younger age, higher education, higher income, the presence of strong social support,

and employment in a white-collar job that was not physically demanding: Despite relatively

13

high rates of recovery, one quarter of persons with lower extremity fractures did not return to

work by the end of 1 year. The study was conducted to find out the socio-demographic profile,

pattern and severity of injuries sustained in road traffic crashes.16

A cross-sectional study was performed in the first six months of 2008 through

questionnaire on a sample of children from an outpatient clinic for pediatric fractures.

Differences in gender, anatomic site, circumstances and location of fracture occurrence,

behavioural lifestyle, and calcium intake were investigated among three different age classes

(pre-school children, school children, and adolescents).The sample consisted of 382 subjects

(2-14 years of age) sustaining a fracture after low or moderate trauma. Males were at a higher

risk of fractures than females; greater than two-thirds of injuries occurred after low-energy

trauma and the upper limb was more frequently involved. Fractures most frequently occurred

in homes (41.6%), followed by playgrounds and footpaths (26.2%), sports facilities (18.3%),

and educational facilities (13.9%), with gender differences existing only in adolescence.

Twenty-three percent of the subjects sustained one or more fractures in the past. The

percentage of recurrent fractures increased with age (p = 0.001), with a similar trend in both

genders.17

3. Studies related to knowledge regarding treatment modalities for lower limb fracture:

A study was conducted on Locked Intramedullary nailing for complex non-union of the

tibia fracture. A Ten patients with complex non-union of the tibia were treated by locked

intramedullary nailing. These patients had scarred skin as a result of initial severe open

fractures, multiple debridement or fasciotomies with external fixators and skin grafts applied.

Seven of the patients also had previous osteomyelitis or pin track infections. Fully pain-free

walking was achieved in all patients and radiological union in nine patients without the need

for a bone graft. Four patients developed infection after nailing, of which three resolved with

treatment.18

A study was conducted on the management in the author's vascular surgery unit of 32

patients who had arterial injuries associated with bone fractures in upper and lower extremities

14

have been reviewed. The majority (87.5%) were young patients: 24 had blunt and 8

penetrating injuries. 11 patients had life-threatening injuries, 17 had limb-threatening

ischemia and 4had neglected arterial injuries. 22 patients underwent preoperative

arteriography. A totalof 38 arteries and 20 major veins were treated by autogenous vein

interposition grafting(22); polytetrafluoroethylene grafts -(4); end-to-end anastomosis (19);

venous patch (6);ligation (8); arterial lavage with fasciotomy (8). Primary nerve repair was

performed in(5) out of (17) injured nerves. Skeletal fixation preceded vascular repair in 26

patients.The limb salvage rate was 85%.19

.

A study was conducted on 83 patients treated with intra medullary nailing followed up

for at least 3 years showed that bony healing was straight forward in 77% of patients but that

nearly a quarter needed 2 or more operations. 35% had knee pain at rest, 71% had difficulty

kneeling, and 16% still had some fracture site pain. The conclusion was that about 70% of

patients had “excellent” results. Looking at the more severe injuries, those with major soft

tissue damage, the results are worse. At an average of 7 years follow up, physical and

psychosocial functioning deteriorated, so that the functional results of saving and

reconstructing a badly damaged leg were no better than those for patients who had amputation

and prosthetic fitting.20

A study was conducted on the best long-term results of patients treated with hybrid

fixation using external fixation and screws are still not very good. At a minimum of 5 years

after surgery, 5 of 40 ankles (12.5%) had undergone a fusion operation for osteoarthritis.

Limited physical recreational activity was the norm (87% unable to run), and 50% of patients

had changed their job as a result of the injury. In a large study of 80 patients followed up for a

mean of 3.2 years, general heath as measured by SF-36 was poorer than age and sex-matched

controls. Significant stiffness, swelling, and pain were each reported in about a third of

patients. 43% of patients employed at the time of injury were unemployed post-injury, mostly

due to the fracture.15

A cross-sectional study was conducted on 185 road traffic crash victims at the casualty

of Lok Nayak Hospital from May 2003 to December 2003. The patients were interviewed

regarding their socio-demographic profile and the severity of injuries was judged using the 15

Injury Severity Scale Majority of subjects were between 15 to 44 years (63.8%) and males

(77.8%). Maximum number of cases were pedestrians (37.3%). Head and Neck injuries were

most common (57.3%) followed by lower extremity (52.4%). Fracture, dislocation, sprain or

strain was the most common pattern of injury among all the age groups, both sexes, all the

three types of road users, in all modes of accident and in all types of vehicles. About 92% of

the subjects had an injury severity score less than 25. Severity of injuries was greater among

pedestrians and in accidents involving an over speeding vehicle.21

After the study the researcher will know the level of knowledge of lower limb

fracture clients on the life style practices.Based on the study result,researcher can give

structured teaching progrmme regarding the topic and it will help to enhance the

knowledge of the samples.

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA

The lower limb fracture clients admitted in the selected hospital, Bangalore.

7.2 METHODS OF COLLECTION OF DATA

Research Design: One group pretest and post test Quasi-experimental design

Research Variable

Dependent Variables : Knowledge of selected group regarding Life style practices.

Independent Variables : It includes the base line information such As age, sex,

religion, marital status, family income, family living area and previous information on lifestyle

practices of Lower limb fracture.

16

Setting of the study: Lower limb fracture clients who are admitted in

selected Hospital, Bangalore , Karnataka.

Population : Lower limb fracture clients those who are admitted in selected hospital,

Bangalore.

Sample Size : 60 clients

Criteria for sample selection :

Inclusion criteria

The lower limb fracture clients who are admitted in medical and

surgical ward in selected hospital.

