Musculoskeletal Trauma Flashcards
What patients are at highest risk for DVT?
Patients with hip fracture or post-hip surgery
Three stages of fractures
Inflammation, hematoma, growth of granulation tissues around site
A break or disruption in the continuity of the bone that affects comfort and mobility
Fractures
Diagnostic procedure needed to identify soft tissue damage
MRI
Fracture causes
Fragility (osteoporosis, bone cancer), stress (athletes), compression (older adults)
Fracture in which bone is broken perpendicular to its length
Transverse
Fracture that follows a spiral or “corkscrew” pattern
Spiral
Fracture occurring along the length of the bone
Longitudinal
Fracture in which the bone shatters into three or more pieces
Comminuted
Fracture that cuts diagonally across the width of the bone
Oblique
Fracture in which the ends of the broken bone are impacted together
Impacted or Buckle fracture
Impacted/Buckle fractures are common in
Children’s arm
Fracture often seen in children in which the bone is broken, but not all the way through
Green stick
Fracture characterized by tiny cracks in a bone, caused by repetitive use
Stress
What kind of bones are commonly affected by stress fractures?
Weight-bearing bones such as the legs/feet
Fracture caused by blow to the flexed knee and simultaneous forceful pull of the quadriceps muscle
Avulsion
T or F: Avulsion fractures are common in pediatric athletes and often heal without surgical intervention
True
Complete fractures occur commonly in
Long bones of arms/legs
Causes of complete fractures
Severe trauma such as MVAs or falls from tall heights
S/S of complete fractures
Pain, limited movement of fractured bone, surrounding tissue/organ damage, internal bleeding
Pulmonary complication of complete fractures
Pneumothorax
Surgical treatment for complete fractures
Open Reduction Internal Fixation (ORIF)
Treatment of intracapsular and extracapsular hip fractures
ORIF
Primary risk factor for hip fracture
Osteoporosis
Locations of intracapsular hip fractures
Femoral neck and intertrochanteric
Intracapsular hip fracture located at the junction of femoral neck and femoral head
Femoral neck
Intracapsular hip fracture located between greater and lesser trochanters
Intertrochanteric
Locations of extracapsular hip fractures
Subtrochanteric and Trochanteric
Extracapsular hip fracture located just below the lesser trochanter, extending down the femur
Subtrochanteric
Extracapsular hip fracture involving greater or lesser trochanter
Trochanteric
Fracture that occurs in children
Salter-Harris
Complications of untreated Salter-Harris fractures
Growth restriction, pain, immobility
Salter-Harris fracture through the growth plate without involving the bone
Type I
Characteristics of Salter-Harris type I
Least effect on bone growth, good prognosis for healing
Salter-Harris fracture through the growth plate and into a portion of the bone
Type II
Characteristics of Salter-Harris type II
Most common, good prognosis with careful monitoring
Salter-Harris fracture through the growth plate and into portion of the joint surface
Type III
Characteristics of Salter-Harris type III
Requires careful evaluation due to risk of joint surface involvement
Salter-Harris fracture through the growth plate, the bone, and a portion of the joint surface
Type IV
Characteristics of Salter-Harris type IV
Common in children with post-traumatic arthritis, complex, extensive treatment
Salter-Harris fracture involving compression injury to the growth plate without a clear fracture line
Type V
Characteristics of Salter-Harris type V
Rare, hard to diagnose, most effect on bone growth
Three phases of bone healing
Inflammatory, reparative, remodeling
Duration of inflammatory phase of bone healing
1-5 days post injury
Duration of reparative phase of bone healing
Several weeks
Duration of remodeling phase of bone healing
Months to years
Bone healing phase that involves blood clot formation, inflammation, and immune cell activity
Inflammatory phase
Phase of bone healing characterized by soft and hard callus formation
Reparative phase
Soft callus is made of __________
Collagen
What structures are responsible for the formation of soft callus in the reparative phase of bone healing?
