Musculoskeletal Trauma Flashcards
Contusions
soft tissue injury, resorts from blunt force, hematoma at site of impact, pain, discoloration, swelling, employ RICE
Strains
Injury to muscle or tendon, from overuse and overstretching
1st degree: mild pain, no loss of ROM
2nd degree: moderate pain w/ ROM, edema
3rd degree: severe stretching w/ rupture/tearing
Sprains
Injury to ligament, causes joint instability, due to twisting, stretching, hyperextension (Xray to r/o bone injury)
1st degree: tears in fibers, mild pain & swelling
2nd degree: partial tear
3rd degree: complete tear, severe pain & swelling
Strain and sprain treatment
RICE
Fractures causes
Direct force – falls, trauma
* Torsion – twisting such as skiing
* Disease processes –
osteoporosis, cancer
* Stress – runners, sports
Fractures clinical manifestations
Bleeding
* Pain
* Deformity
* abnormal position of bone
* Edema
* Ecchymosis
* extravasation of blood into tissue
* Crepitus
* “crunching” of bony fragments
Greenstick fracture
partial
closed
no open wound
open
breaks through skin
comminuted
3 or more fragments
compression
impact fracture
oblique
fracture runs in slanted direction
Spiral
fracture coils around bone
transverse
fracture straight across the bone
Fracture diagnostics
- X-ray: to confirm bone disruption, misalignment, deformity
- CT-scan: for complicated fractures
- Bone Scan
Fracture complications
Compartment Syndrome
* Rhabdomyolysis
* DVT, PE
* Fat embolism
* Rapid, within 12 hours of injury
* dyspnea, hypoxia, chest pain, fever, crackles, restlessness
* Avascular necrosis (osteonecrosis)
* Osteomyelitis
Fracture emergency care
Remove clothing
* Assessment of site
* Neurovascular assessment
* 5 P’s
* Control bleeding
* Immobilization
* Control pain
* Wound care
Closed reduction
Manual re-alignment of bone
* Application of cast or splint afterward
* Local or general anesthesia
Open reduction and internal rotation
Surgical re-alignment with pins, nails, or screws
to stabilize fracture
Fiberglass cast
lighter weight, stronger, water resistant, dry fast, durable, more difficult to mold, best
for simple fractures, better Xray pictures
Plaster cast
less expensive, heavier, not water resistant, may take up to 72 hrs. to dry
* requires padding, may have rough edges»_space;> smoothing, petaling of edges may be
necessary, application of moleskin or stockingette
Splints
most often for simple fractures, sprains, & soft tissue injuries
* May provide initial stability for complicated fractures
possible complications of external fixators, casting and splinting
Compartment syndrome
* Infection
* Pressure injury
* Disuse syndrome & muscle atrophy
What are compartments?
46 anatomic compartments in body
* each is encased by fascia
* fibrous membrane that covers &
separates muscles
Compartment syndrome and causes
Increased compartmental pressure
»> tissue ischemia»_space;> tissue death
»>
Causes: edema, bleeding, restriction
from cast
* Usually occurs within 8 hours of injury
Compartment syndrome symptoms
deep, throbbing, intense pain that intensifies with passive movement
Compartment syndrome assessment
5 P’s
* nail beds, capillary refill, sensation,
* palpation of muscle»_space;> hard &
swollen, taut skin
Compartment syndrome treatment
immediate
* fasciotomy to relieve pressure
* closure of wound in 2-3 days
* if wound NOT closed, kept moist w/ saline
dressing
* wound VAC may be applied
* keep limb elevated above heart level
* passive ROM can be performed
Compartment syndrome complications
rhabdo, AKI, infection, limb loss
Healing process for fractures
48-72 hrs: osteoblasts rush to site»_space;> production of
granulation tissue or new bone
Week 1: formation of hematoma at site
Week 2-3: callus formation (bony network composed of
cartilage, osteoblasts, calcium
Week 4-16: callus ossifies & prevents movement of fracture
Week 17+: callus continues to develop & closes fracture
