Chapter 29A - Musculoskeletal/Orthopedic Injuries Flashcards
Sprains – signs/symptoms
– Pain and tenderness
– swelling
– discoloration
– may have heard it snap
– often significant enough to prevent walking
– often significant especially of the ankle
– delayed it, sometimes by 24 hours
Sprains – pathophysiology
A torn ligament that a joint
Sprains - treatment
R. I. C. E.
Rest - stop using the injured joint
Ice - apply an ice pack, remember to insulate the skin
Compression - wrap joint with an elastic bandage
Elevation - keep limb above heart as much as possible
Strains – pathophysiology
A torn tendon (or muscle)
Strains – signs/symptoms
– Pain and tenderness – severe weakness – may have heard it snap - can be significantly usually discomfort is more likely – extreme point tenderness if touched
deformity, swelling, discoloration unlikely
Strains – treatment
R. I. C. E.
Dislocations - pathophysiology
Usually involve significant tearing of ligaments at a joint sufficient for the bones to come out of normal alignment
Dislocations – signs/symptoms
- Deformity (usually dramatic)
– pain and tenderness (usually extreme pain)
– swelling (occurs, but takes time, and may be mastered by the deformity)
– discoloration (occurs, but takes time, possibly many hours
– inability to move (as a joint frequently locks in the dislocation position, there is often true inability to move
Dislocations - treatment
Treat as you would a fracture
Fractures – pathophysiology
A bone breaks
Fractures – signs/symptoms
– Deformity (often present, but not always)
– pain and tenderness (usually significant pain)
– swelling, Edema (occurs, but takes time)
– discoloration (occurs, but takes time)
– inability to move (usually it can be moved, it isn’t because it hurts too much to do so)
– crepitus (very diagnostic)
– patient information (usually they can tell you that they heard a break)
Fractures – treatments
– Immobilize
– ice (at least considerate)
– elevation (if possible)
– sterile dressing (if an open fracture)
remove any rings immediately before limb swelling causes them to create tourniquets effect
Explain the rationale for splinting fractures
By immobilizing the bone ends, it reduces the pain caused by movement. Splinting helps minimize the possibility of further tissue damage in the bone ends, and helps control bleeding by allowing for blood clotting.
Basic principles of splinting - fractures
The split must immobilize the bone ends, and adjacent joints.
So for a forearm fracture, the splint must immobilize both the wrist and elbow joints
Basic principles of splinting - joint injuries
Splint must immobilize the joint, and the adjacent bones
So for a fractured wrist, the splint includes the full forearm and supports the full hand
Explain the rationale for splinting most of fractures in natural alignment
- Leaving the little distorted or bent usually violate all the purposes of splinting
- it significantly adds to the patient’s pain, both physically and emotionally
- it complicates bleeding control or in fact promote further bleeding
– it makes it almost impossible to immobilize. Virtually all of our splints are designed for a straight limb because that is what should be done before the split is applied - restoring circulation is one of the most important goals following a fracture. The best way to do this is to straight in the limb
Explain rationale for exception to rule = joint injuries/fractures
Joint fractures are not realigned or moved during splinting because there is a significant likelihood that further damage will occur due to the design of the joint = extreme possibility that nerve or vessels
Fractures – General complications
– Permanent disability or deformity
– nerve or blood vessel damage (hemorrhage)
– fat emboli entering the circulation
– infection
Sprain/strain – General complications
– Vascular impairment from swelling
Dislocations – General complications
– Nerve damage
– vascular impairment
Pelvic fracture – specific complications
Massive bleeding – patient may lose up to half of their blood volume with very little outward indication of where bleeding is taking place – bladder damage can also occur
Femur fracture – specific complication
Massive bleeding – patient may lose up to one third of their blood volume (severe shock or possibly fatal) with very little outward indication that significant bleeding is taking place
from inside the bone marrow
fat emboli are also possible
Clavicle fracture – specific complications
If the fracture was caused from an impact, there can be a massive bleeding from the subclavian artery and vein, and possibly from the carotid and jugular. There are also a lot of nerves that run under the clavicle (brachioplexus).
Auscultate breath sounds. Lungs may be punctured.
Elbow fracture – special complications
The joint injury carries a high degree of likelihood of permanent nerve damage that will affect the function of the hand.
The nerves that control the function of the hand run through the elbow joint.
