Chapter 28 Musculoskeletal Trauma

Question 1

Musculoskeletal system is composed of?

Answer 1

Of all the bodies: Bones, joints, and muscles, as well as cartilage, tendons, and ligaments

Question 2

Bones are formed of?

Answer 2

Dense connective tissue

Question 3

Bones: facts

Answer 3

• Formed of dense connective tissue
• Bones store salt and metabolic materials and provide a site for the production of red blood cells
• Bones are very vascular
• Bones contain calcium which helps make it very hard
• Bones also contain protein fibers that make it somewhat flexible

Question 4

Periosteum

Answer 4

Strong, white, fibrous material that cover the bones

• blood vessels and nerves pass through this membrane as they enter and leave the bone

Question 5

Joint

Answer 5

Places where bones articulate, or meet, and are a critical element in the body’s ability to move

Question 6

Cartilage

Answer 6

Tough tissue that covers the joint ends of bones and helps to form certain body parts such as the ear

Question 7

Epiphysis

Answer 7

The rounded end of a long bone

Question 8

Tendons

Answer 8

Tissues that connects muscle to bone

Question 9

Ligaments

Answer 9

Tissues that connects bone to bone

Question 10

Three types of mechanisms that cause musculoskeletal injuries:

Answer 10

Direct force
- A person being struck by an automobile causing crushed tissues and fractures

Twisting or rotational forces
- can cause stretching or tearing of muscles and ligaments, as well as broken bones

Indirect force
- can’t be just as powerful. For example, a well-known injury pattern occurs when people fall from heights and land on their feet. The direct forces cause injuries to the feet, ankles, where as indirect forces usually cause injuries to the knees, femurs, Pelvis, and spinal column

Question 11

Traction splint

Answer 11

A splint that applies constant pull along the length of a lower extremity to help stabilize the fractured bone and to reduce muscle spasm in the limb. Traction splint are used primarily on femoral shaft fractures

Question 12

4 types of musculoskeletal injuries

Answer 12

1. Fractures can be classified by open or closed and also by the way the bone breaks
   - Comminuted fracture
   - Green stick fracture
   - Angulated fracture
2. Dislocation
3. Sprain
4. Strain

Question 13

Fracture

Answer 13

Any break in a Bone

Question 14

Comminuted fracture

Answer 14

We factor in which the bone is broken in several places

Question 15

Greenstick fracture

Answer 15

An incomplete fracture

Question 16

Angulated fracture

Answer 16

Fracture in which the broken bones segments are at an angle to each other

Question 17

Anticipated blood loss from pelvis, femur and tibia/fibula fractures?

Answer 17

1. Pelvis fracture = 3-4 pints
2. Femur fracture = 2 pints
3. Tibia/fibula fracture = 1 pint

Question 18

Dislocation

Answer 18

The disruption or coming apart of a joint

• for a joint to dislocate, the soft tissue of the joint capsule and ligaments must be stretched beyond the normal range of motion and Torn

Question 19

Sprain

Answer 19

The stretching and tearing of ligaments

• is most commonly associated with joint injuries

Question 20

Strain

Answer 20

Muscle injury resulting from overstretching are over exertion of that muscle

Question 21

Closed extremity injury

Answer 21

An injury to an extremity with no associated openings in the skin

Question 22

Open extremity injury

Answer 22

And extremity injury in which the skin has been broken or torn through from the inside by an injured bone or from the outside by something that has caused a penetrating wound with associated injury to the bone
- serious situation because of the increased likelihood of contamination and subsequent infection

Question 23

Compartment syndrome

Answer 23

Serious condition caused by severe swelling in the extremity.
Progresses as follows
- a fracture or crush injury causing bleeding within the extremity
- pressure and swelling caused by the bleeding within the muscle compartment becomes that the body can no longer perfume the tissues against the pressure
- cellular damage occurs and causes additional swelling
- blood flow to the area is lost. The limb itself may be lost if the pressure is not relieved

Signs and symptoms
• pain, swelling, sensation of pressure, on palpating extremity it’s rigid, and distal pulses are reduced or absent

Question 24

Patient care : musculoskeletal injuries

Answer 24

1. Standard precaution
2. Primary assessment - don’t be distracted by dramatic looking or painful extremity injury
3. secondary assessment
4. After life threatening condition have been addressed (this is always first), any expected extremity fracture Must Be Splinted

Question 25

For any splint to be effective

Answer 25

It must immobilize adjacent joints and bone ends

Question 26

Effective Splints:

Answer 26

• Minimize the movement of disrupted joints and broken bone ends
• Decreases patients pain
• prevents additional injury to soft tissues such as nerves, arteries, veins and muscles
• can prevent a closed fracture from becoming an open fracture
• minimize blood loss

Question 27

Realigning an angulated injury: points

Answer 27

• if extremity is not realigned, the splint may be effective, causing increased pain and possible further injury (like an open fracture)
• if extremity is not realigned, the chances of nerves, arteries, and veins.
  Being compromised increases, when distal circulation is compromised or shut down, tissues beyond the injury become starved for O2 and die
• pain is increased for only a moment during realignment under traction. Pain is reduced by effective splinting

Question 28

General rules that apply to all types of immobilization are as follows:

Answer 28

• care for life threatening problems first
• expose the injury site
• assess distal pulses
• sling long bone injuries to the anatomical position
• do not push protruding bones back into place
• immobilize both the injury site and adjacent joints
• choose a method of splinting
• splinting before moving the patient to a stretcher or other locations if possible