Musculoskeletal TRAUMA Flashcards
Strain
stretching or tearing of a muscle or tendon
muscle to bone
Sprain
stretching or tearing of a ligament
bone to bone
Contusion
injury to soft tissue that results in a hematoma
1st Degree Strain
- mild edema, pain, and muscle spasms
- ROM NOT affected
- may last 3-5 days
2nd Degree Strain
- Moderate
- Edema/bruising
- Pain/muscle spasms
- Loss of strength
- 2-3 weeks
3rd Degree Strain
- Complete Tearing
- Internal bleeding w/ bruising
- Severe pain, edema, muscle spasms
- Complete loss of function
- May need surgery
1st Degree Sprain
- stretching or minimal tearing
- edema/mild discomfort
- function unaffected
2nd Degree Sprain
- Moderate incomplete tearing
- Edema, redness, pain w/ moving
- Discomfort evident w/ weight bearing
3rd Degree Sprain
- Complete tearing
- Ambulation not possible
- Severe pain, redness, edema
Diagnostic Tests for Strains/Sprains
- X-rays
- CT Scans
- MRI
- Ultrasounds
Treatment for 1st-2nd Degree
R- rest I- ice (30 mins 5x a day) C- compression E- elevate NSAID's Splinting
3rd Degree Treatment
Surgery
- Arthroscopic
- Reconstructive
- Recovery is 4-6 weeks of immobilization and therapy
- Percocet/Norco
Complications of Sprains and Strains
- Joint instability
- Higher Risk for repeated injury
- Bursitis/ Tendonitis
- Limited Mobility
- Compartment Syndrome
Joint Dislocation
Articular surfaces of bone are no longer aligned
5 Types of Dislocation
- Total or Partial
- Congenital
- Spontaneous
- Traumatic
S/S of Dislocation
- Abnormal appearance of joint
- Shortening of affected limb
- Loss of normal mobility
- Confirmed w/ x-ray
Treatment for Dislocation
- Immediate immobilization
- Reduction ASAP
- Re-immobilize
- Neurovascular checks q 1-2 hours
When can the patient begin to move their extremity again after dislocation?
-Begin slowly progressing movement IF joint is stable
When may surgery be necessary?
If no stability can be attained
When is treatment considered emergent for a dislocation?
When it is traumatic and is to prevent Avascular Necrosis
Fractures
A disruption or break in the continuity of a bone
What might cause an elderly person’s bones to fracture?
- Weakened bones secondary to osteoporosis
- Loss of bone density due to aging
- Falls
What are the most common causes of fractures for teens-young adults?
- Motor vehicle accidents
- Sports injuries
Where do fractures in young children often occur?
Growth plates
Complete Fracture
Bones break into 2 or more parts and may involve displacement
Incomplete Fracture
Break does not go all the way through the bone
Oblique Fracture
Break runs across the bone diagonally
Comminuted Fracture
Produces bone fragments
- may have missing pieces
- hardest to heal
Impacted Fractures
Ends of the bones are driven into each other
-often w/ falls
Closed (Simple) Fracture
Does NOT break the skin
Open (Compound) Fracture
Bone protrudes through the skin
Stress Fractures
Repeated bone trauma
-Athletes
Compression Fracture
Compression of vertebrae
-May be pathological (osteoporosis)
Avulsion Fracture
tendon/ligament is pulled away and takes the bone w/ it
Depression Pattern Fracture
Inward fracture from blunt force trauma
Green stick Fracture
One side is broken and the other is bent
-Children
Spiral Fracture
Twisting of the bone
-Child abuse
S/S of a Fracture
- Pain
- Loss of Function
- Deformity
- Shortening
- Crepitus
- Swelling
- Discoloration
What are the non-surgical treatments for a fracture?
- Immobilization (splints/casts)
- Pain Meds
- Closed Reduction
What pain meds are used for fractures?
