Module 16- Musculoskeletal Injuries Flashcards
What are some patterns and mechanisms of musculoskeletal injuries?
- Blunt and penetrating
- MVC
- Falls
- Athletic injuries
- Pathologic fracture
What mechanism of injury is common in adult’s and children?
In adults and children MVC’s, falls and athletic injuries are common causes
What mechanism of injury is common in infants and children?
Among infants and children, intentional trauma or maltreatment is a common cause of fractures and musculoskeletal injuries
What is direct force?
- An object that strikes a person will transfer its energy to its point of impact
- Energy is first absorbed by soft tissues
- When amount of force is so great that the tissues can’t dissipate it a fracture occurs
What is indirect force?
- Force is applied to one area of the body but causes injury to another area
- Force travels through skeleton until at some point it reaches an area that is structurally weak in comparison
Ex. Hip fracture may occur when a person’s knee strike the dashboard
EX. Person falling on an outstretched hand may have one or more injuries as the result of forces transmitted proximally from the point of impact
Twisting injury
- Football or skiing
- Distal end of limb remains fixed, while torsion develops in the proximal section of limb
- Spiral fractures, sprains, dislocation
Fatigue fractures
- Also called March fractures
- Repetitive stress
- Occurs in feet after prolonged walking
Pathological fractures
- A force that might not generally cause harm to a normal healthy bone produces a fracture
- A medical condition causes the bone to become weak
- Elderly patients with osteoporosis
If you find Scapular fractures, look for…
- Rib fractures, pulmonary contusions, pneumothorax
If you find Scaphoid fractures, look for…
- Wrist, elbow, or shoulder fracture
If you find pelvic fractures, look for…
- Lumbosacral spine and other long bone fractures, intra-abdominal or genitourinary injury
If you find hip dislocation, look for…
- Fracture of the acetabulum or femoral head
If you find femoral fractures, look for…
- Dislocation of ipsilateral hip
If you find patellar fractures, look for…
- Fracture-dislocation of ipsilateral hip
If you find knee dislocation, look for…
- Tibial fracture; distal pulse may be absent
If you find calcaneal fracture, look for…
- Fracture of the ankle, leg, hip, pelvis, spine, and the other calcaneus
What is a fracture?
- A fracture is a break in the continuity of a bone
- Fractures may be classified based on the type of displacement
Angulation of a bone means what?
Angulation means that each end of the bone is not aligned in a straight line and an angle has formed between them
What is a open fracture?
- Opened fracture (compound) occurs when there is a break in the skin
- Higher risk of infection and blood loss
What is a closed fracture?
- Closed fracture occurs when the skin remains intact
- Sometimes have obvious deformity
Greenstick
incomplete fracture
Spiral
encircles the bone
Comminuted
2 fracture fragments located in same area
Transverse
straight across the bone
S/S of a Fracture
- Pain- hearing the snap
- Tenderness
- Deformity- the most reliable sign of a fracture. Compare to other limb
- Shortening- broken ends override each other. (femur)
- Swelling- bleeding and accumulation of fluid
- guarding/ loss of use
- Crepitus- incidental finding
- Exposed bone ends
What is a dislocation?
- A bone is totally displaced from joint
- Joint capsule and supporting ligaments are usually damaged
- Muscle spasms lock dislocated bones in place.
- The major risk is the potential for distal neurovascular compromise
S/S of a dislocations
- Feeling of pressure over the joint
- Pain
- Obvious and significant deformity
- Decrease in range of motion (“Frozen” in place)
- Possibly compromised distal PMS
Dislocations themselves are not life threatening but failure to recognize and treat them, may lead to permanent disability
What is subluxation?
- Partial joint dislocation
- Associated with joint capsule and ligament damage
- May be able to move the joint to some degree
What is diastasis?
- Occurs when significant damage is done to ligaments that hold bones together
- Causes a space between the bones
- Example would be injury to the pubic symphysis
What are sprains?
- Occur when ligaments are stretched or torn
- Sprains result from sudden twisting or overextension at a joint
- Characterized by pain, swelling, discoloration, and unwillingness to use the limb
- Common in knee and ankle
- Do not involve deformity, and joint mobility is usually limited by pain (ask if they physically can’t move or it’s limited by the pain)
What is the treatment of sprains?
Treat like a fracture, including:
- Rest
- Ice
- Compression
- Elevation
- Reduced weight bearing
- Pain management
What are strains?
- Occur when there is an injury to a muscle and/or tendon
- Result from violent muscle contraction, excessive stretching, or repeated overuse
- Characterized by minor swelling and pain, increased with movement
- Basically a pulled muscle
What is achilles tendon rupture?
- Usually occurs in athletes older than 30 years involved instop-and-start sports
- Pain from heel to calf and inability for plantar flexion
- Can be identified by Thompson test
What is the management of achilles tendon rupture?
- Management includes RICE and pain relief
- Surgery and 6 month recovery time
What is arthritis?
Inflammation of a joint
What are the three common types?
- Osteoarthritis
- Rheumatoid arthritis
- Gout
What is osteoarthritis (OA)?
- Disease of the joint that occurs as they age and begin to wear
- Characterized by pain and stiffness
What is rheumatoid arthritis (RA)?
- Systemic inflammatory disease that affects joints and other body systems
- Significant bone erosion at affected joints
What is Gout?
Body has difficulty eliminating uric acid, crystallizes within the joint
What injuries may signify fractures?
- Amputations
- Lacerations
What is devascularization?
- Loss of blood supply
- Occurs when blood vessels are damaged following a musculoskeletal injury
- May result from vascular contusions, lacerations, bending/ kinking, pseudoaneurysms, and thromboses (occluded with a clot)
- Very important to assess and reassess pulses, control bleeding, and maintain adequate intravascular volume. Ie. frequent pulse checks
What is the general principles of assessment and managment?
- Don’t be distracted by grotesque injuries!
- Complete an initial assessment before focusing on the extremities.
- A fracture can wait, the airway cannot.
What is the possible blood supply loss of a pelvic fracture?
1500-3000 mls
What is the possible blood supply loss of a femur fracture?
1000-1500 mls
What is the possible blood supply loss of a humerus fracture?
250-500 mls
What is the possible blood supply loss of a tibia or fibula fracture?
250-500 mls
What is the possible blood supply loss of a ankle fracture?
250-500 mls
What is the possible blood supply loss of a elbow fracture?
250-500 mls
