Chapter 29A - Musculoskeletal/Orthopedic Injuries

Question 0

Sprains – signs/symptoms

Answer 0

– 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

Question 1

Sprains – pathophysiology

Answer 1

A torn ligament that a joint

Question 2

Sprains - treatment

Answer 2

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

Question 3

Strains – pathophysiology

Answer 3

A torn tendon (or muscle)

Question 4

Strains – signs/symptoms

Answer 4

– 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

Question 5

Strains – treatment

Answer 5

R. I. C. E.

Question 6

Dislocations - pathophysiology

Answer 6

Usually involve significant tearing of ligaments at a joint sufficient for the bones to come out of normal alignment

Question 7

Dislocations – signs/symptoms

Answer 7

• 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

Question 8

Dislocations - treatment

Answer 8

Treat as you would a fracture

Question 9

Fractures – pathophysiology

Answer 9

A bone breaks

Question 10

Fractures – signs/symptoms

Answer 10

– 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)

Question 11

Fractures – treatments

Answer 11

– 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

Question 12

Explain the rationale for splinting fractures

Answer 12

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.

Question 13

Basic principles of splinting - fractures

Answer 13

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

Question 14

Basic principles of splinting - joint injuries

Answer 14

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

Question 15

Explain the rationale for splinting most of fractures in natural alignment

Answer 15

• 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

Question 16

Explain rationale for exception to rule = joint injuries/fractures

Answer 16

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

Question 17

Fractures – General complications

Answer 17

– Permanent disability or deformity
– nerve or blood vessel damage (hemorrhage)
– fat emboli entering the circulation
– infection

Question 18

Sprain/strain – General complications

Answer 18

– Vascular impairment from swelling

Question 19

Dislocations – General complications

Answer 19

– Nerve damage

– vascular impairment

Question 20

Pelvic fracture – specific complications

Answer 20

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

Question 21

Femur fracture – specific complication

Answer 21

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

Question 22

Clavicle fracture – specific complications

Answer 22

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.

Question 23

Elbow fracture – special complications

Answer 23

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.

Question 24

Rib fractures – special complications

Answer 24

The force that broke the ribs usually also damages the underlying lung tissue causing a contusion with internal bleeding (bruising of the lungs). Could also cause hemo or pneumothorax – also, the amount of pain tends to cause the patient to limit the volume of his breathing, leading to respiratory insufficiency. This complicates oxygenation.

Question 25

Epiphyseal fracture – special complications

Answer 25

The growth plate (epiphysis) is at the end of long bones – fractures such as falling on the outstretched hand can damage the epiphysis, and result in growth ceasing in that limb.

Epiphyseal fractures are especially dangerous in children who are still growing

Question 26

List of three parameters that must be assessed before and after immobilization of a fracture – in the order they are to be performed

Answer 26

Pulse check- to confirm that circulation is present, and/or re-establish and was not lost during splinting (that the tire or wrap have not cut it off

-this is the highest priority, and checking it is the least invasive.

Sensory check - to confirm nerve status (may give an indication of severe or pinched nerve)

• this again is minimally invasive

Motor check - to confirm nerve status (may give an indication of a served or pinched nerve)

• this requires gross movement & often causes significant pain. Sensory is hard to check after Motor if they experienced great pain upon moving.