Narcotics: Percocet, Norco
NSAIDs: Motrin, Advil, Aleve
Closed Reduction
Bones are realigned through manual manipulation and traction while the patient is under conscious sedation
- Cast/splint used for immobilization
- X-rays used to verify realignment
Surgical Treatment for Fractures
- Open reduction w/ internal fixation
- Closed reduction w/ internal fixation
- Open reduction w/ external fixation
Open Reduction w/ Internal Fixation
Plates, screws, and rods are used internally to stabilize the fracture
Closed Reduction w/ Internal Fixation
Bones aligned manually, but small incisions are made to place plates and screws
Open Reduction w/ External Fixation
Rods and pins create a frame externally to support the fracture
What should be done for an Open Fracture?
- Irrigation and debridement of wounds
- Reduction and stabilization
- Antibiotics w/in 6 hours of trauma
- Sterile dressing/wound VAC/debridement
- Closure w/ patients skin or secondary intention
Reactions to Internal Fixations
May be the result of mechanical or material failure, allergic reaction, or device corrosion
-causes pain and decreased mobility
How can you treat a reaction to internal fixation devices?
Removal may be possible if bone strength and functioning can be adequately maintained
-Must treat infection 1st
Reactions to External Fixation Devices
Infection typically common w/ pins and pin sights
- Erythema
- Drainage
- Warmth of infected extremity
- Fever
- Increased WBC’s
Treatment and Prevention for reactions to external fixation devices
Pin care and antibiotics
Complex Regional Pain Syndrome
Constant intense limb pain associated w/ limb fractures
S/S of Complex Regional Pain Syndrome
- *Severe burning pain
- Swelling
- Excessive sensitivity (hyperesthesia)
- Discoloration
- Limited ROM
What should be done for a patient w/ Complex Regional Pain?
- Avoid prolonged contact w/ affected extremity
- Vitamin C supplements
- Early Mobilization
- Elevation
- Physical Therapy
- Pain reduction
What medications can be used fir Complex Regional Pain?
- NSAIDs
- Corticosteroids
- Nerve blocks
- Muscle relaxants
- Opioids
Fat Embolism
usually occurs when there is trauma to a long bone or the PELVIS
- A piece of fat from the marrow breaks away and obstructs smaller vessels
- multiple fractures, CRUSH injuries, ortho surgery, pelvic/long bone fractures
S/S of Fat Embolisms
- Disorientation
- Agitation
- Acute HA
- Hypoxia
- Tachypnea
- Tachycardia
- Dyspnea/crackles/wheezing
- Petechia
How are fat embolisms diagnosed?
CT San of lungs and Cerebral MRI
What can happen if a fat embolism is NOT treated?
- pulmonary edema
- heart failure
- stroke
- death
Prevention and Treatment of Fat Embolism
- Immediate immobilization
- Minimal manipulation and support
- Strict fluid and electrolyte balance
- Respiratory support
- Corticosteroids
- Vasopressors
Delayed Union
prolonged healing/realignment
Malunion
fractures do not heal in correct alignment causing deformities
Nonunion
Fractures do NOT heal
- Internal fixations
- Bone grafting
- Electrical bone stimulation
Treatment for the Unions
- Smoking cessation
- Limit alcohol
- Proper nutrition
- Avoid NSAID’s
Venous Thromboemboli VTE
clots develop in the large vessels of the extremities
-can break away and move to the lungs resulting in pulmonary embolism
What should you monitor for w/ VTE?
- sudden SOB and chest pain
- restlessness
- tachypnea
- tachycardia
- acute persistent cough
- blood-tinged sputum
What can prevent/treat VTE?