The lower limb fracture clients who are willing to participate.

who can read and write Kannada or English

who are available during the time of data collection

Exclusion criteria

The lower limb fracture clients who are not willing to participate

who cannot read and write Kannada or English

who are not available during the time of data collection

Sampling Technique: Non probability convenience sampling technique is adopted for

selecting the sample.

Tools for data collection 17

Section A: The structured interview schedule to assess the demographic data of

lower limb fracture clients.

Section B: Self administered questions will be used to assess the knowledge of

the clients.

Methods of data collection:

Phase 1: After obtaining the permission from the significant authorities demographic

data will be assessed for 15 minutes, followed by which structured questionnaire will

be administered for 45 minutes to assess the knowledge of life style practices of lower

limb fracture clients admitted in medical and surgical ward of selected hospital.

Phase 2: Self administered structured questions will be used to assess the knowledge

and skill regarding life style practices of lower limb fracture clients.

Phase 3: Investigator may distribute the pamphlets at the end of the study based on the

results obtained.

Duration of the study: 4 week.

Plan for data analysis: Data collected will be analyzed by means of descriptive and

inferential statistics.

Descriptive statistics: Mean, percentage, Distribution and Standard Deviation will be used.

Inferential statistics: Correlation-co-efficient for correlating knowledge and skill of lower

limb fracture clients in life style practices.

And chi-square for association of the knowledge and skill with selected demographic

variable will be used.

Projected outcome: 18

After the study the researcher will know the level of knowledge and skill of lower limb

fracture clients regarding life style practices. Based on the study results researcher may

distribute pamphlets to lower limb fracture clients regarding life style practices.

7.3 Does the study requires any investigation or intervention to be

conducted onthe patients or other human beings or animals. If so please

describe briefly

Yes, in the form of structured teaching programme.The study will be conducted on

lower limb fracture clients in in-patient ward at selected hospital of Bangalore.

7.4 Has ethical clearance been obtained from your institution in case of the

above?

Yes, Ethical clearance has will be obtained from the institutions ethical committee.

8. LIST OF REFERENCES

1. Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open

long bone fractures. Injury.1998 Sep ; 29(7):529-34.

2. Howard M, Court-Brown CM. Epidemiology and management of open fractures of the

lower limb. Br J Hosp Med.1997  Jun 4-17 ; 57(11):582-87.

3. Parrett BM, Matros E, Pribaz JJ, et al. Lower extremity trautrends in the management

of soft-tissue reconstruction of open tibia-fibula fractures: Plast Reconstr Surg

2006;117: 1315–22 discussion 23-4.

19

4. Greebspan L. Mclellan BA, Grieg H. Abbreviated injury severity and injury severity

score L Ascoring Chart. J Trauma 1985: 25 (1): 60-64.

5. Gopal S, Majumder S, Batchelor AG, et al. Fix and flap: the radical orthopaedic and

plastic treatment of severe open fractures the tibia. J Bone Joint Surgery

Br 2000; 82:,959–66.

6. P Saija Karinkanta, Maarit Piirtola, Harri Sievänen, Kirsti Uusi-Rasi& Pekka

Kannus. Nature Reviews Endocrinology6, 2010 July:340

7. Bhandari M, Guyat GH, swiontkowsi MF, schemitsch EH. Treatment of open fractures

of the tibia.The journal of bone joint surgery 2001: 83-B:,62-68.

8. Gershuni DH, Pinsker R. Bone grafting for nonuation of fractures of the tibia: a

critical review. The journal of bone and joint surgery (American). 2005:87:1415-22.

9. Jennie Phd, Bridget MSCP. Journal of trauma, injury, infection and critical care.

vol. 64, issue 4, 2008 Apr ,pages 1001-09.

10. J.Kaye and H.Jick.Epidemiology of lower limb fractures in general practice in the

United Kingdom,Dec.2004;10[6]:368-74.

11. S.Ghali, N.Bowman. Department of plastic and reconstructive surgery, charing cross

hospital volume 58 ,issue 2005dec 3 ,1086-89

12. Fowlar. J. Macintyre : The importance of surgical sequence in the treatment of lower

extremity injuries with concomitant vascular injury 2009: Jan:40 (1) 72-6.

13. C.T.Davis , A.J.Sargiant. Physiological responses to exercise in patients following fracture

of the lower limb 1998, 128-33.

14. Dawson, Hughes. Calcium and protein in bone health, November 2003:62:505-09

20

15.Michelle D.Miller, MNutrDiet, Lynne A.Daniels Phd. Department of rehabitation and age

gap Austrialia 1989 mar,volume 240.

16. F.J.Clay, S.V.Newstead, A.D.Ella. First return to work following injury:2010 Nov

1 :67:730-36.

17. Jeffrey O.Anglen,MD.Department of orthopaedics,Indiana University,clinical chemistry

53;2007, 131-34.

18. K.J.O. Dwver, RD.Charkravarthy , intra medullary nailing technique and its effect on

union rates of tibial fracture injury ,volume 25, issue 7, 1994 Sep, 461-64

19. Abha,Saudi Arabia,postbox ,34.

20. Allan.C.Gaszioo.P,DelMarc,Bed rest a potentially harmful treatment needing more careful

evaluation,lancet,1999,354:1229-33

21.Jha N .Srinivasan , DK,Roy , G,Jagdish .S. Injury pattern among road traffic accident

cases:A study from South India. Indian journal of community Medicine 2003; 28(2):85-90.

9. Signature of Candidate :

10. Remarks of the Guide :

11. Name & Designation :

11.1 Guide :

21

11.2 Signature :

11.3 Co-Guide (if any) :

11.4 Signature :

11.5 Head of Department :

11.6 Signature :

12.

12.1 Remarks of the Principal :

12.2 Signature :

22