Chapter 28 Musculoskeletal Trauma Flashcards
Musculoskeletal system is composed of?
Of all the bodies: Bones, joints, and muscles, as well as cartilage, tendons, and ligaments
Bones are formed of?
Dense connective tissue
Bones: facts
- 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
Periosteum
Strong, white, fibrous material that cover the bones
- blood vessels and nerves pass through this membrane as they enter and leave the bone
Joint
Places where bones articulate, or meet, and are a critical element in the body’s ability to move
Cartilage
Tough tissue that covers the joint ends of bones and helps to form certain body parts such as the ear
Epiphysis
The rounded end of a long bone
Tendons
Tissues that connects muscle to bone
Ligaments
Tissues that connects bone to bone
Three types of mechanisms that cause musculoskeletal injuries:
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
Traction splint
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
4 types of musculoskeletal injuries
- Fractures can be classified by open or closed and also by the way the bone breaks
- Comminuted fracture
- Green stick fracture
- Angulated fracture - Dislocation
- Sprain
- Strain
Fracture
Any break in a Bone
Comminuted fracture
We factor in which the bone is broken in several places
Greenstick fracture
An incomplete fracture
Angulated fracture
Fracture in which the broken bones segments are at an angle to each other
Anticipated blood loss from pelvis, femur and tibia/fibula fractures?
- Pelvis fracture = 3-4 pints
- Femur fracture = 2 pints
- Tibia/fibula fracture = 1 pint
Dislocation
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
Sprain
The stretching and tearing of ligaments
- is most commonly associated with joint injuries
Strain
Muscle injury resulting from overstretching are over exertion of that muscle
Closed extremity injury
An injury to an extremity with no associated openings in the skin
Open extremity injury
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
Compartment syndrome
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
Patient care : musculoskeletal injuries
- Standard precaution
- Primary assessment - don’t be distracted by dramatic looking or painful extremity injury
- secondary assessment
- After life threatening condition have been addressed (this is always first), any expected extremity fracture Must Be Splinted
For any splint to be effective
It must immobilize adjacent joints and bone ends
Effective Splints:
- 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
Realigning an angulated injury: points
- 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
General rules that apply to all types of immobilization are as follows:
- 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