Fibroblasts and chondroblasts
Bone cells that replace soft callus with harder woven bone to strengthen the fracture site during the reparative phase of bone healing
Osteoblasts
Phase of bone healing involving modification of newly formed bone, continuing until the bone regains strength
Remodeling phase
Key players in remodeling phase of bone healing
Osteoblasts and osteoclasts
Function of osteoblasts in the remodeling phase of bone healing
Deposit compact bone in an organized manner
Function of osteoclasts in the remodeling phase of bone healing
Removal of excess bone
Stage of bone healing in which hematoma forms at injury site
Stage 1
Stage of bone healing involving granulation formation at the hematoma and formation of fibrocartilage
Stage 2
Stage of bone healing involving callus formation
Stage 3
Stage of bone healing where callus is resorbed and transformed into bone
Stage 4
Stage of bone healing involving remodeling
Stage 5
Nutrition for fractures
High protein (roast beef), vitamin C, vitamin B, high “good” calories (low-fat milk)
Most common sites for compartment syndrome
Tibial and forearm fractures
Compartment syndrome treatment
Fasciotomy
Bleeding into the body cavities or spaces, compressing vital organs
Tamponade
Compression of muscles and tissues, often leading to complications
Crush injury
Breakdown of muscle tissue, releasing myoglobin into the bloodstream
Rhabdomyolysis
Elevated labs in a patient with rhabdomyolysis
BUN and creatinine
Fat embolism risk factors
Hip surgery, patients 20-40, elderly
Fat embolism supportive therapy
IV fluids, O2, bed rest
Increased pressure within a muscle compartment, leading to reduced blood flow and potential nerve damage
Compartment Syndrome
Prolonged healing time where the fractured bone takes longer than usual to reunite
Delayed union
Failure of the bone ends to grow together, resulting in a persistent gap between them
Non-union
Healing of the bone in a misaligned position, leading to deformity or functional impairment
Malunion
Blood clot formation in deep veins, often due to immobilization and reduced blood flow
DVT
DVT prevention
Compression stocks (SCDs), early mobilization, anticoagulants
Migration of a blood clot to the lungs, potentially causing a life-threatening condition
PE
Treatment of DVT
Anticoagulants and bed rest
Treatment of PE
Pain management (IV morphine), O2, bed rest
Diagnostic exam that visualizes and assesses extent and location of fracture
X-Ray
Diagnostic exam that provides detailed imaging of complex fractures
CT scans
Diagnostic exam that provides detailed images of soft tissues, ligaments, ad blood vessels
MRI
Diagnostic exam that identifies areas of increased bone activity
Bone scans
CT scans are useful for complex structures such as the
Hip and pelvis
Bone reduction involving manipulation of the bone to pop back into place
Closed bone reduction
Bone reduction involving surgical opening to fix the bone
Open bone reduction
Purpose of traction
Decrease muscle spasms
Why is ORIF the preferred method for surgical management of fractures?
Allows for early mobility
Preferred method of surgical management for extracapsular hip fractures
ORIF with plates and screws
Removal of a part of the body
Amputation
Primary cause of amputation of upper extremities
Trauma
Complications of amputation
Hemorrhage, infection, phantom limb pain*, neuroma, flexion contracture
Amputation nursing care
Place stump cap before prosthetic, elevate stump to relieve swelling, monitor for infection, assess site every shift, ROM to prevent contractures
signs of internal organ hemorrhage
Rigid abdomen, tachycardia, hypotension
Pelvic fracture assessment finding
Hematuria (urine will be pink)
Position for physical exam for patients with fracture(s)
Supine; unless patient has shoulder or upper arm fracture, then seated is best
Compartment syndrome risk factor
Patients wearing casts
6 P’s of compartment syndrome
Pain, pressure, paralysis, paresthesia, pallor, pulselessness (too late!)
Fracture interventions
Immobilization of injury, bandage, splint, orthotic boots
Why are splints preferred over casts?
Splints are flexible and allow for swelling
Most common type of cast that is lightweight and dries within minutes
Fiberglass
Characteristics of plaster cast
24 hr to dry, leave uncovered to dry
Characteristics of a wet plaster cast
Feels cold, smells musty, grayish in color
Cast window is for patients that have
Wounds
Ice packs may be prescribed for the first ___-___ hrs for cast care
24-48
Cast care
Inspect every shift (drainage,alignment, fit, hot spots), inspect under skin for irritation, cover with plastic bag to shower if not waterproof
Arm cast care
Above heart to decrease swelling
Cast removal
Split with vibrating blade, underlying padding cut with bandage scissors
Two types of traction
Skin (buck’s) and Skeletal
Type of traction that uses Velcro boot or belt secured around affected leg, weighing 5-10 lbs
Skin (Buck’s)
Type of traction where screws are inserted into bone involving heavier weights (15-30 lbs)
Skeletal
Traction care
Inspect each shift, weights should hang freely (not resting on floor)
Older adult risk post ORIF
Delirium, falls
Post hip ORIF care
Consider pillows to prevent hip adduction
Amputation care
ROM to prevent flexion contractures (hip/knee), prone position q4h if tolerated, trapeze over bed for mobility
Complications of skin traction
Edema, vascular obstruction, nerve palsy, skin necrosis over prominences, DVT, PE