Healing length: 6 wks – young adult; 3-6 mos - older adult
Inhibits Healing: smoking, diabetes, RA, age >40,
chronic steroid use, infection
Nursing care of fractures
Pain management
* Immobilization, as indicated
* Monitor neurovascular status
* Maintain skin integrity
* Monitor for complications
* Prevent infection
* Patient education
* Promote mobility
* As indicated
* ROM exercises
* Assistive Devices»_space;»
* Refer to PT/OT
Crutches
tripod stance, crutches out to side and in front of toes, increases stability, should have large rubber tips, patients should wear firm soled, well- fitting shoes
Other assistive devices
cane, quad cane, walker
Traction
Pulling force (with weights) to promote & maintain alignment
* Not commonly used anymore
* depends on orthopedic surgeon’s treatment plan & choice
* surgical reduction more effective
* ??? actual effectiveness of traction
Skin traction
Short-term use to stabilize fracture
& immobilize limb
* 4-8 lbs. for an extremity
* Up to 9 lbs. for pelvis
* Use of boots, straps
* Bucks Traction
* For lower leg
skeletal traction
For longer period of use
* Used when heavier weight is
needed to stabilize & immobilize
* 25-40 lbs.
* Metal wire or pin is passed through
bone
Traction nursing care
assessment, monitor for complications, alignment, pressure injury prevention, infection prevention, pain management, DVT prevention (slides 17-18)
Hip fractures
Age > 65
* Fall = major cause
* Greater risk = women, osteoporosis
* Mortality rate = 25%
* Diagnosis: x-ray
Hip fracture treatment
ORIF, closed reduction with fixation, or replacement of femoral head w/ prosthesis
* maintain abduction
* ice packs
* pain management
* use of trapeze for bed; assistive devices
Post op nursing comps for hip fractures
Pain management
Neurovascular assessment
Prevent complications
* Bleeding: site assessment, monitor BP
* DVT: TED stockings, SCD’s, anticoagulants, encourage fluids, foot exercises
* Infection: monitor temp, CBC, mental status, wound assessment, wound care
* Respiratory: I.S., deep breathing exercises, repositioning, lung assessment
* Skin breakdown: skin care, repositioning, foam mattress, good nutrition, toileting
Positioning
* maintain abduction, turn»_space; uninjured side, use of pillow between legs, use overhead trapeze, out of
bed to chair POD #1, Physical Therapy, assistive devices
Amputation
> 50% amputations are due to diabetic complications
* higher risk = African American
* Extent of amputation determined by circulatory status
* evaluated by: Doppler flow studies, Angiography
Amputation complications
hemorrhage, infection, skin breakdown, joint contracture
Phantom limb pain
due to severing of peripheral nerves
* affects 50-80% patients
* amputated limb feels “crushed, cramped, twisted”
* can last up to 2 yrs
BKA vs AKA amputation
maintenance of knee- improved post op mobility
Guillotine amputation
amputation w/o closure of the skin, urgent situation
Amputation nursing care
pain relief, wound care, assess for infection, psychosocial support, promote self care, promote mobility (slide 37)
Rhabdomyolysis
“striated muscle dissolution”
* rapid breakdown of skeletal muscle following injury
* Large amts. of creatinine, myoglobin, potassium, phosphate “leak” into
circulation
* Precipitates acute tubular necrosis»_space;> acute kidney injury
Rhabdo causes
traumatic injury, crush injury, compartment syndrome, falls, overexertion, alcohol abuse, illicit drug use, burns
Rhabdo symptoms
Tea-colored urine
* Myoglobinuria
* myoglobin = protein which carries & stores O2 in muscle cells
* Hyperkalemia
* Elevated CK levels normal < 200 > 6000 = diagnostic
* CK found in skeletal muscle, heart, brain
* CK-MM = muscle
* CK-MB = heart
* Myalgia & Muscle Weakness
Rhabdo treatment
Adequate IV hydration to prevent AKI
* Splinting and/or repair of muscle damage
* Control bleeding
