62 - Muscoloskeletal Trauma and Orthopedic Surgery Flashcards
sprain
injury to LIGAMENTS surrounding joints
-caused by wrenching or twisting
most sprain soccur in…
ankle, wrist, + knee joints
1st degree sprain
tears of a few fibers w mild tenderness + swelling
2nd degree sprain
partial tear/disruption of tissue w more swelling + tenderness
3rd degree sprain
complete tear of ligament w mod-severe swelling + tenderness
strain
excessive stretching of MUSCLE, FASCIA, + TENDONS
if injury occurs, the immediate focus is on….
1 rest (stop activity + limit mvmt) 2 ice 3 compress 4 elevate 5 pain control (analgesia)
RICEM is for…… during…..
decr local inflammation + pain
acute phase 24-28 hrs
cryotherapy
- cold cause vasoconstriction
- reduce transmission+ perception of nerve pain impulse
cryotherapy is most useful when_____
applied immediate after injury
- w/in 24-28 hrs
- apply no more than 20-30 min at a time
compression helps …
- prevent edema + encourage fluid return
- pain
compression
how to
- wrap starting distally towards trunk
- leave on 30 min + off 15 min
- too tight if there is numbness , tingling, to swelling beyond
how long for elevation
24-48 hr
HEAT
- after acute phase 24-28hr
- warm + moist heat reduce swelling + provide comfort
- dont exceed 20-30 min
should patient use their limb that is protected by cast, brace, splint, or taping?
yes
- joint mvmt maintains nutrition to cartilage
- muscle contraction improves circulation + helps resolve bruising + swelling
- helps prevent contracture of tendons + ligaments
- exercise + wt bearing helps strengthen + prevent reinjury
contracture
stiffening
dislocation
complete displacement or separation of articular surfaces of joint
subluxation
partial or incomplete displacement of joint surface
prophylaxis for injury
- tetanus for open fracture
- abx for open fracture, large tissues defects, or mangled extremity injury
common causes of dislocation/subluxation
- injury + laxity
- forces on the joint that disrupt supporting tissues
- weak/atrophied muscles>chronic joint instability
- sm tears to fribrocartilage>recurrent + chronic dislocation/subluxation
the shoulder often dislocates ANTERIORLY. when does POSTERIOR dislocation typically occur?
electrocution + seizure
most obvious sign of dislocation is…
DEFORMITY
intraarticular fractures
w/in join
avascular necrosis
bone cell death fr blood supply
major complications of dislocation
- open joint injury
- intraarticular fraction
- avascular necrosis
- damage to adjacent nerves + bld vessesl
dislocation is considered a ____ emergency bc ____
orthopedic emergency bc assoc w significant vascular injury
the longer a joint is dislocated, the greater the risk for ___
avascular necrosis
—femoral head of hip joint is especially susceptible
first goal of mgmt vs nursing mgmt of dislocation
realign the dislocated part of the joint to its original anatomic position
nursing: pain mgmt + support + protect injured joint
Repetitive Strain Injury
injuries resulting fr prolonged force or repetitive mvmt + awkward positions
fracture
disruption or break in the continuity of bone
-commonly caused by trauma but may also be due to cancer or osteoporosis
osteoporosis is a type of ___ fracture
pathologic
way to classify fractures
- open vs closed
- complete vs incomplete
- displaced vs nondisplaced
- direction of fracture line (linear, oblique, transverse, spiral, longitudinal)
an INCOMPLETE Fx is often a result of…
bending or crushing forces applied to the bone
displaced fracture
2 ends of the broken bone are separated fr each other
-often COMMINUTED or OBLIQUE
nondisplaced fracture
bone fragments stay in alignment
-usually TRANSVERSE, SPIRAL, or GREENSTICK
7 manifestations of a fracture
1 bruising 2 crepitation 3 deformity 4 edema + swell 5 loss of function 6 muscle spasm 7 pain + tenderness
bruising
discoloration of skin from extravasation of blood in subq tissues
-may appear immediately after injury
crepitation
grating or crunching of bony fragments
-may incr chance of nonunion if bone ends are allowed to move excessively
micromvmt of postfracture fragments _____
helps w osteogenesis
deformity
abnormal position of extremity or part fr of forces of injury
- classic sign of fracture
- if uncorrected, may cause problems w boy union + restoration of function
edema + swelling
disruption or penetration of skin or soft tissue by bone fragments
or
bleeding into surrounding tissues
-may occlude blood vessels + damage nerves + incr risk of compartmnt syndr
muscle spasm
irritation of tissues + protective responsive to injury + fracture
-may displace nondisplaced fractures or prevent it fr reducing spontaneously
stages of fracture healing
1 hematoma (bleed to semi-clot) 2 granulation (forms osteoid) 3 callus 4 ossification 5 consolidation 6 remodeling
osteoid
basis of new bone substance in granulation phase
granulation phase
new bld vessels, fibroblast, osteoblast, + osteoid
callus formation
mostly cartilage, osteoblast, Ca + P
minerals like Ca, P, Mg
new bone matrix
closed reduction
nonsurgical manual realignment of bone fragments to their anatomic position
- may use local or general anesthesia
- traction, casting, splints, orthoses/braces
open reduction
correction of bone alignment w incision
-usually internal fixation w wired, screws, pins, plates etc
pros + cons of open reduction
PRO: early ambulation
CON: risk of infection, complication w anesthesia, + effects of preexisting conditions
traction
application of pulling force to an injured or diseased body part or extremity
Why is traction used?