- Early ambulation
- ROM daily
- Prophylactic anticoagulants
Hypovolemia/Hypovolemic Shock
Secondary to blood loss that may occur
- pelvic, femur, and open fractures
- agitation, confusion, low urine output, clammy hands, hypotension, tachycardia, tachypnea, weak pulse
How to treat Hypovolemia/Hypovolemic Shock
- Rapid stabilization
- Transfusion of PRBC’s
- Pain meds
Disseminated Intravascular Coagulation (DIC)
- Clotting proteins in the blood are consumed leading to widespread hemorrhaging
- *Plasma Transfusions
- Clotting proteins become abnormally active resulting in widespread clots
- *Anti-coagulants
Avascular Necrosis
bone loses its blood supply and dies
5 P’s for Neurovascular Assessment
Pain Pulse Pallor Paresthesia Paralysis
Compartment Syndrome
Swelling w/in a limited space, such as muscle compartment or cast that does not easily expand
- Compresses blood vessels, compromising circulation, and nerves affecting motor function
- Damage can be irreversible and permanent after only 3 hours
Late S/S of Compartment Syndrome
- Loss of sensation
- Cool skin
- Weak pulse
- Paresthesia
- Decreased mobility
- Sudden increase in pain
Treatment for Compartment Syndrome
CALL PROVIDOR ASAP
- loosen or remove bandage
- Bi-valve cast
- Fasciotomy
Fasciotomy
a surgical procedure where the fascia is cut to relieve tension or pressure
-closed surgically or w/ wound vac
Pressure Ulcers
- Assess for drainage/foul odor
- Remove bandage
- Bi-valve cast or cut window
Disuse Syndrome
Muscle Atrophy
- loss of size and strength in a muscle that has been inactive for a long period of time
- muscle contraction exercises, fist squeezes, PT
Buck’s Traction
Used for immobilization of femur and hip fractures prior to surgical repair
- Free hanging weights
- Extremity remains in proper alignment
- Check for slipping
Skeletal Traction
Used to maintain alignment/prevent limb shortening
- tibia, femur, and cervical fractures
- attached directly to the bone
- Weights attached to rods
External Fixator
- used to maintain alignment and immobilization in stable, complicated fractures
- pins and screws are inserted directly in the bone and secured w/ metal frame
- clamps used to change tension
Traction Care
- Assess weights and ropes q 2 hours
- Ensure proper alignment
- Feet remain in neutral position
- Inspect for pressure ulcers
- Apply to trapeze
- Pressure mattress
- Pin care
- Inspect pin sites daily
Joint Replacement
A surgical procedure in which parts of an arthritic or damaged joint are removed and replaced w/ a metal, plastic, or ceramic device (prosthesis)
-Knees, hips, shoulders
Diagnosis of need for Joint Replacement
-Observation/Assessment
Deformity, limitations, pain
-X-ray/MRI
Conservative treatment for joint injury
- Exercise
- Weight loss
- NSAID’s (stop 1 week before surgery)
- Joint Supplements
Surgery for Joint Replacement
- May be total or partial
- Prosthetic device may be cemented or uncemented
Cemented
Glue or cement is used to attach the new device to the healthy bone
-Older adults that are less active
Uncemented
A hole is drilled into the healthy bone to attach the new device
- younger adults
- high levels of activity, better movement, easier to revise
Total Hip Replacement (Arthroplasty)
involves removal of the ball and socket as well as the neck of the femur
Partial Hip Replacement (Hemi-Arthroplasty)
involves the removal of the ball as well as the neck of the femur, but NOT the socket
Joint Replacement Post Op Education
- Hemovac drain
- May need blood transfusions (autologous)
- Usually closed w/ staples
- Island dressing
- Continuous passive motion machine
- Partial weight bearing w/ slow progression to full
Total Joint Knee Precautions
- Do not pivot or twist
- Do not kneel or squat
Total Joint Hip Precautions
- Avoid flexion beyond 90 degrees
- Do not pivot or twist
- Do not cross legs
- Do not elevate HOB more than 60 degrees
Complications of Joint Replacement
- Bleeding/hypovolemia
- Orthostatic hypotension
- Wound infection
- Dislocation
- DVT
- Pulmonary embolism
S/S Hip dislocation
- pain and swelling
- acute groin pain
- shortening of affected leg
- abnormal rotation
- Popping sound
Amputation
Removal of body part
- performed at the lowest point w/ highest chance of successful healing
- Conserve as much as possible
Complications of Amputation
- Hemorrhage
- Infection
- Skin breakdown
Phantom Limb Pain
Sensation that an amputated body part is still attached, numbness, tingling, and burning sensations manifest from the removed limb
Treatment for Phantom Limb Pain
- Antidepressants
- Anticonvulsants
- Mirror technique
- Validate pain and encourage to touch amputation
- Exercise limb
