musculoskeletal pt 2

Question 1

fracture def

Answer 1

This is the complete or incomplete disruption in the continuity of bone structure

Question 2

s/s of fracture

Answer 2

Pain; Loss of function
Deformity- extremity looks odd (displacement) ; Shortening
Crepitus (crumbling sensation it can felt or heard) ; Localized edema and ecchymosis

practical application- Numb and flaccid (no pain) w/in 30 min there is severe pain

Question 3

emergency management (outside the hospital)

Answer 3

If fracture is suspected, body part MUST be immobilized before the patient is moved.
Distal and proximal joints to the fractured bone must also be immobilized
Long bones of lower extremities: bandage the legs together (unaffected leg serves as splint)
Upper extremities: bandage arm to the chest; injured arm placed in a sling
Don’t forget to check neurovascular status distal to the injury!
Open fracture: wound is covered with sterile dressing; do not attempt to reduce the fracture even if bone fragment is protruding!

Question 4

closed reduction

Answer 4

• accomplished by bringing the bone fragments into anatomic alignment through manipulation and manual traction.
• NO WOUND
• The affected area is placed in aligned position while cast, splint or other device is applied.
• Traction may be used until patient is stable to undergo surgical fixation.
• After manipulation of the bone x-ray should be done (to verify placement)

Question 5

open reduction

Answer 5

• the fracture fragments are anatomically aligned through surgical approach.
• Internal fixation devices (wires, plates, screws, etc.) may be used to hold bone fragments until solid bone healing occurs.

Question 6

immobilization

Answer 6

Bone fragments must be immobilized and maintained in proper position
Bandages, casts, splints, traction, external fixators
Bone healing – properly aligned

Question 7

maintaining and restoring functions

Answer 7

Edema is controlled by elevating injured extremity, and ice application
Pain medication

Question 8

early complications

Answer 8

shock, FES

Question 9

shock

Answer 9

Hypovolemic shock from hemorrhage is more frequently noted among trauma patients with pelvic fractures and in instances
wherein femoral artery is torn by bone fragment. pelvic region has large arteries (external injuries aren’t shown as easily–> internal bleeding)

Treatment: stabilize the fracture; restore blood volume- blood transfusion, large amts of IVF, plasma expanders; pain control (if not controlled could lead to neurogenic shock)

Question 10

FES

Answer 10

fat embolism syndrome- Happens when fat emboli enters the circulation (usually from fracture of long bones)- femur contains yellow marrow which can escape when can leak into circulation

• Fat globules enter the circulation- > occlude small blood vessels- > lungs, kidney, brain, etc.
• Onset of symptoms- rapid (within 12-72 hours of injury)

Question 11

FES s/s

Answer 11

triad symptoms: neurologic compromise; petechial rash; hypoxemia (mnemonic: think NPH!)

First manifestations: pulmonary!- hypoxia; tachypnea; dyspnea; accompanied by tachycardia, substernal chest pain; low grade fever; crackles
Petechial rash – 2-3 days after the onset of symptoms; located in non-dependent region- (BE- chest area!)
Neurologic deficits: restlessness, agitation, seizures

Question 12

FES management and prevention

Answer 12

Immediate immobilization of fracture- to prevent leakage; early surgical fixation (ORIF) ; minimal fracture manipulation (limit assessments) ; adequate support of fracture during turning and repositioning.
Note: there is NO specific treatment of FES; purely supportive.

DX: only hx and presenting s/s

Question 13

compartment syndrome

Answer 13

This is characterized by elevation of pressure within an anatomic compartment.
This arises from either increase in compartment volume (edema or bleeding) and/or decrease in compartment size (restrictive cast).
As pressure rises (within the compartment)- > perfusion decreases- > tissue death.

Question 14

compartment syndrome s/s

Answer 14

Deep, throbbing, unrelenting pain (pain unrelieved by pain meds)

• Paresthesia (early sign) - > with continued nerve ischemia- > diminished sensation - > complete numbness
• Motor weakness - > leading to paralysis (indicate nerve damage)
• Cyanotic nail beds (venous congestion)
• Pallor/dusky, cold digits, prolonged capillary refill time, diminished pulses (impaired arterial perfusion) - > pulselessness (late sign!)

Question 15

compartment syndrome implications

Answer 15

Implication: frequent assessment of the 5 P’s
Note: not all of the 5 P’s may be present; pain assessment is the most crucial in early recognition of acute compartment syndrome!

Question 16

compartment syndrome management

Answer 16

Management:
Notify the surgeon immediately.
Prepare for possible fasciotomy; opening the cast or splint
Position: elevated to the level of the heart (not above, not below the level of the heart!)
- Second best is one small pillow

Question 17

other early complications of fracture

Answer 17

VTE (DVT and PE) pg. 1237
DIC
Rhabdomyolysis pg. 1237