1 prevent/reduce pain +spasms 2 immobilize 3 reduce fracture/dislocation 4 treat pathologic joint condtn 5 prevent soft tissue damage 6 promote active/passive exercise 7 expand a joint space during procedure/reconstructions
skin traction
- usually for short term treatmt (48-72hr) until skeletal traction or surgery is available
- tapes, boots, splints, buck’s,
skin traction weights
5-10 lb
assess key pressure points in skin traction every ___
2-4 hr
skeletal traction
used to align injured bones + joints or to treat joint contractures + congenital hip dysplasia
-HCP inserts pins + wires into bones
weight for skeletal traction
5-45 lbs
major complications of skeletal tractions
- infection are pin sites
- effects of prolonged immobility
balanced suspension is a common type of ____
skeletal traction
fracture immobilization is achieved w
casts brace, splints, immobilizers
cast
temporary immobilizer often applied after closed reduction
- to ensure stability
- restricts tendon + ligament mvmt
casts made from fiberglass or other synth material (NOT plaster of paris) is activated by….
submerging in cool or repid water
should you cover a fresh plaster cast?
NO, must be allowed to air dry.
if covered, it will retain moist heat
-carry gently w palm to not make any dents
reduce the edema of cast by….
elevating the extremity w a sling
or if its a lower body cast, then elevate on pillow during first 24 hr
cephalosporin (cefazolin)
bone penetrating abx
-used prophylactically
drugs for pain meds
carisoprodol (Soma)
cyclobenzaprine
methocarbamol (Robaxin)
nutritional therapy
- protein (1g/kg)
- vit B, C, D, Ca, P, Mg
- fluid (2k-3k mL/day)
- 6 small meals a day
- high in bulk + roughage
a thorough ___ assessment should be done following a fracture
neurovascular assessment of affected area + distal to the fracture site
peripheral vascular assessment
- color
- temp
- periph pulse
- edema
peripheral neurologic assessment
- sensation
- motor function
- pain
pallor or cool colot can indicate
arterial insufficiency
warm cyanotic extermity can indicate
poor venous return
slow cap refill can indicate
arterial insufficiency
late signs of neurovasc damage
- paresthesia (abnorm sensatn like tingling numbness)
- hypersensation/hyperesthesia
- paresis (partial loss of sensatn)
- paralysis (total loss of sensatn)
rapid deconditioning of cardiopulmo system can occur from prolonged bed rest resulting in ____
orthostatic hypotension + decr lung capacity
we always encourage patients to elevate their cast unless ______ is suspected
compartment syndrome
nursing dx for fracture
- impaired phys combility
- risk for infection
- acute pain
bone breakage causes a release of Ca in the blood which puts patient at high risk for
renal calculi
-drink lots of water
if cast is itchy…
patient can place a cool hair dryer under the cast
DIRECT complications of fractures
bone infection, bone union, avascular necrosis
INDIRECT complications of fractures
compartment syndrome, VTE, fat embolism syndrome, rhabdomyolysis, hypovol shock
rhabdomyolysis
breakdown of skeletal muscle cells
- causes release of myoglobin into bloodstream
- —-precipitates + cause obstruction in renal tubules
- —may lead to acute kidney injury
compartment syndrome
swelling causes incr pressure w/in limited space
- cont swelling can compromise the function of bld vessels + nerves
- cap perfusion is reduced
2 basic causes of compartment syndrome
1 decr compartment size (restrictive dressing, splints, casts, excessive traction premature closing of fascia
2 incr compartment contents due to bleeding, inflammation, edema, or IV infiltration
compartment syndrome is usually assoc w…
- fractures of long bone
- extensive soft tissue damage
- crush injury
*distal humerus + proximal tibia are msot common
ischemia can occur w/in ____ after the onset of compartment syndrom
4-8 hrs
paresthesia
abnormal sensation
numbness + tingling
early signs of compartment syndrome
pain + paresthesia
later signs of compartment syndrome
pulselessness + paralysis
with compartment syndrome do not _______ + _______
elevate or ice
high risk for VTE
- lower extremities + hip after a fracture
- limited mobility
- inactivity
prophylactic meds for VTE
anticoagulants for 10-14 days
like warfarin, heparin, aspirin
preventative measures for VTE
- anticoag
- compression stockings
- pneumatic compression device
- dorsiflex/plantarflex against resistance
- ROM exercise unaffected leg
fat embolism syndrome
fat globules entering circ system fr fractures
-collect in areas w abundant bld vessels like lungs + brain
fat embolism syndrome is commonly assoc w fractures of
- long bone
- ribs
- tibia
- pelvis
FES can occur after
- total joint replacement
- spinal fusion
- lipo
- crush injuries
- bone marrow transplant
fat emboli in the LUNGS
hemorrhagic interstitial pneumonitis s/s: acute resp distress syndrome -PETECHIAE IN NECK, CHEST, AXILLA, BUCCAL, + CONJUCTIVA in eye -chest pain -tachypnea -cyanosis -dyspnea -tachycardia -hypoxemia
fat embolism syndrome in lab test
- fat cells in blood, urine, or sputum
- decr PaO2 <60mmHg
- decr platelet + hematocrit
- ST + T wave change son ECG
with FES, chest x ray may show…
bilateral pulmonary infiltrates
FES
management
- dont move/reposition patient
- administer O2
- fluid administration (prevent hypovol shock)
- dobutamine + nitrous oxide
rhabdomyolysis
common s/s
dark reddish brown urine + symptoms of AKI
soft tissue injuries include
sprain
strain
subluxation
dislocation
